Skip to main content

Houding van huisartsen ten aanzien van preventie van angst en depressie bij ouderen

Doel: Preventie van angst- en depressieve stoornissen bij ouderen met symptomen van angst en depressie is zinvol. Wij onderzochten de houding van huisartsen ten aanzien van preventie op dit terrein en de kansen tot verbetering van preventietaken. Methode: 700 huisartsen ontvingen een vragenlijst (respons is 263, 38%). Het preventiegedrag van huisartsen en hun mening over de zinvolheid van screenen op angst en depressie werden gerelateerd aan huisarts-, praktijk- en populatiekenmerken. Ook is onderzocht welke barrières samengaan met preventie. Resultaten: Een derde van de huisartsen vindt screenen op angst en depressie bij ouderen zinvol. Ongeveer driekwart vindt zichzelf extra alert op angst en depressieve symptomen bij ouderen uit hoogrisicogroepen. Vergeleken met ‘extra alert zijn’ vinden zij dat zij minder vaak ongevraagd advies geven over interventiemogelijkheden. Er is meer aandacht voor preventie bij ouderen met somatische en/of psychosociale risicofactoren voor angst en depressie dan bij ouderen met sociaaldemografische risicofactoren. Praktische barrières bij preventie worden het vaakst genoemd. Minder vertrouwen in de effectiviteit van interventies gaat samen met minder vaak ongevraagd adviseren. Meer vertrouwen in de behoefte en motivatie van de doelgroep gaat samen met de mening dat screenen zinvol is. Conclusie: Hoewel huisartsen aangeven alert te zijn op angst en depressie bij ouderen, vinden ze screening en ongevraagd adviseren minder zinvol. Sommige barrières voor screening en ongevraagd adviseren zouden kunnen worden weggenomen. Dit kan leiden tot een verandering in houding en verbeterde preventie.

Abstract

Attitude of General Practitioners towards prevention of anxiety and depression in the elderly

Aim: Prevention of anxiety and depression in later life is effective. We examined the attitude of general practitioners (GPs) towards prevention aimed at elderly with a high risk on anxiety and depression; and also chances for improvement. Methods: 700 GPs received a questionnaire (response is 263, 38%). The preventive activities of GPs and their perception regarding benefits of screening were related to GP, practice, and population characteristics. Besides, the relations between barriers and prevention were studied. Results: One-third of the GPs finds screening for symptoms of anxiety and depression in the elderly relevant. Threequarters find themselves alert for symptoms of anxiety and depression in elderly from high risk groups. Compared to ‘being extra alert’, they find themselves less likely to actively advise on intervention possibilities. They pay more attention to prevention in elderly with somatic and psychosocial risk factors than in elderly with sociodemographic risk factors. Practical barriers in providing prevention were mentioned most frequently. Having doubts about the efficacy of interventions was related to less often actively advising. Having confidence in the needs and the motivation of the elderly was related to the GPs perception that screening is effective. Conclusion: Although GPs report being alert for anxiety and depression in elderly, they have doubts about the benefits of screening and actively advising. Some barriers might be removed. This may result in a different attitude and improved intervention.

This is a preview of subscription content, access via your institution.

Literatuur

  1. Duin C van. Bevolkingsprognose 2008–2050: naar 17,5 miljoen inwoners. CBS Bevolkingstrends, 1e kwartaal 2009. Den Haag: CBS, 2009.

    Google Scholar 

  2. Beekman AT, Penninx BW, Deeg DJ et al. The impact of depression on the well-being, disability and use of services in older adults: a longitudinal perspective. Acta Psychiatr Scand 2002;105:20–7.

    PubMed  Article  Google Scholar 

  3. Graaf R de, Have M ten, Dorsselaer S van. NEMESIS 2: De psychische gezondheid van de Nederlandse bevolking. Opzet en eerste resultaten. Utrecht: Trimbos-instituut, 2010.

    Google Scholar 

  4. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349(9064):1498–504.

    PubMed  Article  CAS  Google Scholar 

  5. Gool CH van, Gommer AM, Poos MJJC. Prevalentie en incidentie naar leeftijd en geslacht. In : Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. Bilthoven: RIVM, 2010.

    Google Scholar 

  6. Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety 2010;27:190–211.

