Abstract
BackgroundDepression is common in people with chronic physical illness and is associated with worse medical outcomes. Cognitive behavioural therapy and problem-solving improve depression, although usually have small to moderate effects among people with chronic physical illness. Behavioural activation interventions for depression, which aim to increase positive reinforcement from the environment by encouraging individuals to increase pleasant/rewarding activities, have been reported to be equivalent to cognitive behavioural therapy. However, the effectiveness of behavioural activation interventions for depression in individuals with chronic physical illness is unclear. The aims of this systematic review are to identify the extent to which different forms of behavioural activation have been used as a treatment for depression in this population, examine the effectiveness of the interventions, and identify any adaptations which have been made specifically to the interventions for individuals with a range of chronic physical illnesses.Methods/DesignElectronic databases will be systematically searched using terms relevant to behavioural activation and depression, and the subset of studies in people with chronic physical illnesses will be identified by manual searching. References and citations of eligible studies will be searched and experts in this field will be contacted to identify additional papers. All study designs will be included in this review to allow for a more extensive identification of the extent of different forms of behavioural activation interventions. The different forms of behavioural activation and the specific chronic physical health conditions for which this intervention has been used will be reviewed narratively. For the effectiveness of the interventions, if sufficient randomised controlled trials have been undertaken the results will be meta-analysed. Non-randomised studies will be narratively synthesised and adaptations to the interventions will also be narratively reviewed.DiscussionThe findings will inform the design, development and subsequent evaluation of a behavioural activation intervention for depression in people with a chronic physical illness. PROSPERO registration number: CRD42013004500.
Highlights
Depression is common in people with chronic physical illness and is associated with worse medical outcomes
Depression affects between 7.9% and 23.0% of people with chronic physical illnesses [1,2] and is associated with worse medical outcomes, such as more physical symptoms [3], greater healthcare use, increased work disability [4] and higher mortality [5,6]
The basic conceptual foundation for Behavioural activation (BA) is based upon the original behavioural models of depression [14,15], which propose depression to be a result of a lack of response-contingent positive reinforcement [14] and emphasise the importance of a functional analysis of behaviour and the role of avoidance and escape behaviours in depression [15]
Summary
There are no systematic reviews that have examined the use of different types of BA when used to treat depression in individuals with chronic physical illness. Based upon the Medical Research Council’s (MRC) guidance [48], this systematic review will clarify and further develop theoretical underpinnings for the use of BA interventions in depressed individuals with chronic physical illnesses and identify adaptations that have been made to BA interventions for this population. Additional file 1: Ovid SP Embase search strategy. Additional file 2: Data extraction form to be used on Microsoft Excel. Authors’ contributions SH designed the study protocol and wrote the manuscript. PF and CD contributed to the design of the protocol and were substantially involved in improving the drafts of the manuscript.
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