Evidence-based Treatments For Depression Research Articles

Is alcohol use associated with psychological treatment attendance and clinical outcomes?

To investigate associations between alcohol use, psychological treatment attendance, and clinical outcomes. We analysed electronic health records for N = 7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre-treatment alcohol use (average units per week) and severity of dependence (SDS), number of therapy contacts attended, pre- and post-treatment anxiety (GAD-7), and depression (PHQ-9) symptom severity. Hierarchical regression was used to examine associations between alcohol use/dependence and post-treatment symptom severity controlling for intake severity and relevant confounders. After controlling for confounders, alcohol use had significant nonlinear associations with pre-treatment depression severity (R2 = .54, p < .01, cubic trend), and post-treatment anxiety (R2 = .23, p < .01, quadratic trend). Alcohol use was not significantly associated with intake anxiety, post-treatment depression or treatment duration. SDS was not significantly associated with depression severity, alcohol severity, or total contacts after controlling for confounders. Alcohol users are just as likely to engage in and benefit from evidence-based psychological treatments for depression in primary care. A nonlinear association between alcohol use and anxiety treatment outcomes indicates that light-to-moderate drinkers have some shared characteristic that favours treatment response. Depression and anxiety problems often co-occur with alcohol use and dependence. Conventional wisdom in the field suggests that heavy alcohol users may not engage well or benefit from psychological therapies for depression and anxiety. We found no empirical support for the above assumptions in a large clinical sample. Alcohol consumption was not significantly associated with treatment attendance or depression treatment outcomes. A nonlinear association between alcohol use and anxiety outcomes suggests that moderate drinkers may have some shared characteristic that favours treatment response.

11.13 Predictors, Moderators, and Mediators in RCTs for the Treatment of Adolescent Depression: A Scoping Review

Evidence-based treatments for depression in adolescents have limited benefits. Discovering who best responds to which treatment and understanding the mechanisms of response can help optimize resources and clinical outcomes. Accordingly, this scoping review aimed to comprehensively map out the study of predictors, moderators, and mediators (PMMs) of outcome in RCTs in the treatment of adolescent depression. We applied a planned search strategy to the following databases: MEDLINE, Embase, APA PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), from inception to February 2020. We included publications testing PMMs of depression symptom severity in the context of RCTs for the treatment of depression in adolescents (aged 13 to 17 years). In duplicate, we extracted variables tested as PMMs, grouped PMM variables into domains, coded analyses as univariate/multivariate, and coded reported results as significant/nonsignificant. Our search yielded 79 publications that tested at least 1 variable as a PMM of outcome across 33 RCTs. The variable domains most commonly studied as baseline predictors included sex (N = 12 RCTs), age (N = 9), race (N = 6), socioeconomic status (N = 5), severity (N = 13), anxiety (N = 10), overall psychopathology (N = 7), suicidal ideation (N = 6), hopelessness (N = 5), general functioning (N = 7), family functioning (N = 6), and history of trauma (N = 5). The domain most commonly tested as a postbaseline predictor was therapy attendance (N = 10). Domains frequently tested as moderators included: sex (N = 13), age (N = 11), race (N = 6), severity (N = 9), anxiety (N = 6), family functioning (N = 6), general functioning (N = 5), and history of trauma (N = 5). The results of mediator analyses were only reported in 4 RCTs. The reported significance of results was generally mixed across trials, and the most consistent finding was that baseline symptom severity was found to be a predictor, with 9 of 13 RCTs reporting significance on at least 1 multivariate analysis. Across RCTs for the treatment of adolescent depression, published PMM analyses have reported mixed results. Our findings can be used to inform the selection of variables for more focused study designs (eg, individual patient data meta-analyses) needed to further understand how these variables can be best used to optimize treatment for adolescents with depression.

