1. Two-year effectiveness of a stepped-care depression prevention intervention and predictors of incident depression in primary care patients with diabetes type 2 and/or coronary heart disease and subthreshold depression: data from the Step-Dep cluster randomised controlled trial
- Author
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Marcel C. Adriaanse, Judith E. Bosmans, Maurits W. van Tulder, Martijn W. Heymans, Susan E.M. van Dijk, Alide D. Pols, Harm W.J. van Marwijk, General practice, Epidemiology and Data Science, APH - Personalized Medicine, VU University medical center, APH - Methodology, Health Economics and Health Technology Assessment, APH - Health Behaviors & Chronic Diseases, AMS - Sports and Work, AMS - Ageing and Morbidity, APH - Societal Participation & Health, Health Sciences, and APH - Mental Health
- Subjects
musculoskeletal diseases ,Male ,medicine.medical_specialty ,General Practice ,Coronary Disease ,Patient Health Questionnaire ,Logistic regression ,preventive medicine ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Cluster Analysis ,Humans ,Cumulative incidence ,030212 general & internal medicine ,Cluster randomised controlled trial ,coronary heart disease ,Depression (differential diagnoses) ,Mini-international neuropsychiatric interview ,Aged ,Netherlands ,Patient Care Team ,Psychiatric Status Rating Scales ,Depressive Disorder, Major ,Primary Health Care ,business.industry ,Incidence (epidemiology) ,Incidence ,Research ,General Medicine ,Middle Aged ,030227 psychiatry ,Logistic Models ,Mental Health ,Diabetes Mellitus, Type 2 ,Multivariate Analysis ,Anxiety ,Female ,medicine.symptom ,business - Abstract
IntroductionMajor depressive disorders (MDD), diabetes mellitus type 2 (DM2) and coronary heart disease (CHD) are leading contributors to the global burden of disease and often co-occur.ObjectivesTo evaluate the 2-year effectiveness of a stepped-care intervention to prevent MDD compared with usual care and to develop a prediction model for incident depression in patients with DM2 and/or CHD with subthreshold depression.MethodsData of 236 Dutch primary care patients with DM2/CHD with subthreshold depression (Patient Health Questionnaire 9 (PHQ-9) score ≥6, no current MDD according to the Mini International Neuropsychiatric Interview (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria)) who participated in the Step-Dep trial were used. A PHQ-9 score of ≥10 at minimally one measurement during follow-up (at 3, 6, 9, 12 and 24 months) was used to determine the cumulative incidence of MDD. Potential demographic and psychological predictors were measured at baseline via web-based self-reported questionnaires and evaluated using a multivariable logistic regression model. Model performance was assessed with the Hosmer-Lemeshow test, Nagelkerke’s R2explained variance and area under the receiver operating characteristic curve (AUC). Bootstrapping techniques were used to internally validate our model.Results192 patients (81%) were available at 2-year follow-up. The cumulative incidence of MDD was 97/192 (51%). There was no statistically significant overall treatment effect over 24 months of the intervention (OR 1.37; 95% CI 0.52 to 3.55). Baseline levels of anxiety, depression, the presence of >3 chronic diseases and stressful life events predicted the incidence of MDD (AUC 0.80, IQR 0.79–0.80; Nagelkerke’s R20.34, IQR 0.33–0.36).ConclusionA model with 4 factors predicted depression incidence during 2-year follow-up in patients with DM2/CHD accurately, based on the AUC. The Step-Dep intervention did not influence the incidence of MDD. Future depression prevention programmes should target patients with these 4 predictors present, and aim to reduce both anxiety and depressive symptoms.Trial registration numberNTR3715.
- Published
- 2018
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