1. Stepped-care to reduce depression and anxiety in visually impaired older adults- RCT
G.H.M.B. van Rens, R.M.A. van Nispen, H.P.A. van der Aa
VU Medical Center dept. Ophthalmology, EMGO+ Institute
Introduction
Background: International studies report that the prevalence of depressive symptoms in visually impaired older adults is between 22-42%. As apposed to 10-15% in general populations. Treatment is crucial, because symptoms are the most important predictors of developing a full-blown depression or anxiety disorder according to DSM-IV.
Objective: The aim of this study ( ) is to develop and investigate the effectiveness and cost-effectiveness of a stepped-care program for visually impaired older adults with subclinical depression and anxiety levels to prevent the development of full-blown disorders.
Method
Design: An international multi-center randomized controlled trial in 2 parallel groups will be used. A total of 230 participants will be randomly assigned to a treatment (stepped-care program) or a control group (usual care). After 3,6,9, 12,18 and 24 months development of depressive and anxiety disorders is assessed, as well as cost-effectiveness from a societal perspective.
Intervention: The stepped-care program consists of 4 steps. If the first step does not lead to diminishing symptoms after three months, then the client moves to the next step.
(1) Watchful waiting
(2) Self-help course (bibliotherapy)
(3) Problem solving treatment
(4) Referral to a general practitioner (for medical treatment)
Results
Hypothesis: We expect that the stepped-care program, developed for visually impaired elderly with subclinical depression and anxiety levels, in cooperation with psychologists and social workers of three rehabilitation centers, will lead to a reduction of the incidence of depression and anxiety disorders of 50% compared to the control group.
Implementation: After providing the necessary evidence of stepped-care in a population of visually impaired older adults, it will be implemented in Dutch and Belgian rehabilitation centers. We expect that the stepped-care program will offer a significant solution to psychosocial problems suffered by visually impaired older adults.