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Littlewood E, Chew-Graham CA, Coleman E, Gascoyne S, Sloan C, Ali S, Badenhorst J, Bailey D, Crosland S, Kitchen CEW, McMillan D, Pearson C, Todd A, Whittlesea C, Bambra C, Hewitt C, Jones C, Keding A, Newbronner E, Paterson A, Rhodes S, Ryde E, Toner P, Watson M, Gilbody S, Ekers D. A psychological intervention by community pharmacies to prevent depression in adults with subthreshold depression and long-term conditions: the CHEMIST pilot RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/ekze0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Depression is common in people with long-term health conditions, and this combination can lead to worsened health outcomes and increased health-care costs. Subthreshold depression, a risk factor for major depression, is prevalent in this population, but many people remain untreated due to the demand on services. The community pharmacy may be an alternative setting to offer mental health support; however, insufficient evidence exists to support implementation.
Objectives
To conduct a feasibility study and pilot randomised controlled trial of a community pharmacy-delivered psychological intervention aimed at preventing depression in adults with long-term health conditions.
Design
A feasibility study with nested qualitative evaluation and an external pilot, two-arm, 1 : 1 individually randomised controlled trial with nested process and economic evaluations.
Setting
Community pharmacies in the north of England.
Participants
Adults aged ≥ 18 years with subthreshold depression and at least one long-term health condition.
Intervention
A bespoke enhanced support intervention (behavioural activation within a collaborative care framework) involving up to six sessions delivered by trained community pharmacy staff (intervention facilitators) compared with usual care.
Main outcome measures
Recruitment and retention rates, completeness of outcome measures and intervention engagement. The intended primary outcome was depression severity at 4 months, assessed by the Patient Health Questionnaire-9.
Results
In the feasibility study, 24 participants were recruited. Outcome measure completeness was 95–100%. Retention at 4 months was 83%. Seventeen participants (71%) commenced intervention sessions and all completed two or more sessions. Depression symptoms reduced slightly at 4 months. The process evaluation suggested that the intervention was acceptable to participants and intervention facilitators. In the pilot randomised controlled trial, 44 participants (target of 100 participants) were randomised (intervention, n = 24; usual care, n = 20). Outcome measure completeness was 100%. Retention at 4 months was 93%. Eighteen participants (75%) commenced intervention sessions and 16 completed two or more sessions. Depression symptoms reduced slightly at 4 months, with a slightly larger reduction in the usual-care arm, although the small sample size limits any conclusions. The process evaluation reported good acceptability of the intervention and identified barriers associated with study implementation and its impact on core pharmacy functions. The economic analysis revealed some indication of reduced resource use/costs associated with the intervention, but this is limited by the small sample size. Intervention costs were low.
Limitations
The main limitation is the small sample size due to difficulties with recruitment and barriers to implementing the study within existing pharmacy practices.
Conclusions
The community pharmacy represents a new setting to deliver a depression prevention intervention. Recruitment was a challenge and pharmacy staff encountered barriers to effective implementation of the study within busy pharmacy practice. Despite these challenges, good retention rates and intervention engagement were demonstrated, and process evaluation suggested that the intervention was acceptable in this setting. To the best of our knowledge, this is the first study to demonstrate that community pharmacy staff can be trained to deliver a depression prevention intervention.
Future work
Further work is needed to address barriers to recruitment, intervention delivery and implementation of psychological interventions in the community pharmacy setting.
