Skip to main content Accessibility help

Effectiveness and predictors of outcome in routine out-patient mental health care for older adults

  • Marjolein A. Veerbeek (a1), Richard C. Oude Voshaar (a2) and Anne Margriet Pot (a1) (a3) (a4)



Meta-analyses show efficacy of several psychological and pharmacological interventions for late-life psychiatric disorders, but generalization of effects to routine mental health care for older people remains unknown. Aim of this study is to investigate the improvement of functioning within one year of referral to an outpatient mental health clinic for older adults.


Pre-post measurement of the Health of Nations Outcome Scale 65+ (HoNOS 65+) in 704 older people referred for psychiatric problems (no dementia) to any of the seven participating mental health care organizations.


The pre-post-test Cohen's d effect size was 1.08 in the total group and 1.23 in depressed patients, the largest subgroup. Linear regression identified better functioning at baseline, comorbid personality disorder, somatic comorbidity and life events during treatment as determinants of a worse outcome.


Functioning of older persons with psychiatric problems largely improves after treatment in routine mental health care.


Corresponding author

Correspondence should be addressed to: Marjolein Veerbeek, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO. Box 725, 3500 AS, Utrecht, the Netherlands. Phone: + 31 30 2959313; Fax: +31 30 2971111. Email:


Hide All
Ackerman, D. L., Greenland, S., Bystritsky, A. and Small, G. W. (1997). Characteristics of fluoxetine versus placebo responders in a randomized trial of geriatric depression. Psychopharmacology Bulletin, 33, 707714.
Becker, B. J. (1988). Synthesizing standardized mean change measures. British Journal of Mathematical and Statistical Psychology, 41, 257278.
Beekman, A. T. F. et al. (1998). Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. International Journal of Geriatric Psychiatry, 13, 717726.
Beekman, A. T. F., Copeland, J. R. M. and Prince, M. J. (1999). Review of community prevalence of depression in later life. British Journal of Psychiatry, 174, 307311.
Broersma, T. W. and Sytema, S. (2010). The Health of the Nation Outcome Scale as clinical outcome indicator in elderly psychiatry. Tijdschrift voor Gerontologie en Geriatrie, 41, 1318.
Burns, A., et al. (1999). Health of the Nation Outcome Scales for elderly people (HoNOS 65+). British Journal of Psychiatry, 174, 424427.
de Beurs, E., Beekman, A. T., Deeg, D. J., van Dyck, R. and van Tilburg, W. (2000). Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam. Psychological Medicine, 30, 515527.
de Beurs, E., Beekman, A. T., Geerlings, S., Deeg, D., van Dyck, R. and van Tilburg, W. (2010). On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events. British Journal of Psychiatry, 179, 426431.
de Beurs, E. et al. (2011). Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of treatment outcome in clinical practice. Clinical Psychology and Psychotherapy, 18, 112. doi:10.1002/cpp.696.
Gee, S. B., Croucher, M. J. and Beveridge, J. (2010). Measuring outcomes in mental health services for older people: an evaluation of the health of the nation outcome scales for elderly people (HoNOS65+). International Journal of Disability, Development and Education, 57, 155174.
Hamilton, K. E. and Dobson, K. S. (2002). Cognitive therapy of depression: Pre-treatment patient predictors of outcome. Clinical Psychology Review, 22, 875893.
Haringsma, R., Engels, G. I., van der Leeden, R. and Spinhoven, P. (2006). Predictors of response to the ‘Coping with Depression’ course for older adults. A field study. Aging and Ment Health, 10, 424434.
Hayward, R. D., Taylor, W. D., Smoski, M. J., Steffens, D. C. and Payne, M. E. (2013). Association of five-factor model personality domains and facets with presence, onset, and treatment outcomes of major depression in older adults. American Journal of Geriatric Psychiatry, 21, 8896. doi: 10.1016/j.jagp.2012.11.012.
Hilderink, P. H., Collard, R., Rosmalen, J. G. and Oude Voshaar, R. C. (2012). Prevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups: a systematic review. Ageing Research Reviews, 12, 151156. doi: 10.1016/j.arr.2012.04.004.
Joel, I., Begley, et al. (2014). Dynamic prediction of treatment response in late-life depression. American Journal of Geriatric Psychiatry, 22, 167176. doi: 10.1016/j.jagp.2012.07.002.
Jongenelis, K. et al. (2005). Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients. International Journal of Geriatric Psychiatry, 20, 10671074.
Katon, W. J. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13, 723.
Kok, R. M., Heeren, T. J. and van Hemert, A. M. (1993). The Geriatric Depression Scale. Tijdschrift voor Psychiatrie, 35, 416421.
Korte, J., Bohlmeijer, E. T., Cappeliez, P., Smit, F. and Westerhof, G. J. (2012). Life review therapy for older adults with moderate depressive symptomatology: a pragmatic randomized controlled trial. Psychological Medicine, 42, 11631173. doi: 10.1017/S0033291711002042.
