Background: Among older persons with chronic somatic diseases, depression often remains unrecognized and untreated in primary care. The Depression in Elderly with Long-Term Afflictions (DELTA) study aimed to evaluate the effectiveness of a nurse-led minimal psychological intervention (MPI) in chronically ill elderly persons with depression. Methods: A randomized controlled trial was conducted, comparing the MPI with usual care in 361 primary care patients. Four nurses had an average of 4 sessions with the intervention patients, each lasting 1 h, over a maximum period of 3 months. Patients were aged 60 years and older, had a minor depression or mild-to-moderate major depression, and either had type II diabetes or chronic obstructive pulmonary disease. Results: Nine months after the intervention, patients receiving the MPI had significantly fewer depressive symptoms; the intervention patients were also more likely than usual-care controls to show a ≧50% reduction in depressive symptoms relative to baseline values. At 9 months, diabetic MPI patients had a better quality of life than diabetic controls. Conclusions: The nurse-led MPI appears to be a feasible and moderately effective method of managing minor-to-moderate depression in chronically ill elderly persons. However, we cannot rule out attention-placebo effects, and the disappointing finding of a recent economic evaluation showing only a 63% chance of the MPI being cost-effective. From a clinical point of view, however, it is of interest to further evaluate adaptations of the MPI, with a stronger emphasis on detection, watchful waiting and mental health problems in general.

The proposed symptomatic remission criterion has clinical validity and represents the right balance between parsimony and inclusiveness.

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Twenty-eight subjects meeting the DSM-III-R criteria for simple phobia and 30 normal controls were subjected to a 35% carbon dioxide panic provocation challenge. Simple phobics were subdivided into two groups, animal phobics and situational or natural phenomena phobics. Animal phobics were not more vulnerable to carbon dioxide than normal controls. However, situational or natural phenomena phobics reacted significantly more strongly to the challenge than normal controls. The increase in anxiety in this group was comparable to the increase of anxiety of panic disorder patients from previous studies. Our results suggest the existence of a constitutional predisposition that may not only lead to panic disorder but also to the development of certain specific phobias.

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