Prevention of depression and anxiety in later life: design of a randomized controlled trial for the clinical and economic evaluation of a life-review intervention

Jojanneke Korte, Ernst T Bohlmeijer, Filip Smit, Jojanneke Korte, Ernst T Bohlmeijer, Filip Smit

Abstract

Background: Depressive and anxiety symptoms in older adults could develop into significant health problems with detrimental effects on quality of life and a possibly poor prognosis. Therefore, there is a need for preventive interventions which are at once effective, acceptable and economic affordable.

Methods and design: This paper describes the design of a study evaluating "The stories we live by", a preventive life-review group intervention, which was recently developed for adults of 55 years and over with depressive and anxiety symptoms. Both clinical and economic effectiveness will be evaluated in a pragmatic randomized controlled trial. The participants in the intervention condition will receive the 8-session preventive intervention. The participants in the control condition will have access to usual care. Clinical end-terms are depressive and anxiety symptoms, current major depressive episode, quality of life and positive mental health post-treatment (3 months after baseline) and at follow-ups (6 and 12 months after baseline). Additional goals of this study are to identify groups for whom the intervention is particularly effective and to identify the therapeutic pathways that are vital in inducing clinical change. This will be done by analyzing if treatment response is moderated by demographics, personality, past major depressive episodes, important life events and chronically disease, and mediated by reminiscence functions, perceived control, automatic positive thoughts and meaning in life. Finally the cost-effectiveness of the intervention relative to care as usual will be assessed by computing incremental costs per case of depression and anxiety avoided (cost-effectiveness) and per quality adjusted life year (QALY) (cost utility).

Discussion: It is expected that both the life-review intervention and its evaluation will contribute to the existing body of knowledge in several ways. First, the intervention is unique in linking life-review with narrative therapy and in its focus on specific, positive memories. Second, the evaluation is likely to answer questions regarding the acceptability and cost-effectiveness of life-review that have not been addressed thoroughly until now. Positive results of this study will make available a new evidence-based intervention to improve public health among people of 55 years and over.

Trial registration: Nederlands Trial Register TC = 1860.

