Abstract
Introduction: Effective non-pharmacological treatment options for depression in older adults are lacking. Objective: The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated. Methods: In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up. Results: Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p < 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24). Conclusions: BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.
| Original language | English |
|---|---|
| Pages (from-to) | 255-266 |
| Number of pages | 12 |
| Journal | Psychotherapy and Psychosomatics |
| Volume | 92 |
| Issue number | 4 |
| Early online date | 29 Jun 2023 |
| DOIs | |
| Publication status | Published - Sept 2023 |
Bibliographical note
Funding Information:The study was funded by the Ministry of Health Funding-program for Health Care Efficiency Research ZonMw (843001606). All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ . GJH occasionally receives honoraria for lectures at symposia. On a yearly basis, it is never more than EUR 1,000. MJHH received a payment for training MHNs for the purpose of this study. DE is chief investigator for UK NIHR-funded multimorbidity in older adults’ programme of research. A programme in a similar clinical area looking at BA in people 65 and over with 2 or more health problems and depression. HvM was supported by the National Institute of Health Research (NIHR) Applied Health Collaboration Kent, Surrey, Sussex. The views expressed are those of the author(s) and not necessarily the NHS, the NIHR, or the Department of Health and Social Care. All other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.
Publisher Copyright:
© 2023 S. Karger AG. All rights reserved.
Funding
The study was funded by the Ministry of Health Funding-program for Health Care Efficiency Research ZonMw (843001606). All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ . GJH occasionally receives honoraria for lectures at symposia. On a yearly basis, it is never more than EUR 1,000. MJHH received a payment for training MHNs for the purpose of this study. DE is chief investigator for UK NIHR-funded multimorbidity in older adults’ programme of research. A programme in a similar clinical area looking at BA in people 65 and over with 2 or more health problems and depression. HvM was supported by the National Institute of Health Research (NIHR) Applied Health Collaboration Kent, Surrey, Sussex. The views expressed are those of the author(s) and not necessarily the NHS, the NIHR, or the Department of Health and Social Care. All other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.
Keywords
- Behavioural activation
- Depression
- Older adults
- Primary care