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A stepped care programme for depressive or anxiety disorders offers good value for money

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Can cost-effective preventive strategies be developed to reduce the onset of mental disorders in an older population?


170 patients over 75 years old presenting with subclinical depressive or anxiety symptoms; 74% were women. Patients had a score of 16 or higher on the Center for Epidemiologic Studies Depression (CES-D) scale but did not meet DSM-IV diagnostic criteria for depression or the Mini International Neuropsychiatric Interview criteria for anxiety disorders.


The Netherlands; time unclear.


The intervention was a stepped care programme with four interventions that could be used as necessary in cycles of 3 months: watchful waiting, bibliotherapy, problem-solving treatment and antidepressant medications. Depression symptom severity was monitored using CES-D. The control group received routine primary care.


MINI/DSM-IV diagnostic status of depressive and anxiety disorders; proportion of patients who had a disorder free year; cost effectiveness (incremental cost-effectiveness ratios) from a societal perspective (costs in € at 2007 prices).

Patient follow-up

72% in the intervention group and 90% in the control group.



Pragmatic randomised controlled trial with economic modelling. …

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