    PubMed  Article  Google Scholar 

  7. Demyttenaere K, Bruffaerts R, Posada-Villa J et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004;291:2581–90.

    PubMed  Article  Google Scholar 

  8. Hoeymans N, Gommer AM, Poos MJJC. Welke ziekten veroorzaken de grootste ziektelast (in DALY’s)? In : Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. Bilthoven: RIVM, 2010.

    Google Scholar 

  9. Ustun TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ. Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004;184:386–92.

    PubMed  Article  CAS  Google Scholar 

  10. Cuijpers P, Van Straten A, Smit F, Mihalopoulos C, Beekman A. Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. Am J Psychiatry 2008; 165:1272–80.

    PubMed  Article  Google Scholar 

  11. Munoz RF, Cuijpers P, Smit F, Barrera AZ, Leykin Y. Prevention of major depression. Annu Rev Clin Psychol 2010;27:181–212.

    Article  Google Scholar 

  12. 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;63:290–6.

    PubMed  Article  Google Scholar 

  13. Veer N van ’t, Marwijk H van, Oppen P van et al. Prevention of anxiety and depression in the age group of 75 years and over: a randomised controlled trial testing the feasibility and effectiveness of a generic stepped care programme among elderly community residents at high risk of developing anxiety and depression versus usual care. BMC Public Health 2006;6:186.

    Article  Google Scholar 

  14. Romeijnders AC, Marwijk HW van, Goudswaard AN. Summary of the practice guideline ’Depressive disorder’ (first revision) from the Dutch College of General Practitioners. Ned Tijdschr Geneeskd 2005;149:523–7.

    PubMed  CAS  Google Scholar 

  15. Terluin B, Grol MH, Pijnenborg L, Goudswaard AN. Summary of the practice guideline ’Anxiety disorders’ (first revision) from the Dutch College of General Practitioners. Ned Tijdschr Geneeskd 2005;149:1211–5.

    PubMed  CAS  Google Scholar 

  16. Statline: Gebruik medische voorzieningen. Den Haag: CBS, 2011.

    Google Scholar 

  17. Nielen MMJ, Schellevis F. Preventie in de huisartspraktijk anno 2008. De vroege opsporing van hart- en vaatziekten, diabetes mellitus en nierziekten. Utrecht: NIVEL, 2008 .

    Google Scholar 

  18. Schoevers RA, Smit F, Deeg DJ et al. Prevention of late-life depression in primary care: do we know where to begin? Am J Psychiatry 2006;163:1611–21.

    PubMed  Article  Google Scholar 

  19. Bijl RV, GR de, Hiripi E et al. The prevalence of treated and untreated mental disorders in five countries. Health Aff (Millwood) 2003;22:122–33.

    Article  Google Scholar 

  20. Bijl D, Marwijk HW van, Haan M de, Tilburg T van, Beekman AJ. Effectiveness of disease management programmes for recognition, diagnosis and treatment of depression in primary care. Eur J Gen Pract 2004;10:6–12.

    PubMed  Article  Google Scholar 

  21. Veer-Tazelaar PJ, Marwijk HW van, Oppen P van et al. Steppedcare prevention of anxiety and depression in late life: a randomized controlled trial. Arch Gen Psychiatry 2009;66:297–304.

    Article  Google Scholar 

  22. Gilbody S, Sheldon T, House A. Screening and case-finding instruments for depression: a meta-analysis. CMAJ 2008;178: 997–1003.

    PubMed  Article  Google Scholar 

  23. Spijker J, Wurff FB van der, Poort EC et al. Depression in first generation labour migrants in Western Europe: the utility of the Center for Epidemiologic Studies Depression Scale (CESD). Int J Geriatr Psychiatry 2004;19:538–44.

    PubMed  Article  CAS  Google Scholar 

  24. Zulman DM, Vijan S, Omenn GS, Hayward RA. The relative merits of population-based and targeted prevention strategies. Milbank Q 2008;86:557–80.

    PubMed  Article  Google Scholar 

  25. Rose G. Sick individuals and sick populations. 1985. BullWorld Health Organ 2001;79:990–6.

    CAS  Google Scholar 

  26. Wurff FB van der, Beekman AT, Dijkshoorn H et al. Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands. J Affect Disord 2004;83:33–41.

    PubMed  Article  Google Scholar 

  27. Dijk-van Dijk DJA van. General Practitioners’ attitudes towards prevention and older people. Focus group interviews. Leiden: LUMC, 2011.

