Can We Prevent Depression in At-Risk Older Adults Using Self-Help? The UK SHARD Trial of Behavioral Activation.

Chew-Graham

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.

Citation

Chew-Graham. (2021). Can We Prevent Depression in At-Risk Older Adults Using Self-Help? The UK SHARD Trial of Behavioral Activation. American Journal of Geriatric Psychiatry, 197-207. https://doi.org/10.1016/j.jagp.2021.06.006

• Acceptance Date: Jun 14, 2021
• Publication Date: Jun 19, 2021
• Journal: American Journal of Geriatric Psychiatry
• Print ISSN: 1064-7481
• Publisher: Elsevier
• Pages: 197-207
• DOI: https://doi.org/10.1016/j.jagp.2021.06.006
• Keywords: Depression; older adults; prevention; behavioral activation; RCT
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1064748121003584?via%3Dihub