Lipsey, M. W. (1990). Design Sensitivity: Statistical Power for Experimental Research. Newbury Park: Sage Publications.
Lipsey, M. W. and Wilson, D. B. (1993). The efficacy of psychological, educational, and behavioral treatment. Confirmation from meta-analysis. American Psychologist, 48, 11811209.
Nelson, J. C., Delucchi, K. L. and Schneider, L. S. (2013). Moderators of outcome in late-life-depression: a patient-level meta-analysis. American Journal of Psychiatry, 170, 651659. doi: 10.1176/appi.ajp.2012.12070927.
Oslin, D. W. et al. (2004). Treatment effects from UPBEAT: a randomized trial of care management for behavioral health problems in hospitalized elderly patients. Journal of Geriatric Psychiatry and Neurology, 17, 99106.
Penninx, B. W. and van Dyck, R. (2010). Depression and somatic comorbidity. Nederlands Tijdschrift voor Geneeskunde, 154, A1784.
Pinquart, M. and Duberstein, P. R. (2007). Treatment of anxiety disorders in older adults: a meta-analytic comparison of behavioral and pharmacological interventions. American Journal of Geriatric Psychiatry, 15, 639651.
Pinquart, M., Duberstein, P. R. and Lyness, J. M. (2006). Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy. American Journal of Psychiatry, 163, 14931501.
Pirkis, J. E., Burgess, P. M., Kirk, P. K., Dodson, S., Coombs, T. J. and Williamson, M. K. (2005). A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health and Quality of Life Outcomes, 3, 76.
Ritchie, K. et al. (2004). Prevalence of DSM-IV psychiatric disorder in the French elderly population. British Journal of Psychiatry, 184,147152.
Rosenbluth, M., Macqueen, G., McIntyre, R. S., Beaulieu, S. and Schaffer, A.; Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force. (2012). The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid personality disorders. Annals of Clinical Psychiatry, 24, 5668.
Schuurmans, J., Comijs, H., Emmelkamp, P. M., Weijnen, I. J., van den Hout, M. and van Dyck, R. (2009). Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders. International Psychogeriatrics, 21, 11481159. doi: 10.1017/S1041610209990536.
Sheikh, R. L. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontology, 5, 165173.
Sinyor, M., Schaffer, A. and Levitt, A. (2010). The sequenced treatment alternatives to relieve depression (STAR*D) trial: a review. Canadian Journal of Psychiatry, 55, 126135.
Smalbrugge, M., Jongenelis, L., Pot, A. M., Beekman, A. T. and Eefsting, J. A. (2008). Screening for depression and assessing change in severity of depression. Is the Geriatric Depression Scale (30-, 15- and 8-item versions) useful for both purposes in nursing home patients? Aging and Mental Health, 12, 244248. doi: 10.1080/13607860801987238.
Staring, T., Stobbe, J. and Mulder, N. (2003). Explenatory schedules for HoNOS 65+: some guidelines to keep in mind. Available at:; last accessed 7 April 2014.
Stein, D. J., Kasper, S., Andersen, E. W., Nil, R. and Lader, M. (2004). Escitalopram in the treatment of social anxiety disorder: analysis of efficacy for different clinical subgroups and symptom dimensions. Depression and Anxiety, 20, 175181.
Trollor, J. N., Anderson, T. M., Sachdev, P. S., Brodaty, H. and Andrews, G. (2007). Prevalence of mental disorders in the elderly: the Australian National Mental Health and Well-Being Survey. American Journal of Geriatric Psychiatry, 15, 455466.
van de Rest, O., van der Zwaluw, N., Beekman, A. T., de Groot, L. C. and Geleijnse, J. M. (2010). The reliability of three depression rating scales in a general population of Dutch older persons. International Journal of Geriatric Psychiatry, 25, 9981005. doi:10.1002/gps.2449.
van der Lem, R., van der Wee, N. J., van Veen, T. and Zitman, F. G. (2011).The generalizability of antidepressant efficacy trials to routine psychiatric out-patient practice. Psychological Medicine, 41, 13531363. doi:10.1017/S0033291710002175.
van der Lem, R., van der Wee, N. J., van Veen, T. and Zitman, F. G. (2012). Efficacy versus effectiveness: a direct comparison of the outcome of treatment for mild to moderate depression in randomized controlled trials and daily practice. Psychotherapy and Psychosomatics, 81, 226234. doi: 10.1159/000330890.
Veerbeek, M., Oude Voshaar, R., Depla, M. and Pot, A. M. (2013a). Mental health care Monitor Older adults (MEMO): Monitoring patient characteristics and outcome in Dutch mental health services for older adults. International Journal of Methods in Psychiatric Research, 22, 100109. doi: 10.1002/mpr.1386.
Veerbeek, M. A., Oude Voshaar, R. C. and Pot, A. M. (2013b). Psychometric properties of the Dutch version of the Health of the Nation Outcome Scales for older adults (HoNOS 65+) in daily care. International Journal of Nursing Studies, 50, 17111719. doi: 10.1016/j.ijnurstu.2013.05.004.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M. and Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed