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A stepped care intervention is effective for elderly people with subthreshold depression or anxiety

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Does an indicated prevention programme reduce the development of major depression and anxiety in an elderly population with subthreshold symptoms?


170 participants (aged ⩾75 years; 73.5% female) identified through a database of participants in the Preventative Intervention for Frail Elderly (PIKO) project. Those who scored ⩾16 on the self-reported Centre for Epidemiologic Studies Depression Scale (CES-D) during the PIKO study (between October 2005 and October 2005), were aged 75 years or over and who did not meet the DSM-IV criteria for depressive or anxiety disorder in the 12 months prior to their PIKO questioning, were approached to participate in this study. Exclusions: DSM-IV depression or anxiety disorder detected by the Mini International Neuropsychiatric Interview (MINI); serious cognitive disorder according to the self-rated Informant Questionnaire on Cognitive Decline in the Elderly.


33 primary care practices in northwest Netherlands; October 2004–October 2005.


A stepped care programme involving 3 month cognitive behavioural therapy (CBT) based self-help, bibliography intervention followed by brief CBT based problem solving treatment (PST). Participants were …

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  • Source of funding Netherlands Health Research Council.


  • Competing interests DM and SG are conducting a large population level trial on the management of subthreshold depression (the CASPER trial) funded by the UK Health Technology Assessment Programme.

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