References

    1. Licht-Strunk E, Windt DA van der, van Marwijk HW, de Haan M, Beekman AT. The prognosis of depression in older patients in general practice and the community. A systematic review. Fam Pract. 2007;24:168–180. doi: 10.1093/fampra/cml071.
    1. Beekman ATF, Penninx BWJH, Deeg DJH, de Beurs E, Geerings SW, van Tilburg W. The impact of depression on the well-being, disability and use of services in older adults: a longitudunal perspective. Acta Psychiat Scand. 2002;105:20–27. doi: 10.1034/j.1600-0447.2002.10078.x.
    1. Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disorders. 2002;72:227–236. doi: 10.1016/S0165-0327(01)00413-X.
    1. Cole MG, Bellavance F, Masour A. Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis. Am J Psychiatry . 1999;156:1182–9.
    1. Schuurmans J, Comijs HC, Beekman ATF, de Beurs E, Deeg DJH, Emmelkamp PGM, van Dyck R. The outcome of anxiety disorders in older people at 6-year follow-up: results from the Longitudinal Aging Study Amsterdam. Acta Psychiat Scand. 2005;111:420–428. doi: 10.1111/j.1600-0447.2005.00531.x.
    1. Copeland JR, Beekman AT, Dewey ME, Hooijer C, Jordan A, Lawlor BA, Lobo A, Magnusson H, Mann AH, Meller I, Prince MJ, Reischies F, Turrina C, deVries MW, Wilson KC. Depression in Europe. Geographical distribution among older people. Br J Psychiatry. 1999;174:312–21. doi: 10.1192/bjp.174.4.312.
    1. McDougall FA, Kvaal K, Matthews FE, Paykel E, Jones PB, Dewey ME, Brayne C. Prevalence of depression in older people in England and Wales: the MRC CFA Study. Psychol Med. 2007;37:1787–1795. doi: 10.1017/S0033291707000372.
    1. Bryant C, Jackson H, Ames D. The prevalence of anxiety in older adults: Methodological issues and a review of the literature. J Affect Disorders. 2008;109:233–250. doi: 10.1016/j.jad.2007.11.008.
    1. Smit F, Comijs HC, Schoevers R, Cuijpers P, Deeg D, Beekman A. Target groups for the prevention of late-life anxiety. Brit J Psychiat. 2007;190:428–434. doi: 10.1192/bjp.bp.106.023127.
    1. Smit F, Ederveen A, Cuijpers P, Deeg D, Beekman A. Opportunities for cost-effective prevention of late-life depression. An epidemiological approach. Arch Gen Psychiatry. 2006;63:290–296. doi: 10.1001/archpsyc.63.3.290.
    1. Cuijpers P, De Graaf R. Van Dorsselaer S: Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. J Affect Disorders. 2004;79:71–79. doi: 10.1016/S0165-0327(02)00348-8.
    1. Cuijpers P, Smit F, van Straaten A. Psychological treatments of subthreshold depression: a meta-analytic review. Acta Psychiatr Scand. 2007;115:434–441. doi: 10.1111/j.1600-0447.2007.00998.x.
    1. Cuijpers P. A psycho-educational approach to the treatment of depression; a meta analysis of Lewinsohn's 'Coping with Depression' course. Beh Ther. 1998;29:521–533. doi: 10.1016/S0005-7894(98)80047-6.
    1. Wilson KC, Mottram PG, Vassilas CA. Psychotherapeutic treatments for older depressed people. Cochrane Database Syst Rev. 2008;1:CD004853.
    1. Miller MD. Using interpersonal therapy (IPT) with older adults today and tomorrow: a review of the literature and new developments. Curr Psychiatry Rep. 2008;10:16–22. doi: 10.1007/s11920-008-0005-6.
    1. Ayers CR, Sorrell JT, Thorp SR, Loebach Wetherell J. Evidence-Based Psychological Treatments for Late-Life Anxiety. Psychol Aging. 2007;22:8–17. doi: 10.1037/0882-7974.22.1.8.
    1. van 't Veer-Tazelaar PJ, van Marwijk HWJ, van Oppen P, van Hout HPJ, Horst HE van der, Cuijpers P, Smit F, Beekman ATF. Stepped-Care Prevention of Anxiety and Depression in Late Life: A Randomized Controlled Trial. Arch Gen Psychiatry. 2009;66:297–304. doi: 10.1001/archgenpsychiatry.2008.555.
    1. Westerhof GJ, Bohlmeijer ET, Webster JD. Reminiscence and mental health: A review of recent progress in theory, research, and intervention. Ageing Soc. 2009.
    1. Wong PTP. The processes of adaptive reminiscence. In: Haight BK, Webster JD, editor. The art and science of reminiscing: Theory, research, methods and applications. Washington DC: Taylor & Frances; 1995. pp. 22–35.
    1. Haight BK. Long-term effects of a structured life review proces. J Gerontol. 1992;47:312–5.
    1. Butler RN. The life-review: An interpretation of reminiscence in the aged. Psychiatry. 1963;26:65–76.
    1. Bohlmeijer E, Smit F, Cuijpers P. Effects of reminiscence and life-review on late-life depression: a meta-analysis. Int J Geriatr Psychiatry. 2003;18:1088–94. doi: 10.1002/gps.1018.
    1. Bohlmeijer ET, Roemer M, Cuijpers P, Smit F. The effects of life-review on psychological well-being in older adults: a meta-analysis. Aging Ment Health. 2007;11:291–300. doi: 10.1080/13607860600963547.
    1. Fry PS. Structured and unstructured reminiscence training and depression in the elderly. Clin Gerontologist. 1983;1:15–37. doi: 10.1300/J018v01n03_06.
    1. Watt LM, Cappeliez P. Integrative and instrumental reminiscence therapies for depression in older adults: intervention strategies and treatment effectiveness. Aging Ment Health. 2000;4:166–177. doi: 10.1080/13607860050008691.
