[Prevention of depression and anxiety in older people].

BACKGROUND: In older people, sub-threshold symptom levels of depression or anxiety are characterised by a high prevalence and an unfavourable prognosis. They are the best predictors of the onset of full-blown disorders. There is an urgent need to develop effective preventative strategies. AIM: To determine the effectiveness and feasibility of an indicated depression- and anxiety- prevention programme for older people. METHODS: 170 individuals (75+) with sub-threshold symptom levels of depression or anxiety were randomized between a preventive intervention programme consisting of watchful waiting, bibliotherapy, problem-solving treatment, and re-referral to primary care to discuss medication, or usual care. RESULTS: The intervention halved the incidence of (DSM-IV) depressive and anxiety disorders. CONCLUSION: A stepped-care approach to the prevention of depression and anxiety in later life was successful in halving the incidence of depressive and anxiety disorders after one year, were cost-effective, and the favourable effects were sustained for up to 24 months.