Abstract
BackgroundTreatment of established depression is the dominant approach to care of older adults, but prevention holds much promise. Self-help interventions are a feasible preventive approach, since they are scalable and low cost. There are few trials in this area. Behavioral Activation (BA) is a credible candidate psychological approach, which has been shown to work in therapist led care but not been trialled in a self-help form. AimTo test the effectiveness of an unguided self-help intervention based on BA for older adults. MethodsWe compared a self-help intervention based on BA for older people (n = 172) to usual care (n = 160) in a pragmatic randomized controlled trial. Outcomes were depression status and severity (PHQ9) and health related quality of life (SF12). The primary timepoint of the primary outcome was depression at 4 months, with longer term follow up at 12 months to test sustained impact of the primary outcome. ResultsAt 4 months adjusted PHQ-9 scores for BA self-help were 0.79 lower (95% CI: -1.70 to 0.13; p = 0.09) and the proportion of participants with case-level depression was significantly reduced (BA 31/137 (22.6%) versus usual care 41/141 (29.1%); Odds Ratio 0.48; 95% CI: 0.26–0.92; p = 0.03). There was no PHQ-9 difference at 12 months or for health related quality of life at any point (4 or 12 months). DiscussionSelf-help using BA for older people at risk of depression is a feasible and scalable intervention with potential short-term benefits in preventing depression.
Highlights
Depression is the leading cause of mental healthrelated disease burden globally, affecting an estimated 300 million people worldwide.[1]
A total of 332 participants were randomized to the two-armed comparison of Behavioral Activation (BA) self-help booklet versus usual care, n = 172 and n = 160 respectively
The first permission to contact was received on February 14, 2014, and the first participant was randomized on March 10, 2014
Summary
Depression is the leading cause of mental healthrelated disease burden globally, affecting an estimated 300 million people worldwide.[1]. Less attention has been paid to those with mild depressive disorders/sub-threshold depression syndromes, or those who give positive responses to screening questions, but do not have sufficient levels of depressive symptoms to meet diagnostic criteria.[4] Those with less severe depression and symptoms that do not meet formal diagnostic criteria (sometimes called “sub-clinical”, “sub-threshold” or “sub-syndromal” depression) suffer impairments in their quality of life and level of functioning, and hold a negative view toward aging.[3] Sub-threshold depression is a clear risk factor for progression to and the development of more severe depressive illness.[5,6] It is this population of older people with lower severity depressive symptoms who are at risk of severe depression that is the focus of the current research. Methods: We compared a self-help intervention based on BA for older people (n = 172) to usual care (n = 160) in a pragmatic randomized controlled trial. Discussion: Self-help using BA for older people at risk of depression is a feasible and scalable intervention with potential short-term benefits in preventing depression. Discussion: Self-help using BA for older people at risk of depression is a feasible and scalable intervention with potential short-term benefits in preventing depression. (Am J Geriatr Psychiatry 2021; &&:&&−&&)
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