    1. Haight BK, Coleman P, Lord K. The Linchpins of a successful life-review: Structure evaluation, and individuality. In: Haight BK, Webster JD, editor. The art and science of reminiscing: Theory, research, methods, and applications. Washington DC: Taylor & Frances; 1995. pp. 179–192.
    1. Bohlmeijer ET. PhD thesis. Utrecht: Netherlands Institute of Mental Health and Addiction; 2007. Reminiscence and depression in later life.
    1. Schuurmans J. PhD thesis. Vrije Universiteit Amsterdam; 2006. Anxiety in late life, moving toward a tailored treatment.
    1. Webster JD. Predictors of reminiscence. A lifespan perspective. Can J Aging. 1994;13:66–78.
    1. Cully JA, LaVoie D, Gfeller JD. Reminiscence, personality, and psychological functioning in older adults. Gerontologist. 2001;41:89–95.
    1. Cappeliez P, O'Rourke N, Chaudhury H. Functions of reminiscence and mental health in later life. Aging Ment Health. 2005;9:295–301. doi: 10.1080/13607860500131427.
    1. Wong PT, Watt LM. What types of reminiscence are associated with successful aging? Psychol Aging. 1991;6:272–279. doi: 10.1037/0882-7974.6.2.272.
    1. Cappeliez P, O'Rourke N. Personality traits and existential concerns as predictors of the functions of reminiscence in older adults. J Gerontol B Psychol Sci Soc Sci. 2002;57:P116–23.
    1. Bohlmeijer ET, Westerhof GJ, Emmerick-de Jong ME. The effects of integrative reminiscence on meaning in life: Results of a quasi-experimental study. Aging Ment Health. 2008;12:639–46. doi: 10.1080/13607860802343209.
    1. Atwood JD, Ruiz J. Social constructionist therapy with the elderly. J Fam Psychother. 1993;4:1–32. doi: 10.1300/j085V04N01_01.
    1. Bluck S, Levine LJ. Reminiscence as autobiographical memory: A catalyst for reminiscence theory development. Ageing Soc. 1998;18:185–208. doi: 10.1017/S0144686X98006862.
    1. Payne M. Narrative therapy An introduction for counsellors. London: Sage; 2000.
    1. Brewin CR. Understanding cognitive behaviour therapy: A retrieval competition account. Behav Res Ther. 2006;44:765–784. doi: 10.1016/j.brat.2006.02.005.
    1. Polkinghorne DE. Transformative narratives: From victimic to agentic life plots. Am J Occup Ther. 1996;50:299–305.
    1. McAdams DP, Reynold J, Lewis M, Patten AH, Bowman PJ. When bad things turn good and good things turn bad: Sequences of redemption and contamination in life narratives and their relation to psychosocial adaptation in midlife adults and in students. Pers Soc Psychol B. 2001;27:474–485. doi: 10.1177/0146167201274008.
    1. Linssen C, Habekotté F. Narratieve psychotherapie. [Narrative psychotherapy] In: Pot AM, Kuin Y, Vink M, editor. Handboek ouderenpsychologie [Handbook psychology for the elderly] Utrecht: De Tijdstroom; 2006. pp. 363–372.
    1. Bohlmeijer ET. De verhalen die we leven, narratieve psychologie als methode [The stories we live by, narrative psychology as a method] Amsterdam: Uitgeverij Boom; 2007.
    1. Baerger DR, McAdams DP. Life story coherence and its relation to psychological well-being. Narrat Inq. 1999;9:69–96.
    1. Brewin CR. Understanding cognitive behaviour therapy: a retrieval competition account. Behav Res Ther. 2006;44:765–784. doi: 10.1016/j.brat.2006.02.005.
    1. Serrano JP, Latorre JM, Gatz M, Montanes J. Life review therapy using autobiographical retrieval practice for older adults with depressive symptomatology. Psychol Aging. 2004;19:270–7.
    1. Williams JM, Scott J. Autobiographical memory and depression. Psychol Med. 1988;18:689–695. doi: 10.1017/S0033291700008370.
    1. Kraemer HC, Wilson T, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiat. 2002;59:877–883. doi: 10.1001/archpsyc.59.10.877.
    1. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. J Applied Psychol Measurement. 1977;1:385–401. doi: 10.1177/014662167700100306.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiat Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Radloff LS, Teri L. Use of the CES-D with older adults. Clin Gerontol. 1986;5:119–36. doi: 10.1300/J018v05n01_06.
    1. Haringsma R, Engels GI, Beekman ATF, Spinhoven P. The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology. Int J Geriatr Psychiatry. 2004;19:558–63. doi: 10.1002/gps.1130.
    1. Spinhoven PH, Ormel J, Sloekers PPA, Kempen GIJM, Speckens AEM, van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27:363–370. doi: 10.1017/S0033291796004382.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77. 11832252.
    1. Sheehan DV, Janavs J, Baker R, Harnett-Sheehan K, Knapp E, Sheehan MF, Dunbar GC. M.I.N.I. – Mini International Neuropsychiatric Interview – English Version 5.0.0 – DSM-IV. J Clin Psychiat. 1998;59:34–57.
    1. van Vliet IM, de Beurs E. Het Mini Internationaal Neuropsychiatrisch Interview (M.I.N.I.). Een kort gestructureerd diagnostisch psychiatrisch interview voor DSM-IV- en ICD-10-stoornissen. [The MINI-International Neuropsychiatric Interview (M.I.N.I.). A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders] Tijdschr Psychiatr. 2007;49:393–397.