59.3 MDD IN AUTISM SPECTRUM DISORDER

Depression is a common comorbid disorder in youth with autism spectrum disorder (ASD), with reported prevalence of up to 10% in adolescents. It is important to identify and treat comorbid depression in youth with ASD. Diagnostic assessment methods for depression in youth with ASD will be discussed. Evidence-based treatments for depression will be reviewed. Although there are no controlled trials of antidepressants for depression in youth with ASD, medication treatment is often needed. CBT has shown some benefit. Increased awareness of the comorbidity of depression in youth with ASD may improve early identification of depression. Controlled trials of antidepressant medications and psychosocial interventions are needed to identify effective treatments for youth with comorbid depression and ASD.

20.3 REMOTE COACHING AND TECHNOLOGY FOR TRAINING COMMUNITY HEALTH WORKERS TO TREAT DEPRESSION IN PRIMARY CARE: CASE EXAMPLE FROM INDIA AND OPPORTUNITIES TO SCALE UP MENTAL HEALTH CARE GLOBALLY

Objectives: Depression is a leading cause of disability that disproportionately impacts low- and middle-income countries. With greater likelihood of access to a mobile phone than mental health care in most countries, there may be opportunities to leverage these digital tools toward increasing access to depression care. We present a case example from the ESSENCE project in India using digital technology to build capacity of community health workers (CHWs), the essential workforce responsible for frontline maternal and child health services in the country, to deliver a brief evidence-based psychological treatment for depression in primary care. Methods: We discuss key considerations in the design and evaluation of the digital training program, with emphasis on strategies to overcome poor mobile connectivity in rural and underresourced settings, and ensuring participant engagement. We describe the systematic approach to tailor the program to meet the needs of the target user group of CHWs. This involved careful design of the digital program and adapting the training content to the local culture and context. We also describe the use of remote coaching and other support techniques to promote engagement and completion of the training program. Results: We present findings from a pilot study with 42 CHWs that directly informed refinements to the training program and design of a subsequent randomized controlled trial enrolling 340 CHWs. We illustrate the progression from formative research to a larger trial, and the integration of remote coaching support, text messaging, and automated reminders within the digital program to promote engagement. We describe how these efforts are informing the design of a digital platform for training frontline health workers to deliver brief psychological treatments in other settings, including the United States. Conclusions: This example of reciprocal learning in global mental health is particularly timely given the impacts of the COVID-19 pandemic, and renewed efforts to train and support frontline health workers to meet the anticipated surge in mental health challenges globally. This study could yield a blueprint for using widely available digital technology for training and supporting frontline health workers toward scaling up mental health services in India and globally. DDD, TREAT, R

The Use of Electronic Health Record Tools to Improve Evidence-Based Treatment of Adolescent Depression in Primary Care.

The aim of the current study was to evaluate primary care pediatrician (PCP) adoption of an electronic health record (EHR) documentation tool and their delivery of a behavioral activation (BA) intervention within their routine practice with adolescents who screened positive for depression. We used the RE-AIM framework to describe PCP adoption and implementation of EHR documentation tools and brief evidence-based protocols. Utilization was assessed using a customized toolbar (ie, actions toolbar) via retrospective chart review. A pre-post design was used to measure changes in PCP-reported knowledge, comfort, and feasibility managing depression before and after they were trained. A mixed-effects logistic regression model was used to analyze associations of resource utilization with depression severity. PCPs used the actions toolbar to document responses to elevated Patient Health Questionnaire (PHQ-9) scores for 29.80% of encounters. The PCPs utilized the BA protocol for 10.5% of encounters with elevated PHQ-9 scores. Higher depression severity categories were associated with significantly higher odds of utilization relative to mild severity. The training was rated highly acceptable and PCPs reported significant post-training increases in comfort and feasibility. This is the first study of its kind to implement and evaluate PCP utilization of an EHR documentation tool aimed to improve delivery of an evidence-based intervention for adolescent depression. Teaching PCPs to implement brief interventions has potential to increase access to evidence-based care; however, large-scale practice change requires an effective implementation strategy that does not increase provider burden and is fully integrated into physician documentation and workflow.

