Behavioural activation by mental health nurses for late-life depression in primary care: a randomized controlled trial

Janssen, Noortje P.; Huibers, Marcus J.H.; Voshaar, Richard C. Oude; Marwijk, Harm van; Bosmans, Judith E.; Pijnappels, Mirjam; Spijker, Jan; Hendriks, Gert-Jan

doi:10.1186/s12888-017-1388-x

Cited by 16 publications

(19 citation statements)

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“…Furthermore, these studies had some issues regarding their risk of bias, with a high risk of bias for the bibliotherapy studies [ 37 , 44 , 47 , 48 ] and a moderate risk of bias for two of the life-review studies [ 35 , 45 ], and these concerns need to be addressed in a future RCT conducted in primary care. Finally, the effect of behavioral activation therapy seems promising in a pilot cohort study conducted in primary care [ 26 ], and is currently being investigated in a well-designed RCT in primary care [ 59 ]. In addition to this latter RCT, also PST, bibliotherapy, and life-review should be studied in a RCT in primary care among depressed patients confirmed by a diagnostic interview and with at least a one-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis

et al. 2017

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BackgroundLate-life depression is most often treated in primary care, and it usually coincides with chronic somatic diseases. Given that antidepressants contribute to polypharmacy in these patients, and potentially to interactions with other drugs, non-pharmacological treatments are essential. In this systematic review and meta-analysis, we aimed to present an overview of the non-pharmacological treatments available in primary care for late-life depression.MethodThe databases of PubMed, PsychINFO, and the Cochrane Central Register of Controlled Trials were systematically searched in January 2017 with combinations of MeSH-terms and free text words for “general practice,” “older adults,” “depression,” and “non-pharmacological treatment”. All studies with empirical data concerning adults aged 60 years or older were included, and the results were stratified by primary care, and community setting. We narratively reviewed the results and performed a meta-analysis on cognitive behavioral therapy in the primary care setting.ResultsWe included 11 studies conducted in primary care, which covered the following five treatment modalities: cognitive behavioral therapy, exercise, problem-solving therapy, behavioral activation, and bright-light therapy. Overall, the meta-analysis showed a small effect for cognitive behavioral therapy, with one study also showing that bright-light therapy was effective. Another 18 studies, which evaluated potential non-pharmacological interventions in the community suitable for implementation, indicated that bibliotherapy, life-review, problem-solving therapy, and cognitive behavioral therapy were effective at short-term follow-up.DiscussionWe conclude that the effects of several treatments are promising, but need to be replicated before they can be implemented more widely in primary care. Although more treatment modalities were effective in a community setting, more research is needed to investigate whether these treatments are also applicable in primary care.Trial registrationPROSPERO CRD42016038442.

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Section: Discussionmentioning

confidence: 99%

Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis

et al. 2017

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“…For example, in an ongoing cluster RCT of BA by mental health nurses for treating late-life depression in primary care, BA is being compared with treatment as usual rather than an attention control condition and one of the research questions is to explore the mechanisms of change that account for the effectiveness of BA compared with treatment as usual. 125 We do not have detailed information on what usual care was at each of the sites. It was intended that treatment-as-usual data would be gathered from the resource use inventory but, as this questionnaire covered all services received, whether treatment was as usual, was sought by participants or paid for, etc., it does not provide the specific usual-care information that would be valuable to collect in a definitive trial.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT

