International Psychogeriatrics



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


R. Haringsma a1c1, G. I. Engels a1, P. Cuijpers a2 and P. Spinhoven a1a3
a1 Division of Clinical and Health Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands
a2 Department of Clinical Psychology, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
a3 Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

Article author query
haringsma r   [PubMed][Google Scholar] 
engels gi   [PubMed][Google Scholar] 
cuijpers p   [PubMed][Google Scholar] 
spinhoven p   [PubMed][Google Scholar] 

Abstract

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.

Correspondence:
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: haringsma@fsw.leidenuniv.nl.