RESUMEN
OBJECTIVE: This study aims to determine the long-term effect of a stepped care cognitive behavioral therapy prevention program for depression in older people and the factors predicting or moderating outcome. METHODS: In a randomized controlled trial, 136 participants, aged 55 years or older, who had been treated for depression, received during 12 months a stepped care program (SCP) or care as usual (CAU) and were then followed up for a second year. Outcome was defined as the start of a new mental health treatment for depression in a specialized outpatient setting, as recorded in the patients' electronic medical records. RESULTS: Of the 123 patients, 38 required new mental health treatment. Survival analysis showed that participants in SCP (n = 27) required new treatment significantly more than patients receiving CAU (n = 11). Negative life events in the last year were predictive for new treatment in CAU but not in SCP. CONCLUSIONS: An SCP seems to lower the threshold for new specialized mental health treatment for depression, whereas new treatment in CAU patients occurs more often in reaction to recent life events.