    1. Lecrubier Y, Sheehan D, Weiller E, Amorim P, Bonora I, Sheehan K, Janavs J, Dunbar G. The Mini International Neuropsychiatric Interview (M.I.N.I.), a short diagnostic interview: Reliability and validity according to the CIDI. Eur Psychiat. 1997;12:224–231. doi: 10.1016/S0924-9338(97)83296-8.
    1. Sheehan DV, Lecrubier Y, Harnett Sheehan K, Janavs J, Weiller E, Bonora LI, Keskiner A, Schinka J, Knapp E, Sheehan MF, Dunbar GC. Reliability and validity of the Mini International Neuropsychiatric Interview (M.I.N.I.) according to the SCID-P. Eur Psychiat. 1997;12:232–241. doi: 10.1016/S0924-9338(97)83297-X.
    1. Kropf NP, Tandy C. Narrative therapy with older clients: The use of a 'meaning-making' approach. Clin Gerontologist. 1998;18:3–16. doi: 10.1300/J018v18n04_02.
    1. Osis M, Stout L. Using narrative therapy with older adults. In: Kenyon GM, Clark PG, de Vries B, editor. Narrative gerontology: Theory, research, and practice. Berlin: Springer; 2001. pp. 273–290.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Euroqol group EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Lamers LM, Stalmeier PFM, McDonnell J, Krabbe PFM, van Busschbach JJ. Kwaliteit van leven meten in economische evaluaties: het Nederlands EQ-5D tarief. [Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff] Ned Tijdschr Geneeskd. 2005;149:1574–1578.
    1. Keyes CLM. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73:539–48. doi: 10.1037/0022-006X.73.3.539.
    1. Keyes CLM. Mental health in adolescence: Is America's youth flourishing? American Journal of Orthopsychiatry. 2006;76:395–402. doi: 10.1037/0002-9432.76.3.395.
    1. Keyes CLM. The mental health continuum: From languishing to flourishing in life. J Health Soc Behav. 2002;43:207–222. doi: 10.2307/3090197.
    1. Westerhof GJ, Keyes CLM. Geestelijke gezondheid is meer dan de afwezigheid van geestelijke ziekte [Mental health is more than the absence of mental illness] Maandblad Geestelijke Volksgezondheid. 2008;63:808–820.
    1. Costa PT, Jr, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory: Professional manual. Odessa FL: Psychological Assessment Resources; 1992.
    1. Hoekstra HA, Ormel H, de Fruyt F. NEO Persoonlijkheidsvragenlijsten: NEO-PI-R & NEO-FFI [NEO Personality Questionnaires: NEO-PI-R & NEO-FFI] Lisse Netherlands: Swets & Zeitlinger; 1996.
    1. Murray G, Rawlings D, Allen NB, Trinder J. NEO Five-Factor Inventory Scores: Psychometric Properties in a Community Sample. Meas Eval in Coun Dev. 2003;36:140–149.
    1. Webster JD. Construction and validation of the Reminiscence Functions Scale. J Gerontol. 1993;48:P256–62.
    1. Webster JD. The Reminiscence Functions Scale: A replication. International Journal of Aging and Human Development. 1997;44:137–148. doi: 10.2190/AD4D-813D-F5XN-W07G.
    1. Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav. 1978;19:2–21. doi: 10.2307/2136319.
    1. Ingram RE, Wisnicke KS. Asessment of positive automatic cognition. J Consult Clin Psychol. 1988;56:898–902. doi: 10.1037/0022-006X.56.6.898.
    1. Boelen PA. Psychometric properties of the Dutch version of the Automatic Thoughts Questionnaire- Positive (ATQ-P) Cogn Behav Ther. 2007;36:23–33. doi: 10.1080/16506070600874315.
    1. Steger M, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire, assessing the presence of and search for meaning in life. J Couns Psychol. 2006;53:80–93. doi: 10.1037/0022-0167.53.1.80.
    1. Hakkaart-van Rooijen L, van Straten A, Doner M, Tiemens B. Trimbos/iMTA questionnaire for costs associated with psychiatric illness (TIC-P) Rotterdam: Erasmus University; 2002.
    1. Koopmanschap MA. PRODISQ: a modular questionnaire on productivity and disease for economic evaluation studies. Expert Rev Pharmacoeconomics Outcomes Res. 2005;5:23–28. doi: 10.1586/14737167.5.1.23.
    1. Oostenbrink JB, Bouwmans CAM, Koopmanschap MA, Rutten FF. Manual for Costing: Methods and Standard Costs for Economic Evaluations in Health Care (in Dutch) Diemen: Health Insurance Board; 2004.
    1. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gøtzsche PC, Lang T. The Revised CONSORT Statement for Reporting Randomized Trials: Explanation and Elaboration. Ann Intern Med. 2001;134:663–694.
    1. Lipsey MW, Wilson DB. The efficacy of psychological, educational, and behavioral treatment. Am Psychol. 1993;48:1181–1209. doi: 10.1037/0003-066X.48.12.1181.
    1. Barrett B, Byford S. Acceptable mental health care? A new decision-making tool for cost-effectiveness analysis. Ment Health Res Rev. 2003;9:39–41.
    1. Efron B, Tibshirani RJ. An Introduction to the Bootstrap. Chapman and Hall: New York; 1993.
    1. Fenwick E, Claxton K, Sculpher M. Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ. 2001;10:779–787. doi: 10.1002/hec.635.
    1. Pot AM, Melenhorst A, Onrust S, Bohlmeijer ET. (Cost)effectiveness of life review for Older Adults: Design of a randomized controlled trial. BMC Public Health. 2008;8:211. doi: 10.1186/1471-2458-8-211.

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