Can we mitigate the psychological impacts of social isolation using behavioural activation? Long-term results of the UK BASIL urgent public health COVID-19 pilot randomised controlled trial and living systematic review

Abstract

BackgroundBehavioural and cognitive interventions remain credible approaches in addressing loneliness and depression. There was a need to rapidly generate and assimilate trial-based data during COVID-19.ObjectivesWe undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trialISRCTN94091479). We also assimilate these data in a living systematic review (PROSPERO CRD42021298788) of cognitive and/or behavioural interventions.MethodsParticipants (≥65 years) with long-term conditions were computer randomised to behavioural activation (n=47) versus care as usual (n=49). Primary outcome was PHQ-9. Secondary outcomes included loneliness (De Jong Scale). Data from the BASIL-C19 trial were included in a metanalysis of depression and loneliness.FindingsThe 12 months adjusted mean difference for PHQ-9 was −0.70 (95% CI −2.61 to 1.20) and for loneliness was −0.39 (95% CI −1.43 to 0.65).The BASIL-C19 living systematic review (12 trials) found short-term reductions in depression (standardised mean difference (SMD)=−0.31, 95% CI −0.51 to −0.11) and loneliness (SMD=−0.48, 95% CI −0.70 to −0.27). There were few long-term trials, but there was evidence of some benefit (loneliness SMD=−0.20, 95% CI −0.40 to −0.01; depression SMD=−0.20, 95% CI −0.47 to 0.07).DiscussionWe delivered a pilot trial of a behavioural intervention targeting loneliness and depression; achieving long-term follow-up. Living meta-analysis provides strong evidence of short-term benefit for loneliness and depression for cognitive and/or behavioural approaches. A fully powered BASIL trial is underway.Clinical implicationsScalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.

Acceptability of a behavioural intervention to mitigate the psychological impacts of COVID-19 restrictions in older people with long-term conditions: a qualitative study

“…Support workers from a range of clinical and research backgrounds (psychological well-being practitioners, mental health nurses, research assistants, clinical support officers, research nurses and crisis support workers) were trained to deliver the intervention by telephone or video call across eight sessions. The intervention is described in more detail elsewhere 19…”

“…The BASIL pilot study findings have been reported elsewhere 15 19. This paper reports the findings from the qualitative study within BASIL, presenting analysis using the theoretical framework of acceptability (TFA) 20…”

“…18 Emerging evidence suggests that Behavioural Activation has an impact on depression and loneliness in the short term. 19 A bespoke intervention was used in the BASIL Study incorporating Behavioural Activation, a self-help booklet and trained BASIL Support Workers, with the aim of encouraging the older adult to recognise the link between mood and behaviour and reinstate or replace valued activities that generate positive reinforcement and so improve mood.…”

“…It is a simpler psychological treatment than cognitive behavioural therapy, but evidence suggests it can be an equally effective therapy for depression, even when delivered by junior mental health workers requiring less intensive and costly training 18. Emerging evidence suggests that Behavioural Activation has an impact on depression and loneliness in the short term 19. A bespoke intervention was used in the BASIL Study incorporating Behavioural Activation, a self-help booklet and trained BASIL Support Workers, with the aim of encouraging the older adult to recognise the link between mood and behaviour and reinstate or replace valued activities that generate positive reinforcement and so improve mood.…”

Multimorbidity in Older Adults with Depression Study (MODS) (Behavioural Activation to improve physical and mental functioning among older people with multiple long-term conditions): Protocol for a fully powered randomised controlled trial

“…A meta-analysis found that BA significantly reduced depressive symptoms in older adults in the community, but recommended further high-quality trials of BA for older adults with multiple LTCs are needed [11]. Whilst there is evidence demonstrating the clinical benefit of brief psychological interventions (including BA) for depression in the short term [16], the clinical and cost effectiveness of BA for older adults with multiple LTCs over the short and longer-term needs to be evaluated in a fully powered, randomised controlled trial (RCT), specifically evaluating both physical functioning and depression in older adults with LTCs.…”