Behavioural activation for low mood and anxiety in male frontline NHS workers (BALM): a pre-post intervention study

Galdas, Paul; Bailey, Della; Bell, Steve; Bosanquet, Katharine; Chew-Graham, Carolyn; Ekers, David; Gilbody, Simon; Littlewood, Elizabeth; Mawhinney, Michael; Stevens, Heidi; Webb, Katie; McMillan, Dean

Abstract

Objectives: To evaluate the impact and acceptability of a tailored, gender-responsive behavioural activation (BA) intervention for improving depression and anxiety in male National Health Service (NHS) frontline workers. Design: Pre-post intervention study. Setting: Three NHS organisations in the North of England. Participants: 45 men aged ≥18 years working in a frontline NHS role scoring in the subclinical range (5–14) on the Patient Health Questionnaire-9 (PHQ-9) (depression) and/or the Generalised Anxiety Disorder-7 (GAD-7) (anxiety) at baseline. Interventions: A tailored BA treatment programme consisting of up to eight telephone support sessions over a period of 4–6 weeks, accompanied by a BA self-help manual. Main outcome measures: Self-reported symptom severity of depression, assessed by PHQ-9, and anxiety, assessed by GAD-7, at baseline and 4 and 6 months. Acceptability from the perspectives of male study participants and coaches who delivered the intervention was assessed in a nested qualitative study using the theoretical framework of acceptability (TFA). Results: PHQ-9 and GAD-7 scores decreased from baseline to 4 months on both the PHQ-9 and GAD-7. While scores increased from 4 months to 6 months, the 6-month scores remained below those of the baseline scores. Acceptability of the intervention was high across all constructs of the TFA. The practical and action-oriented strategies of the intervention, and the confidential, flexible, convenient mode of delivery, worked to support men’s engagement with the intervention. Conclusions: Delivery of a tailored, gender-responsive BA intervention was appealing to, and beneficial for, men working in frontline NHS roles with less severe depression and anxiety. The BALM intervention offers promise as a tailored workplace mental health programme that is aligned with men’s needs and preferences and can help overcome a reticence to engage with mental health support in NHS staff and beyond. Trial registration number: ISRCTN48636092.

Citation

Galdas, P., Bailey, D., Bell, S., Bosanquet, K., Chew-Graham, C., Ekers, D., Gilbody, S., Littlewood, E., Mawhinney, M., Stevens, H., Webb, K., & McMillan, D. (2025). Behavioural activation for low mood and anxiety in male frontline NHS workers (BALM): a pre-post intervention study. BMJ Open, 15(6), https://doi.org/10.1136/bmjopen-2024-094214

• Journal Article Type: Article
• Acceptance Date: Jun 2, 2025
• Online Publication Date: Jun 12, 2025
• Publication Date: Jun 11, 2025
• Deposit Date: Jun 23, 2025
• Publicly Available Date: Jun 23, 2025
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 6
• DOI: https://doi.org/10.1136/bmjopen-2024-094214
• Keywords: Psychosocial Intervention, MENTAL HEALTH, Health Workforce
• Public URL: https://keele-repository.worktribe.com/output/1280893
• Publisher URL: https://bmjopen.bmj.com/content/15/6/e094214