Trial registration
This trial is registered as ISRCTN11290592.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | | | | | - Claire Sloan
- Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Jay Badenhorst
- Whitworth Chemists Ltd, Foxhills Industrial Estate, Scunthorpe, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | | | - Adam Todd
- Institute of Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
- School of Pharmacy, Newcastle upon Tyne, UK
| | - Cate Whittlesea
- University College London School of Pharmacy, University College London, London, UK
| | - Clare Bambra
- Institute of Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Claire Jones
- Public Health Team, Adult & Health Services, Durham County Council, Durham, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | | | - Alastair Paterson
- Pharmacy Department, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Shelley Rhodes
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Eloise Ryde
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Paul Toner
- Department of Health Sciences, University of York, York, UK
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - David Ekers
- Department of Health Sciences, University of York, York, UK
- Research and Development, Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
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Gilbody S, Brabyn S, Mitchell A, Ekers D, McMillan D, Bailey D, Hems D, Chew Graham CA, Keding A, Bosanquet K. Can We Prevent Depression in At-Risk Older Adults Using Self-Help? The UK SHARD Trial of Behavioral Activation. Am J Geriatr Psychiatry 2022; 30:197-207. [PMID: 34266750 DOI: 10.1016/j.jagp.2021.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment 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. AIM To test the effectiveness of an unguided self-help intervention based on BA for older adults. 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. 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. RESULTS At 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). 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.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Hull York Medical School (SG, DM), UK.
| | - Sally Brabyn
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | - Alex Mitchell
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; York Trials Unit (AM, AD), University of York, UK
| | - David Ekers
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Tees Esk and Wear Valleys NHS Foundation Trust (DE), North Yorkshire, UK
| | - Dean McMillan
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Hull York Medical School (SG, DM), UK
| | - Della Bailey
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | - Deborah Hems
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | | | - Ada Keding
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; York Trials Unit (AM, AD), University of York, UK
| | - Kate Bosanquet
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
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Embedding the silver thread in all-age psychological services: training and supervising younger therapists to deliver CBT for anxiety or depression to older people with multi-morbidity. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Providers of cognitive behavioural therapy (CBT) in adult mental health services in the UK are expected to deliver therapy suitable for adults of all ages. However, older people commonly present with co-morbidities that challenge delivery of single-diagnosis CBT protocols. Added to this, the difference in age between therapy-provider and service-user can compromise collaboration. In this paper, I consider two key areas of relevance for training and supervising CBT therapists for work with older people, namely multi-morbidities and intergenerational relations. The evolving evidence base for CBT with older people is summarised and a commentary provided on previous ‘old age’ case studies from the Cognitive Behaviour Therapist (tCBT). Strategies for collaborative relationships are discussed, as are strategies for ‘embedding the silver thread’. I conclude with recommendations for future directions for CBT training and supervision.
Key learning aims
(1)
To be aware that any differences in working with older people are not due to age per se, but factors such as cohort differences and multi-morbidity.
(2)
To reflect on case examples of CBT with older people.
(3)
To learn strategies for developing collaborative relationships across an intergenerational divide.
