Preventing depression among older people living in rural areas: A randomised controlled trial of behavioural activation in collaborative care

Abstract

Objectives This study aimed to test if a behavioural activation (BA) programme was more effective than usual care at reducing the risk of conversion to major depression over 52 weeks among adults aged 65 years or older living in rural Western Australia. Secondary aims were to test if participants assigned to the BA intervention experienced greater decline in the severity of depressive and anxiety symptoms than older adults treated with usual care over 26 and 52 weeks, as well as greater improvement in physical and mental health‐related quality of life. Methods Randomised controlled clinical trial that started recruitment in February 2016 in rural Western Australia. We used the electoral roll to invite adults aged 65 years or over living in suitable regions of Western Australia to take part in the study. We recruited those who consented and screened positive to at least one of the two Whooley questions: feeling down/depressed/hopeless or little interest or pleasure over the past month. Participants were randomly assigned to usual care or usual care plus a phone‐delivered BA program (1:1). The intervention consisted of a self‐managed BA program supported by three 45‐min phone sessions delivered by a BA therapist over a period of 8 weeks. We used the DSM‐5 criteria to establish the presence of a major depressive episode, and Patient Health Questionnaire, Generalised Anxiety Disorder Scale and SF‐36 to assess symptoms of depression, anxiety and quality of life. Results Of the 309 older adults randomised, 307 started the trial: 153 usual care and 154 BA (computer‐generated random permuted even blocks ranging in size from 8 to 20). Six participants developed a major depressive episode during follow‐up, four of them in the usual care group (odds ratio of depression associated with the intervention = 0.49, 95% CI = 0.04, 3.49—blind assessment). Seventy‐three (23.8%) participants were lost over 52 weeks—there were no differences between usual care and intervention group. Intention‐to‐treat analyses using mixed regression models found modest non‐significant effects of the BA intervention, while complete‐case analyses showed that participants treated with BA compared with usual care experienced significant improvements in depression and anxiety symptoms over 52 weeks, as well as improved mental health quality of life. Conclusions Few participants developed a major depressive episode during follow‐up. The BA intervention was associated with improved symptoms of depression and anxiety, although the clinical significance of these benefits remains unclear.

Virtual Care Initiatives for Older Adults in Australia: Scoping Review

“…Other uses included treatment plan management (n=9) [ 18 , 21 - 26 , 30 - 32 , 38 , 41 , 42 , 111 ], rehabilitation services (n=3) [ 20 , 37 , 43 , 44 ], and social support (from health care personnel; n=2) [ 15 , 17 ]. Telephone initiatives were used predominantly for education, follow-up evaluation, and care support (n=20) [ 47 , 50 , 54 , 58 - 62 , 97 - 103 , 105 , 107 , 109 - 113 ]. Telemonitoring interventions (with or without an additional attached device to measure physiological data) were used to record and monitor progress (n=18) [ 80 , 83 - 89 , 93 - 101 , 103 ], as alert or reminder systems (n=10) [ 80 , 83 - 88 , 93 , 94 , 96 ], and for strength training [ 89 - 92 ].…”

“…All but one of these virtual care delivery models yielded either comparable or similar or better health or behavioral outcomes compared with in-person care or other comparators (videoconference: 4/4; telephone: 10/11; telemonitoring: 4/4; web-based: 7/7; app: 2/2). Examples of outcomes measured include emergency visits [ 51 , 84 , 85 ], hospitalization [ 51 , 61 , 84 , 85 , 93 ], quality of life [ 25 , 43 , 49 , 53 , 61 , 75 , 84 , 85 ], mortality [ 21 , 22 ], physical activity or strength [ 43 , 49 , 60 , 64 , 89 ], health literacy [ 46 , 56 , 58 , 73 , 75 , 78 , 79 , 84 , 85 , 93 ], and measures of anxiety or depression [ 47 , 53 , 61 , 66 - 70 ]. Telephone-based coaching was not effective in preventing falls but improved physical activity compared with those receiving unrelated health information [ 60 ], while a telephone-based telerehabilitation study noted worse physical activity versus waitlist control [ 48 ].…”

Telemental health in rural areas: a systematic review

“…A total of 606 reports were screened by title and abstract, and 32 articles were identified. After the full-text screening, six eligible RCTs were identified [18][19][20][21][22][23] . When the reference lists of these studies for this review were audited, no extra RCTs that met the inclusion criteria were identified.…”

“…Table 1 displays the characteristics of the eligible studies. The participants were young individuals (four studies) [18][19][20][21] and older individuals (two studies) 22,23) . Mental disorders included depression 18,20,22) , mental health symptoms 19) , insomnia 23) , and schizophrenia 21) .…”

“…The participants were young individuals (four studies) [18][19][20][21] and older individuals (two studies) 22,23) . Mental disorders included depression 18,20,22) , mental health symptoms 19) , insomnia 23) , and schizophrenia 21) . The telemental health completion rates were 73-100% [18][19][20][21] .…”