    Google Scholar 

  28. Main DS, Lutz LJ, Barrett JE, Matthew J, Miller RS. The role of primary care clinician attitudes, beliefs, and training in the diagnosis and treatment of depression. A report from the Ambulatory Sentinel Practice Network Inc. Arch Fam Med 1993;2:1061–6.

    PubMed  Article  CAS  Google Scholar 

  29. Williams JW, Jr., Rost K, Dietrich AJ et al. Primary care physicians’ approach to depressive disorders. Effects of physician specialty and practice structure. Arch Fam Med 1999;8:58–67.

    PubMed  Article  Google Scholar 

  30. Prins MA, Verhaak PF, Meer K van der, Penninx BW, Bensing JM. Primary care patients with anxiety and depression: need for care from the patient’s perspective. J Affect Disord 2009; 119:163–71.

    PubMed  Article  Google Scholar 

  31. Richards JC, Ryan P, McCabe MP, Groom G, Hickie IB. Barriers to the effective management of depression in general practice. Aust N Z J Psychiatry 2004;38:795–803.

    PubMed  Article  Google Scholar 

  32. Docherty JP. Barriers to the diagnosis of depression in primary care. J Clin Psychiatry 1997;58 Suppl 1:5–10.

    PubMed  Google Scholar 

  33. Lecrubier Y. Widespread underrecognition and undertreatment of anxiety and mood disorders: results from 3 European studies. J Clin Psychiatry 2007;68 Suppl 2:36–41.

    PubMed  Google Scholar 

  34. Alegria M, Bijl RV, Lin E, Walters EE, Kessler RC. Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands. Arch Gen Psychiatry 2000;57:383–91.

    PubMed  Article  CAS  Google Scholar 

  35. Prins MA, Verhaak PF, Smolders M et al. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care. J Gen Intern Med 2010;25:648–55.

    PubMed  Article  Google Scholar 

  36. Lebowitz BD, Pearson JL, Schneider LS et al. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997;278:1186–90.

    PubMed  Article  CAS  Google Scholar 

  37. Whitty P, Gilbody S. NICE, but will they help people with depression? The new National Institute for Clinical Excellence depression guidelines. Br J Psychiatry 2005;186:177–8.

    PubMed  Article  Google Scholar 

  38. Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Intern Med 2009;151: 784–92.

    Google Scholar 

  39. MacMillan HL, Patterson CJ, Wathen CN et al. Screening for depression in primary care: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2005;172:33–5.

    PubMed  Article  Google Scholar 

  40. Nimalasuriya K, Compton MT, Guillory VJ. Screening adults for depression in primary care: A position statement of the American College of Preventive Medicine. J Fam Pract 2009;58:535–8.

    PubMed  Google Scholar 

  41. Rose G. Preventive strategy and general practice. Br J Gen Pract 1993;43:138–9.

    PubMed  CAS  Google Scholar 

  42. Smolders M, Laurant M, Verhaak P et al. Which physician and practice characteristics are associated with adherence to evidence- based guidelines for depressive and anxiety disorders? Med Care 2010;48:240–8.

    PubMed  Article  Google Scholar 

  43. Britt E, Hudson SM, Blampied NM. Motivational interviewing in health settings: a review. Patient Educ Couns 2004;53:147–55.

    PubMed  Article  Google Scholar 

  44. O’Connor EA, Whitlock EP, Gaynes B, Beil TL. Screening for Depression in Adults and Older Adults in Primary Care Settings: An Updated Systematic Evidence Review. Rockville, Maryland: Agency for Healthcare Research and Quality; 2009 Dec. Report No.: Evidende Synthesis No. 75. AHRQ Publication No. 10-05143-EF-1.

  45. UK National Screening Committee. Criteria for appraising the viability, effectiveness and appropriateness of a screening programme. London: UK National Screening Committee, 2011.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

van van Dijk-Dijk, D.J.A., Crone, M.R., van der Weele, G.M. et al. Houding van huisartsen ten aanzien van preventie van angst en depressie bij ouderen. Tijds. gezondheids.wetenschappen 90, 224–232 (2012). https://doi.org/10.1007/s12508-012-0090-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12508-012-0090-0

Trefwoorden

  • angst
  • depressie
  • ouderen
  • preventie
  • hoogrisicogroepen
  • huisarts

Keywords

  • anxiety
  • depression
  • aged
  • prevention and control
  • risk factors
  • general practitioner