BEAT-IT: Comparing a behavioural activation treatment for depression in adults with intellectual disabilities with an attention control: study protocol for a randomised controlled trial.

Andrew Jahoda,Robert S P Jones,Dave Dagnan,Richard Hastings,Chris Hatton,Alex Mcconnachie,Andrew Briggs,Sally-Ann Cooper,Craig Melville,Chris Williams

doi:10.1186/s13063-015-1103-5

Abstract

BackgroundDepression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals’ level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised.Methods/DesignThis study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants’ activity levels, proxy reports of depressive symptoms, and cost-effectiveness.DiscussionThe study will provide evidence about the effectiveness of behavioural activation for depression, adapted for people who have mild/moderate intellectual disabilities, and will inform the delivery of psychological therapies to people with intellectual disabilities in practice.Trial registrationDate trial registered: Nov. 13, 2012; trial registration number: ISRCTN 09753005

Highlights

Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population
This is the first trial of behavioural activation for people with intellectual disabilities and depression and will be the largest trial of an individual psychological intervention for people with intellectual disabilities
There has been scepticism about the possibility of carrying out randomised controlled trials with this population, even though a recent review pointed to the paucity of robust evidence concerning the use of psycho-social interventions with people who have intellectual disabilities and mental health problems [41]

Summary

Discussion

This is the first trial of behavioural activation for people with intellectual disabilities and depression and will be the largest trial of an individual psychological intervention for people with intellectual disabilities. The best evidence is in relation to interventions for anger, one of the most common reasons that people with intellectual disabilities are referred for specialist psychological help. It is usually someone else who refers people with intellectual disabilities for help with an anger problem This highlights a particular challenge with recruiting participants with a learning disability to a study of this nature: people rarely self-refer because they are experiencing depressive symptoms. Recruiting to this study could help to stimulate further trials of complex interventions for a broader range of mental health difficulties experienced by people with intellectual disabilities. Having a credible alternative intervention, with different active ingredients, should help to offer a clearer indication of behavioural activation’s contribution to change in depressive symptoms. Read and approved the final version of the manuscript

Background

Methods/Design

Suicidal

Findings