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Gilbody S, Littlewood E, McMillan D, Chew-Graham CA, Bailey D, Gascoyne S, Sloan C, Burke L, Coventry P, Crosland S, Fairhurst C, Henry A, Hewitt C, Joshi K, Ryde E, Shearsmith L, Traviss-Turner G, Woodhouse R, Clegg A, Gentry T, Hill AJ, Lovell K, Dexter Smith S, Webster J, Ekers D. Behavioural activation to prevent depression and loneliness among socially isolated older people with long-term conditions: The BASIL COVID-19 pilot randomised controlled trial. PLoS Med 2021; 18:e1003779. [PMID: 34637450 PMCID: PMC8509874 DOI: 10.1371/journal.pmed.1003779] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/20/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Older adults, including those with long-term conditions (LTCs), are vulnerable to social isolation. They are likely to have become more socially isolated during the Coronavirus Disease 2019 (COVID-19) pandemic, often due to advice to "shield" to protect them from infection. This places them at particular risk of depression and loneliness. There is a need for brief scalable psychosocial interventions to mitigate the psychological impacts of social isolation. Behavioural activation (BA) is a credible candidate intervention, but a trial is needed. METHODS AND FINDINGS We undertook an external pilot parallel randomised trial (ISRCTN94091479) designed to test recruitment, retention and engagement with, and the acceptability and preliminary effects of the intervention. Participants aged ≥65 years with 2 or more LTCs were recruited in primary care and randomised by computer and with concealed allocation between June and October 2020. BA was offered to intervention participants (n = 47), and control participants received usual primary care (n = 49). Assessment of outcome was made blind to treatment allocation. The primary outcome was depression severity (measured using the Patient Health Questionnaire 9 (PHQ-9)). We also measured health-related quality of life (measured by the Short Form (SF)-12v2 mental component scale (MCS) and physical component scale (PCS)), anxiety (measured by the Generalised Anxiety Disorder 7 (GAD-7)), perceived social and emotional loneliness (measured by the De Jong Gierveld Scale: 11-item loneliness scale). Outcome was measured at 1 and 3 months. The mean age of participants was aged 74 years (standard deviation (SD) 5.5) and they were mostly White (n = 92, 95.8%), and approximately two-thirds of the sample were female (n = 59, 61.5%). Remote recruitment was possible, and 45/47 (95.7%) randomised to the intervention completed 1 or more sessions (median 6 sessions) out of 8. A total of 90 (93.8%) completed the 1-month follow-up, and 86 (89.6%) completed the 3-month follow-up, with similar rates for control (1 month: 45/49 and 3 months 44/49) and intervention (1 month: 45/47and 3 months: 42/47) follow-up. Between-group comparisons were made using a confidence interval (CI) approach, and by adjusting for the covariate of interest at baseline. At 1 month (the primary clinical outcome point), the median number of completed sessions for people receiving the BA intervention was 3, and almost all participants were still receiving the BA intervention. The between-group comparison for the primary clinical outcome at 1 month was an adjusted between-group mean difference of -0.50 PHQ-9 points (95% CI -2.01 to 1.01), but only a small number of participants had completed the intervention at this point. At 3 months, the PHQ-9 adjusted mean difference (AMD) was 0.19 (95% CI -1.36 to 1.75). When we examined loneliness, the adjusted between-group difference in the De Jong Gierveld Loneliness Scale at 1 month was 0.28 (95% CI -0.51 to 1.06) and at 3 months -0.87 (95% CI -1.56 to -0.18), suggesting evidence of benefit of the intervention at this time point. For anxiety, the GAD adjusted between-group difference at 1 month was 0.20 (-1.33, 1.73) and at 3 months 0.31 (-1.08, 1.70). For the SF-12 (physical component score), the adjusted between-group difference at 1 month was 0.34 (-4.17, 4.85) and at 3 months 0.11 (-4.46, 4.67). For the SF-12 (mental component score), the adjusted between-group difference at 1 month was 1.91 (-2.64, 5.15) and at 3 months 1.26 (-2.64, 5.15). Participants who withdrew had minimal depressive symptoms at entry. There were no adverse events. The Behavioural Activation in Social Isolation (BASIL) study had 2 main limitations. First, we found that the intervention was still being delivered at the prespecified primary outcome point, and this fed into the design of the main trial where a primary outcome of 3 months is now collected. Second, this was a pilot trial and was not designed to test between-group differences with high levels of statistical