Does an outreaching stepped care program reduce depressive symptoms in community-dwelling older adults? A randomized implementation trial.

OBJECTIVES: To examine the effects of an outreaching stepped care intervention program (Lust for Life) compared with usual care on depressive symptoms in older adults living in the community. DESIGN: Randomized clinical implementation trial. SETTING: 18 general practices and a home care organization in the Netherlands. PARTICIPANTS: 263 community-dwelling 65+-year-olds with depressive symptoms according to the Patient Health Questionnaire-9 (PHQ-9). INTERVENTION: After three months of watchful waiting, participants could sequentially choose between the following evidence-based interventions: 1) guided self-help or an exercise program, 2) problem solving treatment or life review, and 3) a referral to their general practitioner. MEASUREMENTS: The outcome measure was depression severity (PHQ-9), measured every three months over 2 years. RESULTS: After the provision of the stepped care program, a significant short-term positive effect on depressive symptoms was found in the first three months after implementation, in which average PHQ-9 scores dropped from 9.34 (SE: 0.61, 95% CI: 8.14-10.5) to 7.83 (SE: 0.51, 95% CI: 6.84-8.81). CONCLUSIONS: The Lust for Life program has a promising potential to relieve depressive symptoms of older adults in primary care in the short term. Providing one single clinical intervention in accordance with participants' choices instead of stepped care could be sufficient.