Samenvatting

STEPPED-CARE PREVENTS DEPRESSIVE AND ANXIETY DISORDERS IN VISUALLY IMPAIRED OLDER ADULTS

H.P.A. VAN DER AA, G.H.M.B. VAN RENS & R.M.A. VAN NISPEN

Objective of this study was to compare the effectiveness of steppedcare with usual care in visually impaired older adults (¨50 years) with subthreshold depression/anxiety. A single-masked multicentre randomised controlled trial was performed (n=265). Steppedcare contained: 1) watchful waiting, 2) cognitive behavioural therapy-based guided self-help, 3) problem solving treatment, and 4) referral to the general practitioner. The primary outcome was the 24-month cumulative incidence of depressive and anxiety disorders. Stepped-care signifi cantly reduced the incidence of disorders (relative risk .63; 95%CI .57 to .69), even if time to the event was taken into account (adjusted hazard ratio .57; 95%CI .35 to .93). The number needed to treat was 5.8. It is concluded that stepped-care seems to be a promising way to deal with depression and anxiety in visually impaired older adults. (Trial registration: http://www. trialregister.nl, identifier: NTR3296.)


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Eén op de drie visueel beperkte oudere volwassenen ervaart klachten van depressie en/of angst. Dit is twee keer zo veel als in de algemene bevolking. Een nieuw ontwikkelde stepped-care interventie blijkt effectief in het voorkomen van depressie en angststoornissen in deze populatie, zo blijkt uit onderzoek van Hilde van der Aa en collega’s. Deze interventie bestaat uit vier stappen die oplopen in intensiteit: 1) ‘watchful waiting’, 2) een zelfhulpcursus gebaseerd op cognitieve gedragstherapie, 3) ‘problem solving treatment’ en 4) een verwijzing naar de huisarts.

Introductie

Volgens de World Health Organization (WHO, 2010) zijn wereldwijd ongeveer 285 miljoen mensen visueel beperkt, van wie 65 procent vijftig jaar of ouder is. Klachten van depressie en angst komen veel voor bij visueel beperkte oudere volwassenen. Ongeveer een derde van hen ervaart subklinische klachten van depressie en/of angst (Augustin et al., 2007; Evans, Fletcher & Wormald, 2007; Lotery et al., 2007; Van der Aa et al., 2015a)1111924. Zeven procent heeft een daadwerkelijke angststoornis (Van der Aa et al., 2015a), en vijf tot zeven procent heeft een depressieve stoornis volgens de DSM-IV (Brody et al., 2001; Horowitz, Reinhardt & Kennedy, 2005; Van der Aa et al., 2015a)713. Deze percentages zijn substantieel hoger dan de prevalentie in de algemene oudere bevolking (Beekman, Copeland & Prince, 1999; Bryant, Jackson & Ames, 2008)28.

Zowel depressie als angst worden geassocieerd met een aanzienlijke ziektelast. Zij kunnen al in een subklinisch stadium leiden tot een

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