power. Type 2 errors are likely to have occurred, and a larger trial is now underway to test for robust effects and replicate signals of effectiveness in important secondary outcomes such as loneliness. CONCLUSIONS In this study, we observed that BA is a credible intervention to mitigate the psychological impacts of COVID-19 isolation for older adults. We demonstrated that it is feasible to undertake a trial of BA. The intervention can be delivered remotely and at scale, but should be reserved for older adults with evidence of depressive symptoms. The significant reduction in loneliness is unlikely to be a chance finding, and replication will be explored in a fully powered randomised controlled trial (RCT). TRIAL REGISTRATION ISRCTN94091479.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Dean McMillan
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Della Bailey
- Department of Health Sciences, University of York, York, United Kingdom
| | - Samantha Gascoyne
- Department of Health Sciences, University of York, York, United Kingdom
| | - Claire Sloan
- Department of Health Sciences, University of York, York, United Kingdom
| | - Lauren Burke
- Department of Health Sciences, University of York, York, United Kingdom
| | - Peter Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Suzanne Crosland
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Andrew Henry
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kalpita Joshi
- Department of Health Sciences, University of York, York, United Kingdom
| | - Eloise Ryde
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | - Leanne Shearsmith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Rebecca Woodhouse
- Department of Health Sciences, University of York, York, United Kingdom
| | - Andrew Clegg
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Andrew J. Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | - Sarah Dexter Smith
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | | | - David Ekers
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
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Bonvoisin T, Paton LW, Hewitt C, McMillan D, Gilbody S, Tiffin PA. Collaborative care for depression in older adults: How much is enough? Behav Res Ther 2020; 135:103725. [PMID: 33002685 DOI: 10.1016/j.brat.2020.103725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/06/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
Collaborative care in primary care has been shown to be effective for subthreshold depression in older adults in the 'CASPER' trial. However, to understand the impact of adherence, and to explore the minimum effective dose of collaborative care, we reanalysed the trial data using a complier average causal effect (CACE) analysis. Data were available for 705 participants, 519 with 12-month PHQ-9 scores. 'Compliance' could be observed for participants in the intervention group. Latent complier status in the control group was estimated. Completion of five or more sessions of care was defined as 'compliance'. Sensitivity analyses, using alternative cut-offs of two to eight sessions, assessed the impact of changing the definition of 'compliance'. Compliers in the intervention group had lower PHQ-9 scores at 12-month follow up than assumed compliers in the control group (1.75 lower, 95% confidence interval 0.29 to 3.21, p = 0.02), a greater effect than originally reported. Sensitivity analyses confirmed statistically significant differences between the intervention and control groups in those attending five or more sessions. We conclude that collaborative care is causally effective in reducing subthreshold depressive symptoms in older people who adhere to treatment. Our findings suggest the minimum effective dose is five sessions.
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Affiliation(s)
- Toby Bonvoisin
- Department of Health Sciences, University of York, Heslington, YO10 5DD, UK; Hull University Teaching Hospitals NHS Trust, Hull, HU3 2JZ, UK.
| | - Lewis W Paton
- Department of Health Sciences, University of York, Heslington, YO10 5DD, UK.
| | - Catherine Hewitt
- Department of Health Sciences, University of York, Heslington, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences, University of York, Heslington, YO10 5DD, UK; Hull York Medical School, University of York, Heslington, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, YO10 5DD, UK; Hull York Medical School, University of York, Heslington, YO10 5DD, UK.
| | - Paul A Tiffin
- Department of Health Sciences, University of York, Heslington, YO10 5DD, UK; Hull York Medical School, University of York, Heslington, YO10 5DD, UK.
