Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol

Denise Meuldijk; Viviana M. Wuthrich; Ronald M. Rapee; Brian Draper; Henry Brodaty; Pim Cuijpers; Henry Cutler; Megan Hobbs; Carly Johnco; Michael Jones; Jessamine T.H. Chen; Andrew Partington; Chanaka Wijeratne

doi:10.1016/j.cct.2021.106360

Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol

Denise Meuldijk^*, Viviana M. Wuthrich, Ronald M. Rapee, Brian Draper, Henry Brodaty, Pim Cuijpers, Henry Cutler, Megan Hobbs, Carly Johnco, Michael Jones, Jessamine T.H. Chen, Andrew Partington, Chanaka Wijeratne

^*Corresponding author for this work

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Abstract

Background: With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system. Design: A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention. Discussion: This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings. Trail registration: Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850).

Original language	English
Article number	106360
Pages (from-to)	1-9
Number of pages	9
Journal	Contemporary Clinical Trials
Volume	104
Early online date	22 Mar 2021
DOIs	https://doi.org/10.1016/j.cct.2021.106360
Publication status	Published - May 2021

Bibliographical note

Funding Information:
This project is co-funded by the National Health and Medical Research Council (NHMRC) and Beyond Blue [APP ID: 1151138; July 2008]. The trial is registered on ANZCTR (ACTRN12619000219189) and ISRCTN (ISRCTN37503850).

Funding Information:
This project is co-funded by the National Health and Medical Research Council ( NHMRC ) and Beyond Blue [APP ID: 1151138 ; July 2008]. The trial is registered on ANZCTR ( ACTRN12619000219189 ) and ISRCTN ( ISRCTN37503850 ).

Publisher Copyright:
© 2021

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Funding

This project is co-funded by the National Health and Medical Research Council (NHMRC) and Beyond Blue [APP ID: 1151138; July 2008]. The trial is registered on ANZCTR (ACTRN12619000219189) and ISRCTN (ISRCTN37503850). This project is co-funded by the National Health and Medical Research Council ( NHMRC ) and Beyond Blue [APP ID: 1151138 ; July 2008]. The trial is registered on ANZCTR ( ACTRN12619000219189 ) and ISRCTN ( ISRCTN37503850 ).

Funders	Funder number
ANZCTR	ACTRN12619000219189, ISRCTN37503850
National Health and Medical Research Council	1151138
National Health and Medical Research Council

Keywords

Anxiety
Depression
Geriatric
Protocol paper
Psychological treatment
Stepped care

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10.1016/j.cct.2021.106360

Translating evidencebased psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care frameworkFinal published version, 568 KBLicence: Article 25fa Dutch Copyright Act

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Meuldijk, D., Wuthrich, V. M., Rapee, R. M., Draper, B., Brodaty, H., Cuijpers, P., Cutler, H., Hobbs, M., Johnco, C., Jones, M., Chen, J. T. H., Partington, A., & Wijeratne, C. (2021). Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol. Contemporary Clinical Trials, 104, 1-9. Article 106360. https://doi.org/10.1016/j.cct.2021.106360

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abstract = "Background: With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system. Design: A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention. Discussion: This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings. Trail registration: Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850).",

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author = "Denise Meuldijk and Wuthrich, {Viviana M.} and Rapee, {Ronald M.} and Brian Draper and Henry Brodaty and Pim Cuijpers and Henry Cutler and Megan Hobbs and Carly Johnco and Michael Jones and Chen, {Jessamine T.H.} and Andrew Partington and Chanaka Wijeratne",

note = "Funding Information: This project is co-funded by the National Health and Medical Research Council (NHMRC) and Beyond Blue [APP ID: 1151138; July 2008]. The trial is registered on ANZCTR (ACTRN12619000219189) and ISRCTN (ISRCTN37503850). Funding Information: This project is co-funded by the National Health and Medical Research Council ( NHMRC ) and Beyond Blue [APP ID: 1151138 ; July 2008]. The trial is registered on ANZCTR ( ACTRN12619000219189 ) and ISRCTN ( ISRCTN37503850 ). Publisher Copyright: {\textcopyright} 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = may,

doi = "10.1016/j.cct.2021.106360",

language = "English",

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Meuldijk, D, Wuthrich, VM, Rapee, RM, Draper, B, Brodaty, H, Cuijpers, P, Cutler, H, Hobbs, M, Johnco, C, Jones, M, Chen, JTH, Partington, A & Wijeratne, C 2021, 'Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol', Contemporary Clinical Trials, vol. 104, 106360, pp. 1-9. https://doi.org/10.1016/j.cct.2021.106360

Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol. / Meuldijk, Denise; Wuthrich, Viviana M.; Rapee, Ronald M. et al.
In: Contemporary Clinical Trials, Vol. 104, 106360, 05.2021, p. 1-9.

Research output: Contribution to Journal › Article › Academic › peer-review

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AU - Hobbs, Megan

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AU - Chen, Jessamine T.H.

AU - Partington, Andrew

AU - Wijeratne, Chanaka

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Meuldijk D, Wuthrich VM, Rapee RM, Draper B, Brodaty H, Cuijpers P et al. Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol. Contemporary Clinical Trials. 2021 May;104:1-9. 106360. Epub 2021 Mar 22. doi: 10.1016/j.cct.2021.106360

Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol

Abstract

Bibliographical note

Funding

Keywords

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