This site uses cookies to measure how you use the website so it can be updated and improved based on your needs and also uses cookies to help remember the notifications you’ve seen, like this one, so that we don’t show them to you again. If you could also tell us a little bit about yourself, this information will help us understand how we can support you better and make this site even easier for you to use and navigate.

A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial


Leontjevas, Ruslan, Gerritsen, Debby L, Smalbrugge, Martin, Teerenstra, Steven, Vernooij-Dassen, Myrra JFJ, Koopmans, Raymond TCM


Lancet, Volume: 381, No.: 9885, Pages.: 2255-2264

Year of Publication



Background: Depression in nursing-home residents is often under-recognised. We aimed to establish the effectiveness of a structural approach to its management.; Methods: Between May 15, 2009, and April 30, 2011, we undertook a multicentre, stepped-wedge cluster-randomised trial in four provinces of the Netherlands. A network of nursing homes was invited to enrol one dementia and one somatic unit per nursing home. In enrolled units, nursing-home staff recruited residents, who were eligible as long as we had received written informed consent. Units were randomly allocated to one of five groups with computer-generated random numbers. A multidisciplinary care programme, Act in Case of Depression (AiD), was implemented at different timepoints in each group: at baseline, no groups were implenting the programme (usual care); the first group implemented it shortly after baseline; and other groups sequentially began implementation after assessments at intervals of roughly 4 months. Residents did not know when the intervention was being implemented or what the programme elements were; research staff were masked to intervention implementation, depression treatment, and results of previous assessments; and data analysts were masked to intervention implementation. The primary endpoint was depression prevalence in units, which was the proportion of residents per unit with a score of more than seven on the proxy-based Cornell scale for depression in dementia. Analyses were by intention to treat. This trial is registered with the Netherlands National Trial Register, number NTR1477.; Findings: 16 dementia units (403 residents) and 17 somatic units (390 residents) were enrolled in the course of the study. In somatic units, AiD reduced prevalence of depression (adjusted effect size -7·3%, 95% CI -13·7 to -0·9). The effect was not significant in dementia units (0·6, -5·6 to 6·8) and differed significantly from that in somatic units (p=0·031). Adherence to depression assessment procedures was lower in dementia units (69% [SD 19%]) than in somatic units (82% [15%]; p=0·045). Adherence to treatment pathways did not differ between dementia units (43% [SD 33%]) and somatic units (38% [40%]; p=0·745).; Interpretation: A structural approach to management of depression in nursing homes that includes assessment procedures can reduce depression prevalence in somatic units. Improvements are needed in depression screening in dementia units and in implementation of nursing-home treatment protocols generally.; Funding: The Netherlands Organization for Health Research and Development.; Copyright © 2013 Elsevier Ltd. All rights reserved.

Bibtex Citation

@article{Leontjevas_2013, doi = {10.1016/s0140-6736(13)60590-5}, url = {}, year = 2013, month = {jun}, publisher = {Elsevier {BV}}, volume = {381}, number = {9885}, pages = {2255--2264}, author = {Ruslan Leontjevas and Debby L Gerritsen and Martin Smalbrugge and Steven Teerenstra and Myrra JFJ Vernooij-Dassen and Raymond TCM Koopmans}, title = {A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial}, journal = {The Lancet} }


aged, aged, 80 and over, depression, depressive disorder, diagnosis, female, humans, male, multidisciplinary, neuropsychological tests, nursing homes, patient care team, prevalence, prevention & control, programme, quality of life, severity of illness index, statistics & numerical data, therapy

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Depression and Anxiety, Prevention and/or management of co-morbidities


Nursing Homes

Type of Interventions

Non-pharmacological Treatment, Treatment/prevention of co-morbidities or additional risks

Non-Pharmaceutical Interventions

Behavioural Therapies, Other


Depression / Prevention Management