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Wang X, Zhou X, Yang H. Guided Self-Help Behavioral Activation Intervention for Geriatric Depression: Protocol for Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18259. [PMID: 32518060 PMCID: PMC7545326 DOI: 10.2196/18259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/18/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Aging 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. Objective The aim of this study is to pilot a self-help guided intervention for the treatment of depression in older adults. Methods This 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. Results The 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. Conclusions 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. The intervention is modular and adapted from an empirically supported behavioral activation treatment for depression. The generalizability and broad inclusion criteria are strengths. Trial Registration Chinese Clinical Trial Register ChiCTR1900026066; http://www.chictr.org.cn/showprojen.aspx?proj=43548 International Registered Report Identifier (IRRID) PRR1-10.2196/18259
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Affiliation(s)
- Xiaoxia Wang
- Department of Basic Psychology, College of Psychology, Army Medical University, Chongqing, China
| | - Xiaoyan Zhou
- Department of Clinical Psychology, Mental Health Center of Chongqing, Chongqing, China
| | - Hui Yang
- Department of Clinical Psychology, Mental Health Center of Chongqing, Chongqing, China
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Bilbrey AC, Laidlaw K, Cassidy-Eagle E, Thompson LW, Gallagher-Thompson D. Cognitive Behavioral Therapy for Late-Life Depression: Evidence, Issues, and Recommendations. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Velasquez Reyes D, Patel H, Lautenschlager N, Ford AH, Curran E, Kelly R, Lai R, Chong T, Flicker L, Ekers D, Gilbody S, Etherton-Beer C, Lo Giudice D, Ellis KA, Martini A, Almeida OP. Behavioural activation in nursing homes to treat depression (BAN-Dep): study protocol for a pragmatic randomised controlled trial. BMJ Open 2019; 9:e032421. [PMID: 31676658 PMCID: PMC6830697 DOI: 10.1136/bmjopen-2019-032421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/06/2019] [Accepted: 10/11/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Depression is a common disorder among older people living in residential aged care facilities. Several trials have demonstrated the effectiveness of behavioural therapies in treating depressive symptoms in older adults living in the community and in residential aged care. Behavioural Activation is demonstrably effective even when delivered by non-specialists (staff without formal psychological training), although strategies for adapting its use in residential aged care facilities are yet to be explored. This study will determine whether training residential care staff in the use of a structured Behavioural Activation programme is more effective at decreasing depressive symptoms among older residents than internet-based training about depression recognition and management alone. METHOD AND ANALYSIS The behavioural activation in nursing homes to treat depression (BAN-Dep) trial is a pragmatic two-arm parallel clustered randomised controlled trial. It will recruit 666 residents aged 60 or older from 100 residential aged care facilities, which will be randomly assigned to the Behavioural Activation or control intervention. Staff in both treatment groups will be encouraged to complete the Beyondblue Professional Education to Aged Care e-learning programme to improve their recognition of and ability to respond to depression in older adults. Selected staff from intervention facilities will undergo additional training to deliver an 8-module Behavioural Activation programme to residents with subthreshold symptoms of depression-they will receive ongoing Mental support from trained Behavioural Activation therapists. Outcome measures will be collected by blind research officer at baseline and after 3, 6 and 12 months. The Patient Health Questionnaire-9 is the primary outcome measure of the study. ETHICS AND DISSEMINATION The trial will comply with the principles of the Declaration of Helsinki for Human Rights and is overseen by the University of Western Australia (reference RA/4/20/4234) and Melbourne Health (reference number HREC/18/MH/47) Ethics Committees. The results of this research project will be disseminated through publications and/or presentations in a variety of media to health professionals, academics, clinicians and the public. Only de-identified group data will be presented. TRIAL REGISTRATION ACTRN12618000634279.
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Affiliation(s)
| | - Hema Patel
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | - Andrew H Ford
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Eleanor Curran
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachael Kelly
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Rhoda Lai
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Terence Chong
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leon Flicker
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | | | - Christopher Etherton-Beer
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | - Kathryn A Ellis
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angelita Martini
- Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Osvaldo P Almeida
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
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Simmonds-Buckley M, Kellett S, Waller G. Acceptability and Efficacy of Group Behavioral Activation for Depression Among Adults: A Meta-Analysis. Behav Ther 2019; 50:864-885. [PMID: 31422844 DOI: 10.1016/j.beth.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/29/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
The evidence base for behavioral activation (BA) as a front-line treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at posttreatment/follow-up, recovery and dropout rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes postgroup BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k=13, N=461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k=15, N=526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The dropout rate for group BA (14%) was no different from other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.