Response and remission rates during 24 weeks of mood-stabilizing treatment for bipolar depression depending on early non-response

BackgroundWe aimed to study the probability of bipolar depression response at 24 weeks given initial non-response. MethodsWe combined two multi-site, 24-week trials including similar populations following the same evidence-based guidelines randomizing patients to lithium or quetiapine. Additional mood-stabilizing treatment was possible if clinically indicated. We report cumulative proportions of response (>50% improvement in MADRS) and remission (MADRS<10). ResultsWe included 592 participants with bipolar depression (mean 39 years, 59% female, mean MADRS 25). Among 393 (66%) participants without response after 2 weeks, 46% responded by 24 weeks; for 291 (49%) without response at 4 weeks, 40% responded and 33% remitted by 24 weeks; for 222 (38%) without a response at 6 weeks, 36% responded and 29% remitted by 24 weeks; for 185 (31%) without a response at 8 weeks, 29% responded and 24% remitted by 24 weeks. Rates were similar for participants who had started an additional mood-stabilizing drug during the first 6 or 8 weeks. ConclusionsAmong patients with bipolar depression and non-response after 6 weeks treatment, representing an adequate bipolar depression trial, only one-third responded by 24 weeks. These results highlight the need for better treatment alternatives for non-responders to evidence-based treatments for bipolar depression.

Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project.

Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems. This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use. This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia. This project may inform models of care that can extend to other regions of Latin America or other LMICs.

Cognitive Control Deficits in Depression: A Novel Target to Improve Suboptimal Outcomes in Childhood.

Cognitive control deficits are one of three primary endophenotypes in depression, and the enhanced targeting of these deficits in clinical and research work is expected to lead to improved depression outcomes. Cognitive control is a set of self-regulatory processes responsible for goal-oriented behavior that predicts clinical/functional outcomes across the spectrum of brain-based disorders. In depression, cognitive control deficits emerge by the first depressive episode, persist during symptom remission, and worsen over the course of depression. In addition, the presence of these deficits predicts a poor response to evidence-based depression treatments, including psychotherapy and antidepressant medication. This is particularly relevant to childhood depression, as 1%-2% of children are diagnosed with depression, yet there are very limited evidence-based treatment options. Cognitive control deficits may be a previously underaddressed factor contributing to poor outcomes, although there remains a dearth of research examining the topic. The investigators describe the prior literature on cognitive control in depression to argue for the need for increased focus on this endophenotype. They then describe cognitive control-focused clinical and research avenues that would likely lead to improved treatments and outcomes for this historically undertreated aspect of childhood depression.

Barriers to Increasing Access to Brief Pediatric Mental Health Treatment From Primary Care

A quality improvement process targeted mental health care uptake and system capacity in an underserved region. The pediatric program created pathways for rapid referral from primary care and schools to four sessions of evidence-based treatments for disruptive behavior and depression with community clinicians. Of 250 referrals, 46 families enrolled in treatments for disruptive behavior and 21 for depression. Many families did not respond or required more intensive treatment. Acceptability of the program was high for participating families, referrers, and clinicians. Brief treatment met most participating families' needs. The process demonstrated barriers to mental health care access and delivery and the need for integrated and multitiered care delivery.

The effects of app-based mindfulness practice on the well-being of university students and staff

Mental health problems like anxiety, depression, and stress have been increasing in many countries and the 2020 COVID-19 pandemic has further exacerbated their toll. Mindfulness-based interventions have been shown to provide evidence-based treatments for anxiety and depression, and accumulating evidence is emerging in support of using mindfulness apps yielding small-to-moderate treatment effects. The study was a 4-week randomized controlled trial with 561 university students and staff as participants, divided into a treatment group (mindfulness app) and an active control group (psychoeducational online content). Depression, anxiety, and stress were evaluated as primary study outcomes. Saliva cortisol samples were also collected from a subgroup of the treatment arm (n = 29). Using the mindfulness app for four weeks resulted in small reductions in stress (d = .16), and depression (d = .16). Attrition was 28.0%. Subjects who practiced more did not experience additional improvement in wellbeing. Mindfulness apps offer modest but clear benefits to users in terms of improved mental health. They present a promising supplement to traditional mental health services.

