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Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial
- Source :
- Pols, A D, van Dijk, S E M, Bosmans, J E, Hoekstra, T, Van Marwijk, H W J, van Tulder, M W & Adriaanse, M C 2017, ' Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression : A pragmatic cluster randomized controlled trial ', PLoS ONE, vol. 12, no. 8, e0181023 . https://doi.org/10.1371/journal.pone.0181023, PLoS ONE, 12(8):e0181023. Public Library of Science, PLoS ONE, PLoS ONE, Vol 12, Iss 8, p e0181023 (2017), Pols, A D, Van Dijk, S E, Bosmans, J E, Hoekstra, T, Van Marwijk, H W J, Van Tulder, M W & Adriaanse, M C 2017, ' Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression : A pragmatic cluster randomized controlled trial ', PLoS ONE, vol. 12, no. 8, e0181023 . https://doi.org/10.1371/journal.pone.0181023, Pols, A D, Van Dijk, S E, Bosmans, J E, Hoekstra, T, van Marwijk, H W J, Van Tulder, M W & Adriaanse, M C 2017, ' Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression : A pragmatic cluster randomized controlled trial ', PLoS ONE, vol. 12, no. 8, e0181023 . https://doi.org/10.1371/journal.pone.0181023
- Publication Year :
- 2017
- Publisher :
- Public Library of Science, 2017.
-
Abstract
- Purpose\ud \ud Given the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease. We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and/or CHD.\ud \ud Methods\ud \ud A cluster randomized controlled trial, with 27 primary care centers serving as clusters. A total of 236 DM2 and/or CHD patients with subthreshold depression (nine item Patient Health Questionnaire (PHQ-9) score ≥ 6, no current MDD according to DSM-IV criteria) were allocated to the intervention group (N = 96) or usual care group (n = 140). The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to the general practitioner. The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview (MINI). Secondary outcomes included severity of depression (measured by PHQ-9) at 3, 6, 9 and 12 months.\ud \ud Results\ud \ud Of 236 patients (mean age, 67,5 (SD 10) years; 54.7% men), 210 (89%) completed the MINI at 12 months. The cumulative incidence of MDD was 9 of 89 (10.1%) participants in the intervention group and 12 of 121 (9.9%) participants in the usual care group. We found no statistically significant overall effect of the intervention (OR = 1.21; 95% confidence interval (0.12 to 12.41)) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups.\ud \ud Conclusions\ud \ud This study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and/or CHD and subthreshold depression.
- Subjects :
- Male
Time Factors
Medical Doctors
Health Care Providers
lcsh:Medicine
Nurses
Coronary Disease
Comorbidity
Severity of Illness Index
Vascular Medicine
0302 clinical medicine
Endocrinology
Surveys and Questionnaires
Medicine and Health Sciences
Cluster Analysis
Coronary Heart Disease
030212 general & internal medicine
lcsh:Science
Problem Solving
Netherlands
Medicine(all)
Multidisciplinary
Agricultural and Biological Sciences(all)
Depression
Incidence
Middle Aged
Type 2 Diabetes
Self-Help Groups
Professions
Female
Research Article
Drug Research and Development
Patients
Endocrine Disorders
Cardiology
Research and Analysis Methods
03 medical and health sciences
SDG 3 - Good Health and Well-being
General Practitioners
Physicians
Mental Health and Psychiatry
Diabetes Mellitus
Humans
Clinical Trials
Watchful Waiting
Primary Care
Aged
Pharmacology
Depressive Disorder, Major
Primary Health Care
Mood Disorders
Biochemistry, Genetics and Molecular Biology(all)
lcsh:R
Randomized Controlled Trials
030227 psychiatry
Health Care
Diabetes Mellitus, Type 2
Metabolic Disorders
People and Places
lcsh:Q
Population Groupings
Clinical Medicine
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Database :
- OpenAIRE
- Journal :
- Pols, A D, van Dijk, S E M, Bosmans, J E, Hoekstra, T, Van Marwijk, H W J, van Tulder, M W & Adriaanse, M C 2017, ' Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression : A pragmatic cluster randomized controlled trial ', PLoS ONE, vol. 12, no. 8, e0181023 . https://doi.org/10.1371/journal.pone.0181023, PLoS ONE, 12(8):e0181023. Public Library of Science, PLoS ONE, PLoS ONE, Vol 12, Iss 8, p e0181023 (2017), Pols, A D, Van Dijk, S E, Bosmans, J E, Hoekstra, T, Van Marwijk, H W J, Van Tulder, M W & Adriaanse, M C 2017, ' Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression : A pragmatic cluster randomized controlled trial ', PLoS ONE, vol. 12, no. 8, e0181023 . https://doi.org/10.1371/journal.pone.0181023, Pols, A D, Van Dijk, S E, Bosmans, J E, Hoekstra, T, van Marwijk, H W J, Van Tulder, M W & Adriaanse, M C 2017, ' Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression : A pragmatic cluster randomized controlled trial ', PLoS ONE, vol. 12, no. 8, e0181023 . https://doi.org/10.1371/journal.pone.0181023
- Accession number :
- edsair.doi.dedup.....298e18b346ba27ff2bbeb1790743cac3