Abstract
BackgroundAging is a social concern. The increased incidence of depression in older populations in China poses a challenge to the health care system. Older adults who are depressed often suffer from a lack of motivation. Behavioral activation treatment, an evidence-based guided self-help treatment, is effective in reducing anhedonia and amotivation in depression; however, the efficacy of guided self-help behavioral activation in older adults with depression is not yet known.ObjectiveThe aim of this study is to pilot a self-help guided intervention for the treatment of depression in older adults.MethodsThis study has been designed as a pilot randomized controlled trial with inpatients (n=60; to be randomly allocated 1:1) between the ages of 60 and 70 and who have major depressive disorder. Patients attending clinical psychological clinics at the Mental Health Center of Chongqing will be randomized to either receive guided self-help behavioral activation (intervention) or to be on a 6-week waiting list (control). Participants in the treatment group will receive 6 sessions of guided self-help behavioral activation delivered over the telephone. The waiting list control group will receive the intervention after a period of 6 weeks. Exclusion criteria will be individuals who are at significant risk of harming themselves or others, who have a primary mental health disorder other than depression, or who have an intellectual disability that would hamper their ability to participate in the intervention. Effects of the treatment will be observed using outcomes in 3 domains: (1) clinical outcomes (symptom severity, recovery rate), (2) process variables (patient satisfaction, attendance, dropout), and (3) economic outcomes (cost and resource use). We will also examine mediators of outcomes in terms of patient variables (behavioral activation or inhibition motivation). We hypothesize that guided self-help behavioral activation will have a beneficial effect.ResultsThe study was approved by the research ethics committee of the Mental Health Center of Chongqing in November 2019. As of July 2020, recruitment had not yet begun. Data collection is expected to be completed by December 2020. Data analysis is expected to be completed by June 2021. Results will then be disseminated to patients, to the public, to clinicians, and to researchers through publications in journals and presentations at conferences.ConclusionsThis will be the first study in China to investigate guided self-help interventions for patients who are older adults and who are depressed, a group which is currently underrepresented in mental health research. The intervention is modular and adapted from an empirically supported behavioral activation treatment for depression. The generalizability and broad inclusion criteria are strengths.Trial RegistrationChinese Clinical Trial Register ChiCTR1900026066; http://www.chictr.org.cn/showprojen.aspx?proj=43548International Registered Report Identifier (IRRID)PRR1-10.2196/18259
Highlights
With the increase in life expectancy and low fertility rate, the health of the aging population has become a social concern
Results will be disseminated to patients, to the public, to clinicians, and to researchers through publications in journals and presentations at conferences. This will be the first study in China to investigate guided self-help interventions for patients who are older adults and who are depressed, a group which is currently underrepresented in mental health research
Geriatric depression refers to primary depression that first occurs after the age of 60 and which cannot be explained by physical symptoms or other organic diseases [3]
Summary
With the increase in life expectancy and low fertility rate, the health of the aging population has become a social concern. With the increase in the aging population, depression in older adults has become the most important public health issue and can significantly increase the total cost of medical services [2]. Geriatric depression refers to primary depression that first occurs after the age of 60 and which cannot be explained by physical symptoms or other organic diseases [3]. In a 2006 nationwide survey, among urban and rural older adults who were assessed with 15-item Geriatric Depression Scale, 13.6% and 25.5% demonstrated moderate or severe depressive symptoms, respectively [4]. Among older adults in Chongqing, 24.3% had depressive symptoms (a score greater than 11 on the 30-item Geriatric Depression Scale) [6]. The increased incidence of depression in older populations in China poses a challenge to the health care system. Behavioral activation treatment, an evidence-based guided self-help treatment, is effective in reducing anhedonia and amotivation in depression; the efficacy of guided self-help behavioral activation in older adults with depression is not yet known
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