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Stepped-care to reduce depression and
Titel voorbeeld titel
anxiety in visually impaired older adults- RCT
G.H.M.B. van Rens, R.M.A. van Nispen, H.P.A. van der Aa
VU Medical Center dept. Ophthalmology, EMGO+ Institute
Introduction
Results
Background: International studies report
that the prevalence of depressive
symptoms in visually impaired older
adults is between 22-42%. As apposed
to 10-15% in general populations.
Treatment is crucial, because symptoms
are the most important predictors of
developing a full-blown depression or
anxiety disorder according to DSM-IV.
Objective: The aim of this study (20122915) is to develop and investigate the
effectiveness and cost-effectiveness of a
stepped-care program for visually
impaired older adults with subclinical
depression and anxiety levels to prevent
the development of full-blown disorders.
Hypothesis: We expect that the steppedcare program, developed for visually
impaired elderly with subclinical depression
and anxiety levels, in cooperation with
psychologists and social workers of three
rehabilitation centers, will lead to a
reduction of the incidence of depression
and anxiety disorders of 50% compared to
the control group.
Implementation: After providing the
necessary evidence of stepped-care in a
population of visually impaired older adults,
it will be implemented in Dutch and Belgian
rehabilitation centers. We expect that the
stepped-care program will offer a
significant solution to psychosocial
problems suffered by visually impaired
older adults.
Method
Design: An international multi-center
randomized controlled trial in 2 parallel
groups will be used. A total of 230
participants will be randomly assigned to
a treatment (stepped-care program) or a
control group (usual care). After 3,6,9,
12,18 and 24 months development of
depressive and anxiety disorders is
assessed, as well as cost-effectiveness
from a societal perspective.
Intervention: The stepped-care program
consists of 4 steps. If the first step does
not lead to diminishing symptoms after
three months, then the client moves to
the next step.
(1) Watchful waiting
(2) Self-help course (bibliotherapy)
(3) Problem solving treatment
(4) Referral to a general practitioner (for
medical treatment)