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Affiliation(s)
| | - Stephen Kellett
- University of Sheffield, and Sheffield Health and Social Care NHS Foundation Trust
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10
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Burroughs H, Bartlam B, Bullock P, Lovell K, Ogollah R, Ray M, Bower P, Waheed W, Gilbody S, Kingstone T, Nicholls E, Chew-Graham CA. Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAnxiety and depression often coexist in older people. These disorders are often underdiagnosed and undertreated, and are associated with increased use of health and social care services, and raised mortality. Barriers to diagnosis include the reluctance of older people to present to their general practitioner (GP) with mood symptoms because of the stigma they perceive about mental health problems, and because the treatments offered are not acceptable to them.ObjectivesTo refine a community-based psychosocial intervention for older people with anxiety and/or depression so that it can be delivered by non-traditional providers such, as support workers (SWs), in the third sector. To determine whether or not SWs can be trained to deliver this intervention to older people with anxiety and/or depression. To test procedures and determine if it is feasible to recruit and randomise patients, and to conduct a process evaluation to provide essential information to inform a randomised trial.DesignThree phases, all informed by a patient and public involvement and engagement group. Qualitative work with older people and third-sector providers, plus a consensus group to refine the intervention, training, SW manuals and patient participant materials (phase 1). Recruitment and training of SWs (phase 2). Feasibility study to test recruitment procedures and assess fidelity of delivery of the intervention; and interviews with study participants, SWs and GPs to assess acceptability of the intervention and impact on routine care (phase 3).SettingNorth Staffordshire, in collaboration with Age UK North Staffordshire.InterventionA psychosocial intervention, comprising one-to-one contact between older people with anxiety and/or depression and a SW employed by Age UK North Staffordshire, based on the principles of behavioural activation (BA), with encouragement to participate in a group activity.ResultsInitial qualitative work contributed to refinement of the psychosocial intervention. Recruitment (and retention) of the SWs was possible; the training, support materials and manual were acceptable to them, and they delivered the intervention as intended. Recruitment of practices from which to recruit patients was possible, but the recruitment target (100 patients) was not achieved, with 38 older adults randomised. Retention at 4 months was 86%. The study was not powered to demonstrate differences in outcomes. Older people in the intervention arm found the sessions with SWs acceptable, although signposting to, and attending, groups was not valued by all participants. GPs recognised the need for additional care for older people with anxiety and depression, which they could not provide. Participation in the study did not have an impact on routine care, other than responding to the calls from the study team about risk of self-harm. GPs were not aware of the work done by SWs with patients.LimitationsTarget recruitment was not achieved.ConclusionsSupport workers recruited from Age UK employees can be recruited and trained to deliver an intervention, based on the principles of BA, to older people with anxiety and/or depression. The training and supervision model used in the study was acceptable to SWs, and the intervention was acceptable to older people.Future workFurther development of recruitment strategies is needed before this intervention can be tested in a fully powered randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN16318986.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 7, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Heather Burroughs
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Mo Ray
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, York, UK
| | - Tom Kingstone
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Elaine Nicholls
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
- Collaboration for Leadership in Applied Health Research and Care West Midlands, Warwick, UK
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11
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Abstract
OBJECTIVES Depression rates are substantially higher among older adults in long-term care when compared with older adults in the community. Furthermore, the needs of older adults in long-term care are increasingly complex, and risk factors that contribute to depression in this population are unclear. This limits not only the identification of those at risk for depression but also the development of therapeutic interventions. This review summarizes the evidence on risk factors for depression. METHODS Searches were performed using CINAHL, Cochrane Library, Ovid Medline, PsycINFO and Scopus for research published 1980-2017. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Eleven studies met the inclusion criteria, representing a total of 11,703 participants, with a mean sample size of 1,064. The most consistently supported risk factor was cognitive impairment, followed by functional impairment and baseline depression score. CONCLUSIONS The studies lacked a systematic approach to investigating risk factors for depression, and the research remains largely atheoretical. Few risk factors were consistently studied, with over 20 risk factors examined no more than once each. Psychological and environmental risk factors, which may be modifiable and have the potential to inform therapeutic interventions and preventative strategies, remain under-studied. CLINICAL IMPLICATIONS The most consistently supported risk factors-cognitive impairment, functional disability and baseline depression score-have the potential to inform screening protocols and should be monitored longitudinally. When developing psychotherapeutic interventions, close consideration should be given to cognitive and functional impairment as barriers to implementation and uptake.
