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. Copyright © 2013 John Wiley & Sons, Ltd.