Prevention of depression and anxiety in later life: a randomised trial of integrative reminiscence versus no prevention
01 / 2008 - unknown
Aim : To determine the cost-effectiveness of integrative reminiscence (The stories we live by intervention) in people of 55 years and over with mild depressive and/or anxiety symptoms, in particular to address the following questions:1. Is the preventive intervention superior relative to no prevention (i.e., only care-as-usual) in reducing anxiety and depressive symptom levels and promoting psychological well-being and quality of life?2. Is the intervention superior in terms of cost-utility (i.e., costs per QALY gained)?3. What prognostic factors predict success or failure in symptom reduction?4. Do mastery , a sense of meaning and negative thoughts act as significant mediators of the preventive effects of the intervention focusing on integrative reminiscence? Among community dwelling people in the age group of 55 years and over, symptoms and full-blown disorders of depression and anxiety are highly prevalent, co-occur often, carry a poor prognosis, compromise quality of life, and are associated with economic costs due to excessive health care uptake. By far the most important risk factors of late-life depression and anxiety is presence of depressive and anxiety symptoms not meeting the diagnostic criteria. There is a need for low-threshold preventive interventions which are seen as attractive by the intended target group. Integrative reminiscence may just meet these requirements. It is a low threshold intervention specifically developed for the elderly directed at an active re-evaluation of one s life. Meta-analyses indicated that integrative reminiscence leads to a sharp reduction in depressive symptoms comparable with the effects of cognitive therapy and may also be effective in reducing anxiety. In the Netherlands, an integrative reminiscence intervention The stories we live by has been developed and has been successfully tested in a pilot study. We now propose to conduct a randomised trial to study its cost-effectiveness, and the effect predictors and mediators therein.