Effectiveness of the Coping With Depression (CWD) course for older adults provided by the community-based mental health care system in the Netherlands: a randomized controlled field trial
Background: The Dutch version of the Coping With Depression (CWD) course for older adults has been implemented in the prevention arm of the community-based mental health care system in the Netherlands. The study group included older adults with subclinical depression as well as those with a major depressive disorder; all were enrolled into the course by mental health care professionals. The effectiveness (immediate and long-term) of the course for this heterogeneous population was studied in an effectiveness trial.
Method: Participants were self-referred, responding to media announcements. A total of 119 participants aged 55–85 years (69% female), with subclinical depression and major depression, were randomized to either the CWD course (N = 61) or the waiting list (N = 58).
Results: Nine participants dropped out of the course. According to a diagnostic interview based on the DSM-IV, 39% had a major depressive disorder (MDD), 69% had had a previous MDD, and 45% had an anxiety disorder. Older adults in the intervention group showed a significant decrease in depression symptoms. Gains were maintained over 14 months. In the intervention condition 83% had a pre-treatment score [greater-than-or-equal] 16 on the Center for Epidemiologic Studies Depression Scale (CES-D); at post-treatment 62% still scored [greater-than-or-equal] 16.
Conclusions: The course was beneficial for participants with mild or severe depression, and treatment acceptability was high. It should be fitted into a stepped-care protocol that varies intervention intensity according to clinical needs, using the post-treatment level of functioning as an indication for the next step.(Received March 1 2005)
(returned for revision May 19 2005)
(revised version received June 27 2005)
(Accepted June 28 2005)
(Published Online October 28 2005)
Key Words: depression; elderly; self-referred; effectiveness trial; outreach; prevention; stepped care.
c1 Correspondence should be addressed to: R. Haringsma, Division of Clinical and Health Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, the Netherlands. Phone: +31 71 5273690; Fax: +31 71 5274678. Email: [email protected].