Trajectories of change in depression symptoms and suicidal ideation over the course of evidence-based treatment for depression: Secondary analysis of a randomised controlled trial of cognitive behavioural therapy plus fluoxetine in young people.

Effective treatment of depression is a key target for suicide prevention strategies. However, only around one-third of young people with suicide risk respond to evidence-based treatments. Understanding the trajectory of suicidal ideation, as a marker of suicide risk, over the course of evidence-based treatment for depression might provide insight into more targeted and effective treatments. This is a secondary analysis of data from the multicentre Youth Depression Alleviation-Combined Treatment trial. A total of 153 young people aged 15-25 years diagnosed with major depressive disorder were randomly assigned in this double-blind, placebo-controlled trial to either cognitive behavioural therapy plus fluoxetine or cognitive behavioural therapy plus placebo. Participants were assessed for depression and suicidal ideation at baseline and at weeks 4, 8 and 12. Using group-based trajectory modelling, we identified two distinct depression trajectories. The first (Improving; 54.9%; n = 83) comprised those who experienced a consistent decline in depression symptoms. The second (Persisting; 45.1%; n = 70) comprised those who, despite treatment, still had clinically significant levels of depression by the end of treatment. For suicidal ideation, we identified four distinct trajectories: Non-clinical (15.5%; n = 20), Low Improving (47.1%; n = 75), High Improving (24.8%; n = 38) and High Persisting (12.7%; n = 20). Treatment allocation was not significantly associated with trajectory membership for either depression or suicidal ideation. Understanding the course of depression and suicidal ideation during treatment has important implications for managing suicide risk. The findings suggest that there is an identifiable group of young people for whom enhanced psychological and/or pharmacological intervention might be required to ensure a better treatment response. Specific interventions for those with suicidal ideation may also be prudent from the outset. The Youth Depression Alleviation-Combined Treatment trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12612001281886).

Blending group-based psychoeducation with a smartphone intervention for the reduction of depressive symptoms: results of a randomized controlled pilot study

BackgroundGiven their ubiquity and technological facilities, smartphone-based interventions (SBIs) hold potential to support the cost-effective dissemination of evidence-based treatments for depression. As technologically enriched, blended approach–avoidance modification trainings (AAMTs) have recently been shown effective for symptom reduction in various mental health problems, we developed a blended SBI combining group-based psychoeducation and 14 days of app training utilizing principles from AAMT to reduce depressive symptoms.MethodsIn this pilot trial, N = 16 individuals with heightened depression scores were randomized to either an intervention group using the mentalis Phoenix app or a wait list control condition. As outcomes, we descriptively explored usability of the app, engagement with the intervention, and possible reductions of depressive symptoms.ResultsData analyses suggest that the SBI tested in this pilot trial possesses high usability, is frequently engaged with, and reduces depressive symptoms in participants in the intervention group when compared to wait list controls.ConclusionsThis pilot study provides preliminary evidence that an SBI utilizing AAMT can reduce depressive symptoms. Future studies should replicate these findings using larger samples and disentangle possible mechanisms of change.Trial registrationDRKS-ID: DRKS00021613 (retrospectively registered).

