Effects and costs of a combined screening and treatment program
for elderly (aged 75 years and over) with depressive symptoms
in general practice

Although depressive symptoms in the elderly have serious negative influences
and effective treatment is available, elderly with depressive symptoms are
often untreated. Under-recognition is an important reason; depressive symptoms
seem to be accepted as an unavoidable part of 'normal' aging. In general,
combined screening and treatment programs are advocated to treat depressive
symptoms more adequately. However, the effects and costs of such programs in
elder elderly in general practice are unknown.

To study the effects and costs of a screening and treatment program for elderly
with depressive symptoms in general practice.

Pragmatic cluster randomised controlled trial with the general practice as the
unit of randomisation. Elderly aged 75 years and over enlisted in general
practices will be screened at baseline for depressive symptoms, measured by
Geriatric Depression Scale (GDS-15). If GDS-15 score is > 4 points intervention
or usual care will be offered according to the allocated treatment to their
general practice.

In the intervention practices elderly with depressive symptoms will be offered
a stepped care treatment program, including 1) individual counselling by a
community psychiatric nurse 2) psycho-education by a Coping with Depression
group course or a similar therapy on individual basis, and 3) pharmacological
treatment and/or referral for patients with persistence of depressive symptoms
after step 1 and 2.

After agreement to participate in the study, the first part of baseline
measurement will take approximately 50 minutes, to administer the screening
questionnaires by a research nurse. In elderly who screen positive for
depression (GDS-15 > 4) and have no severe cognitive impairment an extension of
the baseline measurement is needed, mainly for measurement of severity of
depressive symptoms by the MADRS; this part will take approximately another 50
minutes. In those elderly who screen positive for depression and a sample of
elderly who screen negative for depression, outcome measurements will be
repeated at 6 months and 12 months.
Patients with severe depressive symptoms at baseline (MADRS >30 points) and/or
suicidal risk (according to the MADRS) will be referred to the GP, both in the
intervention and the control group, to discuss and provide appropriate
treatment.