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01-12-2012 | ONDERZOEK
Stepped care voor depressieve ouderen
Auteurs: dr. Gerda van der Weele, dr. Margot de Waal, dr. Wilbert van der Hout, dr. Anton de Craen, prof.dr. Philip Spinhoven, prof.dr. Theo Stijnen, prof.dr. Willem Assendelft, prof.dr. Roos van der Mast, prof.dr. Jacobijn Gussekloo
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Samenvatting
Van der Weele GM, De Waal MW, Van den Hout WB, De Craen AJ, Spinhoven P, Stijnen T, Assendelft WJ, Van der Mast RC, Gussekloo J. Steppedcare voor depressieve ouderen. Huisarts Wet2012;55(12):548-52.
Doel
Relatief veel ouderen hebben depressieve symptomen die hun kwaliteit van leven aantasten. Vaak worden de symptomen niet herkend en dus ook niet behandeld, hoewel psychologische interventies bewezen effectief zijn. Wij onderzochten of een screening op depressieve symptomen voor ouderen vanaf 75 jaar in de huisartsenpraktijk, gevolgd door een programma van stepped care in de ggz, (kosten)effectief zou zijn.
Methode
Wij verrichtten een pragmatisch, clustergerandomiseerd gecontroleerd onderzoek onder 239 patiënten ouder dan 75 jaar uit 67 huisartsenpraktijken, die bij screening blijk hadden gegeven van depressieve symptomen. In dit onderzoek vergeleken wij de gebruikelijke huisartsenzorg (34 praktijken, 118 ouderen) meteen stepped care-interventie door de ggz (33 praktijken, 121 ouderen). De interventie bestond uit drie stappen: individuele counseling,de cursus ‘In de put, uit de put’ en op indicatie terugverwijzing naar de huisarts voor eventuele verdere behandeling. Onze primaire uitkomst was de verandering in depressieve symptomen na zes maanden, gemeten met de Montgomery Åsberg Depression Rating Scale (MADRS). De MADRS bevat tien items met een score tussen 0 en 6 punten: een hoge score hangt samen met meer depressieve symptomen.
Resultaten
De meeste ouderen hadden bij het begin van het onderzoek lichte tot matige depressieve symptomen. Na zes maanden waren de depressieve symptomen in de controlegroep meer verbeterd dan in de interventiegroep (MADRS-score –2,9 versus –1,1, p = 0,032), na twaalf maanden was het verschil niet significant meer (–4,6 versus –3,1, p = 0,084). Van de deelnemers in de interventiegroep accepteerde 83% een verwijzing naar de ggz voor de stepped care interventie, maar nam slechts 19% deel aan de cursus en rondde 13% die ook af.
Conclusie
Een aanbod van stepped care aan ouderen met depressieve symptomen, opgespoord door screening in de huisartsenpraktijk, is niet effectiever dan de gebruikelijke huisartsenzorg. Mogelijk komt dit doordat slechts weinigen deelnamen aan de kerninterventie, een cursus. Wellicht ook zou eeninterventie effectiever zijn als de huisarts, die voor veel ouderen een vertrouwenspersoon is, een grotere rol kreeg in de aanpak van desymptomen.
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Metagegevens
- Titel
- Stepped care voor depressieve ouderen
- Auteurs
-
dr. Gerda van der Weele
dr. Margot de Waal
dr. Wilbert van der Hout
dr. Anton de Craen
prof.dr. Philip Spinhoven
prof.dr. Theo Stijnen
prof.dr. Willem Assendelft
prof.dr. Roos van der Mast
prof.dr. Jacobijn Gussekloo
- Publicatiedatum
- 01-12-2012
- Uitgeverij
- Bohn Stafleu van Loghum
- DOI
- https://doi.org/10.1007/s12445-012-0277-2