A Feasibility Study of a One-to-One Mindfulness-Based Intervention for Improving Mood in Stroke Survivors

ObjectivesMindfulness is an evidence-based treatment for depression but has never been rigorously tested with stroke survivors with depression. This feasibility study examined several issues relevant to a potential trial of a mindfulness-based intervention (MBI) for improving mood after stroke.MethodsIn 2017–2019 in New Zealand, we recruited 20 stroke survivors with low mood to undergo a 6-week, one-on-one MBI course delivered by an occupational therapist experienced in MBIs. Pre, post, and 4-week follow-up assessments were completed.ResultsFifteen participants completed all six sessions and a 4-week “booster” or top-up session. The 1-hour session duration was considered appropriate by participants and all enjoyed the face-to-face individualized format. Mean Beck Depression Inventory-II scores improved by more than one standard deviation and this was maintained at follow-up. However, the baseline assessment package was too long for some participants due to the cognitive component. Three participants indicated feeling emotionally challenged by some of the practices. These effects were managed by the mindfulness facilitator by adjusting the practice, so participants maintained their sense of agency, well-being, and overall benefit from the program.ConclusionsMBI training delivered individually over six weekly sessions was acceptable to stroke survivors with 14/15 participants reporting improved mood. Three participants reported feeling emotionally challenged by some of the practices and we recommend MBIs for stroke survivors be provided by practitioners experienced in mindfulness, working with stroke, and trauma-informed therapy. It is important now to conduct rigorous randomized controlled trials to test the effectiveness and efficacy of MBIs for stroke survivors.

Digital training for non-specialist health workers to deliver a brief psychological treatment for depression in India: Protocol for a three-arm randomized controlled trial

BackgroundTraining non-specialist health workers (NSHWs) at scale is a major barrier to increasing the coverage of depression care in India. This trial will test the effectiveness of two forms of digital training compared to conventional face-to-face training in changing the competence of NSHWs to deliver a brief evidence-based psychological treatment for depression. MethodsThis protocol is for a three-arm, parallel group randomized controlled trial comparing three ways of training NSHWs to deliver the Healthy Activity Program (HAP), a brief manualized psychotherapy for depression, in primary care. The arms are: digital training (DGT); digital training combined with individualized coaching support (DGT+); and conventional face-to-face training (F2F). The target sample comprises N = 336 government contracted NSHWs in Madhya Pradesh, India. The primary outcome is change of competence to deliver HAP; secondary outcomes include cost-effectiveness of the training programs, change in participants' mental health knowledge, attitudes and behavior, and satisfaction with the training. Assessors blind to participant allocation status will collect outcomes pre- (baseline) and post- (endpoint) training to ascertain differences in outcomes between arms. Training program costs will be collected to calculate incremental costs of achieving one additional unit on the competency measure in the digital compared to face-to-face training programs. Health worker motivation, job satisfaction, and burnout will be collected as exploratory outcome variables. DiscussionThis trial will determine whether digital training is an effective, cost-effective, and scalable approach for building workforce capacity to deliver a brief evidence-based psychological treatment for depression in primary care in a low-resource setting. Trial RegistrationClinicalTrials.gov Identifier: NCT04157816

Depression treatment in Germany \u2013 using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy

BackgroundSocieties strive for fast-delivered, evidence-based and need-oriented depression treatment within budget constraints. To explore potential improvements, selective contracts can be implemented. Here, we evaluate if the German collaborative psychiatry-neurology-psychotherapy contract (PNP), which extends the gatekeeping-based general practitioner (GP) program, improved guideline adherence or need-oriented and timely access to psychotherapy compared to usual care (UC).MethodsWe conducted a retrospective observational cohort study based on health insurance claims data. After we identified patients with depression who were on sick leave due to a mental disorder in 2015, we applied entropy balancing to adjust for selection effects and employed chi-squared tests to compare guideline adherence of the received treatment between PNP, the GP program and UC. Subsequently, we applied an extended cox regression to assess need-orientation by comparing the relationship between accumulated sick leave days and waiting times for psychotherapy across health plans.ResultsN = 23,245 patients were included. Regarding guideline adherence, we found no significant differences for most severity subgroups; except that patients with a first moderate depressive episode received antidepressants or psychotherapy more often in UC. Regarding need-orientation, we observed that the effect of each additional month of sick leave on the likelihood of starting psychotherapy was increased by 6% in PNP compared to UC.Irrespective of the health plan, we found that within the first 12 months only between 24.3 and 39.7% (depending on depression severity) received at least 10 psychotherapy sessions or adequate pharmacotherapy.ConclusionsThe PNP contract strengthens the relationship between sick leave days and the delay until the beginning of psychotherapy, which suggests improvements in terms of need-oriented access to care. However, we found no indication for increased guideline adherence and – independent of the health plan – a gap in sufficient utilization of adequate treatment options.