Thomas

Drummond

Lincoln

et al. 2019

Health Technol Assess

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Background There is currently insufficient evidence for the clinical effectiveness and cost-effectiveness of psychological therapies for post-stroke depression. Objective To evaluate the feasibility of undertaking a definitive trial to evaluate the clinical effectiveness and cost-effectiveness of behavioural activation (BA) compared with usual stroke care for treating post-stroke depression. Design Parallel-group, feasibility, multicentre, randomised controlled trial with nested qualitative research and a health economic evaluation. Setting Acute and community stroke services in three sites in England. Participants Community-dwelling adults 3 months to 5 years post stroke who are depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) or the Visual Analogue Mood Scales ‘Sad’ item. Exclusions: patients who are blind and/or deaf, have dementia, are unable to communicate in English, do not have mental capacity to consent, are receiving treatment for depression at the time of stroke onset or are currently receiving psychological intervention. Randomisation and blinding Participants were randomised (1 : 1 ratio) to BA or usual stroke care. Randomisation was conducted using a computer-generated list with random permuted blocks of varying sizes, stratified by site. Participants and therapists were aware of the allocation, but outcome assessors were blind. Interventions The intervention arm received up to 15 sessions of BA over 4 months. BA aims to improve mood by increasing people’s level of enjoyable or valued activities. The control arm received usual care only. Main outcome measures Primary feasibility outcomes concerned feasibility of recruitment to the main trial, acceptability of research procedures and measures, appropriateness of baseline and outcome measures, retention of participants and potential value of conducting the definitive trial. Secondary feasibility outcomes concerned the delivery of the intervention. The primary clinical outcome 6 months post randomisation was the PHQ-9. Secondary clinical outcomes were Stroke Aphasic Depression Questionnaire – Hospital version, Nottingham Leisure Questionnaire, Nottingham Extended Activities of Daily Living, Carer Strain Index, EuroQol-5 Dimensions, five-level version and health-care resource use questionnaire. Results Forty-eight participants were recruited in 27 centre-months of recruitment, at a recruitment rate of 1.8 participants per centre per month. The 25 participants randomised to receive BA attended a mean of 8.5 therapy sessions [standard deviation (SD) 4.4 therapy sessions]; 23 participants were allocated to usual care. Outcome assessments were completed by 39 (81%) participants (BA, n = 18; usual care, n = 21). Mean PHQ-9 scores at 6-month follow-up were 10.1 points (SD 6.9 points) and 14.4 points (SD 5.1 points) in the BA and control groups, respectively, a difference of –3.8 (95% confidence interval –6.9 to –0.6) after adjusting for baseline PHQ-9 score and centre, representing a reduction in depression in the BA arm. Therapy was delivered as intended. BA was acceptable to participants, carers and therapists. Value-of-information analysis indicates that the benefits of conducting a definitive trial would be likely to outweigh the costs. It is estimated that a sample size of between 580 and 623 participants would be needed for a definitive trial. Limitations Target recruitment was not achieved, although we identified methods to improve recruitment. Conclusions The Behavioural Activation Therapy for Depression after Stroke trial was feasible with regard to the majority of outcomes. The outstanding issue is whether or not a sufficient number of participants could be recruited within a reasonable time frame for a definitive trial. Future work is required to identify whether or not there are sufficient sites that are able to deliver the services required for a definitive trial. Trial registration Current Controlled Trials ISRCTN12715175. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 47. See the NIHR Journals Library website for further project information.

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“…The mild form of depression corresponds to 5-9 points on the PHQ-9 scale. In mild cases only psychotherapy and / or behavioral activation techniques should be recommended [13].…”

Section: Principles Of Treatmentmentioning

confidence: 99%

“…At this stage, treatment should be stopped and antidepressant therapy should be stopped within a few weeks and the patient should be informed about the cessation of psychotherapeutic interventions. End therapy and maintain contact with the patient every 3-12 months in case of stabilization is advised [1], [2], [3], [13], [14].…”

Section: Recommendations For the Management Of Patients With Depression In General Clinical Practicementioning

confidence: 99%

Recommendations For The Management Of Patients With Depression In General Clinical Practice

Lebedyn¹

2020

EJMED

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Depression is one of the biggest health problems. If patient has symptoms of depression, then the patient should be treated. Patients with depression have a four times higher risk of suicide than the general population, which worsens their physical health and overall quality of life. This is associated with an increased risk of coronary heart disease, stroke, pain, alcohol abuse, smoking and illicit drug use. This determines the urgency of the problem of depression at the stage of primary care. A good family-patient relationship is essential in the treatment of depressed patients. In the practice of a general practitioner the prevalence of depression is 5%. Each year, two patients are hospitalized for depression, and one patient commits suicide every other day. The formation of the patient's attitude to the disorder depends on the correct assessment by doctor. There is a need for a clear ability to use various depression screening tools be general practitioners. This article discusses some available recommendations for depression management for primary health care physicians.

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Behavioural activation by mental health nurses for late-life depression in primary care: a randomized controlled trial

Cited by 16 publications

References 75 publications

Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis

Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis

Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT

Recommendations For The Management Of Patients With Depression In General Clinical Practice

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