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Affiliation(s)
- Rebecca Chau
- a School of Psychological Sciences , Monash University , Clayton , Victoria , Australia.,b Department of Psychiatry , Monash University , Clayton , Victoria , Australia
| | - David W Kissane
- b Department of Psychiatry , Monash University , Clayton , Victoria , Australia
| | - Tanya E Davison
- c Institute for Health & Ageing , Australian Catholic University , Melbourne , Victoria , Australia
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Bosanquet K, Adamson J, Atherton K, Bailey D, Baxter C, Beresford-Dent J, Birtwistle J, Chew-Graham C, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hamilton J, Hargate R, Hewitt C, Holmes J, Keding A, Lewis H, McMillan D, Meer S, Mitchell N, Nutbrown S, Overend K, Parrott S, Pervin J, Richards DA, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Gilbody S. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-252. [PMID: 29171379 DOI: 10.3310/hta21670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of collaborative care for older adults with major depressive disorder in primary care. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with embedded qualitative study. Participants were automatically randomised by computer, by the York Trials Unit Randomisation Service, on a 1 : 1 basis using simple unstratified randomisation after informed consent and baseline measures were collected. Blinding was not possible. SETTING Sixty-nine general practices in the north of England. PARTICIPANTS A total of 485 participants aged ≥ 65 years with major depressive disorder. INTERVENTIONS A low-intensity intervention of collaborative care, including behavioural activation, delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual general practitioner (GP) care. The control arm received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was Patient Health Questionnaire-9 items score at 4 months post randomisation. Secondary outcome measures included depression severity and caseness at 12 and 18 months, the EuroQol-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder-7 items, Connor-Davidson Resilience Scale-2 items, a medication questionnaire, objective data and adverse events. Participants were followed up at 12 and 18 months. RESULTS In total, 485 participants were randomised (collaborative care, n = 249; usual care, n = 236), with 390 participants (80%: collaborative care, 75%; usual care, 86%) followed up at 4 months, 358 participants (74%: collaborative care, 70%; usual care, 78%) followed up at 12 months and 344 participants (71%: collaborative care, 67%; usual care, 75%) followed up at 18 months. A total of 415 participants were included in primary analysis (collaborative care, n = 198; usual care, n = 217), which revealed a statistically significant effect in favour of collaborative care at the primary end point at 4 months [8.98 vs. 10.90 score points, mean difference 1.92 score points, 95% confidence interval (CI) 0.85 to 2.99 score points; p < 0.001], equivalent to a standard effect size of 0.34. However, treatment differences were not maintained in the longer term (at 12 months: 0.19 score points, 95% CI -0.92 to 1.29 score points; p = 0.741; at 18 months: < 0.01 score points, 95% CI -1.12 to 1.12 score points; p = 0.997). The study recorded details of all serious adverse events (SAEs), which consisted of 'unscheduled hospitalisation', 'other medically important condition' and 'death'. No SAEs were related to the intervention. Collaborative care showed a small but non-significant increase in quality-adjusted life-years (QALYs) over the 18-month period, with a higher cost. Overall, the mean cost per incremental QALY for collaborative care compared with usual care was £26,016; however, for participants attending six or more sessions, collaborative care appears to represent better value for money (£9876/QALY). LIMITATIONS Study limitations are identified at different stages: design (blinding unfeasible, potential contamination), process (relatively low overall consent rate, differential attrition/retention rates) and analysis (no baseline health-care resource cost or secondary/social care data). CONCLUSION Collaborative care was effective for older people with case-level depression across a range of outcomes in the short term though the reduction in depression severity was not maintained over the longer term of 12 or 18 months. Participants who received six or more sessions of collaborative care did benefit substantially more than those who received fewer treatment sessions but this difference was not statistically significant. FUTURE WORK RECOMMENDATIONS Recommendations for future research include investigating the longer-term effect of the intervention. Depression is a recurrent disorder and it would be useful to assess its impact on relapse and the prevention of future case-level depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN45842879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Department of Health Sciences, University of York, York, UK.,Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, Durham University, Durham, UK.,Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Jahnese Hamilton