Low-hanging fruit for getting back on your feet: A critical review of diet and exercise interventions for depression

• Diet and exercise interventions are evidence-based treatments for depression. • People with depression should eat more fruits/vegetables and less sweets. • Although exercise may have independent antidepressant effects, adherence rates are low.

Incorporating family factors into treatment planning for adolescent depression: Perceived parental criticism predicts longitudinal symptom trajectory in the Youth Partners in Care trial

BackgroundThis study aimed to clarify the predictive significance of youth perceptions of parental criticism assessed using a brief measure designed to enhance clinical utility. We hypothesized that high perceived parental criticism would be associated with more severe depression over 18-months of follow-up. MethodsThe study involved secondary analyses from the Youth Partners in Care trial, which demonstrated that a quality improvement intervention aimed at increasing access to evidence-based depression treatment in primary care led to improved depression outcomes at post-treatment compared to usual care enhanced by provider education regarding depression evaluation/management. Patients (N = 418; ages 13–21) were assessed at four time points: baseline; post-treatment (six-month follow-up); 12- and 18-month follow-ups. The primary analysis estimated the effect of perceived parental criticism on likelihood of severe depression (i.e., Center for Epidemiological Studies-Depression Scale ≥ 24) over post-intervention follow-ups using a repeated-measures logistic regression model. Secondarily, a linear mixed-effects growth model examined symptom trajectories from baseline through 18-months using the Mental Health Index-5, a measure of emotional distress available at all time-points. ResultsHigh perceived parental criticism emerged as a robust predictor of clinically-elevated depression (OR=1.66, p=.02) and a more pernicious symptom trajectory over 18-months (β =-1.89, p<.0001). LimitationsThe association between the self-report perceived criticism and traditional expressed emotion measures derived from verbal and nonverbal parental behaviors was not evaluated. ConclusionsResults support perceived parental criticism as a predictor of youth depression outcomes over 18-months. This brief measure can be feasibly integrated within clinical assessment to assist clinicians in optimizing treatment benefits.

Design and Development of a Digital Program for Training Non-Specialist Health Workers to Deliver an Evidence-Based Psychological Treatment for Depression in Primary Care in India.

Digital technologies hold promise for building capacity of non-specialist health workers towards scaling up depression care in low-resource settings. The purpose of this study was to describe the systematic approach to designing a digital program for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program, in primary care in rural India. The design and development of the training program involved 5 steps: 1) develop program blueprint; 2) create instructional content; 3) digitize content for a smartphone app; 4) develop a platform for uploading and hosting the digital content; and 5) user-testing and refinements to ensure program functioning. This was followed by field-testing and focus group discussions with non-specialist health workers recruited from primary care facilities in Madhya Pradesh, India, to inform further modifications and improvements to the digital training program. Training program development occurred over 12-months, and the final digital training consisted of 16 modules with videos, role-plays, and digital content tailored to the local culture and context. Focus group discussions with 19 non-specialist health workers generated three key action items and modifications to the digital training in response to participant feedback: 1) addressing technical challenges by making the digital content available offline; 2) account for low digital literacy by including a comprehensive orientation session about navigating the smartphone app; and 3) addition of remote coaching to support participants in completing the training. This study illustrates a step-wise approach to combine evidence-based content with iterative feedback from stakeholders to develop a digital training program tailored to the context in a low-resource setting. Further research is needed to validate this approach and to evaluate the effectiveness of the final modified digital training program, while considering whether this approach can be adopted and replicated in other settings.

Effect of Telehealth Treatment by Lay Counselors vs by Clinicians on Depressive Symptoms Among Older Adults Who Are Homebound

Older adults who are homebound and have low income have limited access to psychosocial treatments because of their homebound state and geriatric mental health workforce shortages. To evaluate clinical effectiveness of a brief, aging service-integrated, videoconferenced behavioral activation (tele-BA) treatment delivered by lay counselors compared with videoconferenced problem-solving therapy (tele-PST) delivered by licensed clinicians and attention control (AC; telephone support calls). This 3-group randomized clinical trial using a randomization prior to consent approach included individuals aged 50 years or older who were homebound and had 24-item Hamilton Depression Rating Scale (HAMD) scores of 15 or greater between February 15, 2016, and April 15, 2019. Tele-BA and tele-PST participants received 5 weekly treatment sessions. Assessments were performed at baseline and 12, 24, and 36 weeks after baseline. Intention-to-treat statistical analyses were performed from January 1, 2020, to February 15, 2020. Tele-BA participants were taught 5 steps for reinforcing healthy behaviors to improve mood, physical functioning, and social engagement. Tele-PST participants were taught a 7-step approach for problem solving coping skills. The primary outcome was the 24-item HAMD scores. Response (ie, ≥50% reduction in HAMD) and remission (ie, HAMD <10) rates and effect sizes for clinically meaningful differences were examined. Secondary outcomes were disability, social engagement and activity frequency, and satisfaction with participation in social roles. A total of 277 participants were enrolled, including 193 (69.7%) women, 83 (30.0%) who were Black, 81 (29.2%) who were Hispanic, and 255 (92.1%) with income of $35 000 or less. The mean (SD) age was 67.5 (8.9) years. Among these, 90 participants were randomized to tele-BA, 93 participants were randomized to tele-PST, and 94 participants were randomized to the AC. Compared with participants in the AC group, participants in the tele-BA and tele-PST groups had significantly higher response and remission rates and medium to large effect sizes (tele-BA: raw growth modeling analysis d = 0.62 [95% CI, 0.35 to 0.89]; P < .001; tele-PST: raw growth modeling analysis d = 1.00 [95% CI, 0.73 to 1.26]; P < .001) for HAMD scores. While tele-PST was significantly more effective than tele-BA for reducing HAMD scores (t258 = -2.79; P = .006), there was no difference between tele-BA and tele-PST on secondary outcomes. In this randomized clinical trial, participants who received tele-BA by lay counselors achieved statistically and clinically meaningful changes in depressive symptoms. Given shortages of licensed mental health clinicians, tele- and lay counselor-delivered services may help improve access to evidence-based depression treatment for large numbers of underserved older adults. ClinicalTrials.gov Identifier: NCT02600754.

Patient experiences with group behavioural activation in a partial hospital program.

Behavioural activation (BA) is an evidence-based treatment for depression that has been primarily delivered in individual out-patient treatment. Prior research supports a positive participant experience in individual therapy; however, less is known about the patient experience in group therapy, which is common in acute psychiatric settings. The present study examined the patient experience of Brief Behavioral Activation Treatment for Depression (BATD) delivered in group acute psychiatric treatment. We used thematic analysis to extract themes from feedback surveys administered as part of quality improvement practice at a partial hospital program. Survey questions explored what patients learned, liked, disliked and thought could be improved in the BATD groups. Three individuals independently coded survey responses and collaboratively developed categories and themes. Themes included several helpful content areas (e.g. value-driven activities, increasing motivation, goal setting, activity scheduling, cognitive behavioural model, self-monitoring) and learning methods (e.g. group format, experiential exercises, worksheets). Patients also identified unhelpful content (e.g. specific focus on depression and listing activities by mood). There was mixed feedback regarding the repetition of material and balance of lecture versus group participation. Overall, these findings suggest a mostly positive patient experience of group-delivered BATD and support the acceptability of group-delivered BATD as a component of short-term intensive treatment.