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - David A Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
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13
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Lewis H, Adamson J, Atherton K, Bailey D, Birtwistle J, Bosanquet K, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hargate R, Hewitt C, Holmes J, Keding A, Lilley-Kelly A, Maya J, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Overend K, Pasterfield M, Richards D, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Ziegler F, Gilbody S. CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-196. [PMID: 28248154 DOI: 10.3310/hta21080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Efforts to reduce the burden of illness and personal suffering associated with depression in older adults have focused on those with more severe depressive syndromes. Less attention has been paid to those with mild disorders/subthreshold depression, but these patients also suffer significant impairments in their quality of life and level of functioning. There is currently no clear evidence-based guidance regarding treatment for this patient group. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of a low-intensity intervention of collaborative care for primary care older adults who screened positive for subthreshold depression. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with a qualitative study embedded within the pilot. Randomisation occurred after informed consent and baseline measures were collected. SETTING Thirty-two general practitioner (GP) practices in the north of England. PARTICIPANTS A total of 705 participants aged ≥ 75 years during the pilot phase and ≥ 65 years during the main trial with subthreshold depression. INTERVENTIONS Participants in the intervention group received a low-intensity intervention of collaborative care, which included behavioural activation delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual GP care. Control-arm participants received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was a self-reported measure of depression severity, the Patient Health Questionnaire-9 items PHQ-9 score at 4 months post randomisation. Secondary outcome measures included the European Quality of Life-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder seven-item scale, Connor-Davidson Resilience Scale two-item version, a medication questionnaire and objective data. Participants were followed up for 12 months. RESULTS In total, 705 participants were randomised (collaborative care n = 344, usual care n = 361), with 586 participants (83%; collaborative care 76%, usual care 90%) followed up at 4 months and 519 participants (74%; collaborative care 68%, usual care 79%) followed up at 12 months. Attrition was markedly greater in the collaborative care arm. Model estimates at the primary end point of 4 months revealed a statistically significant effect in favour of collaborative care compared with usual care [mean difference 1.31 score points, 95% confidence interval (CI) 0.67 to 1.95 score points; p < 0.001]. The difference equates to a standard effect size of 0.30, for which the trial was powered. Treatment differences measured by the PHQ-9 were maintained at 12 months' follow-up (mean difference 1.33 score points, 95% CI 0.55 to 2.10 score points; p = 0.001). Base-case cost-effectiveness analysis found that the incremental cost-effectiveness ratio was £9633 per quality-adjusted life-year (QALY). On average, participants allocated to collaborative care displayed significantly higher QALYs than those allocated to the control group (annual difference in adjusted QALYs of 0.044, 95% bias-corrected CI 0.015 to 0.072; p = 0.003). CONCLUSIONS Collaborative care has been shown to be clinically effective and cost-effective for older adults with subthreshold depression and to reduce the proportion of people who go on to develop case-level depression at 12 months. This intervention could feasibly be delivered in the NHS at an acceptable cost-benefit ratio. Important future work would include investigating the longer-term effect of collaborative care on the CASPER population, which could be conducted by introducing an extension to follow-up, and investigating the impact of collaborative care on managing multimorbidities in people with subthreshold depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN02202951. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, University of Durham, Durham, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Tees, Esk and Wear Valleys NHS Foundation Trust, NIHR Clinical Research Network North East and North Cumbria, Research and Development Department, Middlesbrough, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | | | - Jahnese Maya
- Northumberland, Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jodi Meredith
- Department of Health Sciences, University of York, York, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | | | - David Richards
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
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