Behavioural activation in nursing homes to treat depression (BAN-Dep): Results from a clustered, randomised, single-blinded, controlled clinical trial

Osvaldo P Almeida; Hema Patel; Diana Velasquez; Rachael Kelly; Rhoda Lai; Andrew H Ford; Eleanor Curran; Leon Flicker; Terence W H Chong; Christopher Etherton-Beer; Dina LoGiudice; Kathryn A Ellis; Angelita Martini; Alissa Westphal; David Ekers; Simon Gilbody; Nicola T Lautenschlager

doi:10.1016/j.jagp.2022.05.009

Behavioural activation in nursing homes to treat depression (BAN-Dep): Results from a clustered, randomised, single-blinded, controlled clinical trial

Osvaldo P Almeida, Hema Patel, Diana Velasquez, Rachael Kelly, Rhoda Lai, Andrew H Ford, Eleanor Curran, Leon Flicker, Terence W H Chong, Christopher Etherton-Beer, Dina LoGiudice, Kathryn A Ellis, Angelita Martini, Alissa Westphal, David Ekers, Simon Gilbody, Nicola T Lautenschlager

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs).

METHODS: Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%).

CONCLUSIONS: Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.

Original language	English
Pages (from-to)	1313-1323
Number of pages	11
Journal	American journal of geriatric psychiatry
Volume	30
Issue number	12
Early online date	31 Oct 2022
DOIs	https://doi.org/10.1016/j.jagp.2022.05.009
Publication status	Published - 1 Dec 2022

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Almeida, O. P., Patel, H., Velasquez, D., Kelly, R., Lai, R., Ford, A. H., Curran, E., Flicker, L., Chong, T. W. H., Etherton-Beer, C., LoGiudice, D., Ellis, K. A., Martini, A., Westphal, A., Ekers, D., Gilbody, S., & Lautenschlager, N. T. (2022). Behavioural activation in nursing homes to treat depression (BAN-Dep): Results from a clustered, randomised, single-blinded, controlled clinical trial. American journal of geriatric psychiatry, 30(12), 1313-1323. https://doi.org/10.1016/j.jagp.2022.05.009

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title = "Behavioural activation in nursing homes to treat depression (BAN-Dep): Results from a clustered, randomised, single-blinded, controlled clinical trial",

abstract = "OBJECTIVES: To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs).METHODS: Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%).CONCLUSIONS: Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.",

author = "Almeida, {Osvaldo P} and Hema Patel and Diana Velasquez and Rachael Kelly and Rhoda Lai and Ford, {Andrew H} and Eleanor Curran and Leon Flicker and Chong, {Terence W H} and Christopher Etherton-Beer and Dina LoGiudice and Ellis, {Kathryn A} and Angelita Martini and Alissa Westphal and David Ekers and Simon Gilbody and Lautenschlager, {Nicola T}",

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doi = "10.1016/j.jagp.2022.05.009",

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Almeida, OP, Patel, H, Velasquez, D, Kelly, R, Lai, R, Ford, AH, Curran, E, Flicker, L, Chong, TWH, Etherton-Beer, C, LoGiudice, D, Ellis, KA, Martini, A, Westphal, A, Ekers, D, Gilbody, S & Lautenschlager, NT 2022, 'Behavioural activation in nursing homes to treat depression (BAN-Dep): Results from a clustered, randomised, single-blinded, controlled clinical trial', American journal of geriatric psychiatry, vol. 30, no. 12, pp. 1313-1323. https://doi.org/10.1016/j.jagp.2022.05.009

TY - JOUR

T1 - Behavioural activation in nursing homes to treat depression (BAN-Dep)

T2 - Results from a clustered, randomised, single-blinded, controlled clinical trial

AU - Almeida, Osvaldo P

AU - Patel, Hema

AU - Velasquez, Diana

AU - Kelly, Rachael

AU - Lai, Rhoda

AU - Ford, Andrew H

AU - Curran, Eleanor

AU - Flicker, Leon

AU - Chong, Terence W H

AU - Etherton-Beer, Christopher

AU - LoGiudice, Dina

AU - Ellis, Kathryn A

AU - Martini, Angelita

AU - Westphal, Alissa

AU - Ekers, David

AU - Gilbody, Simon

AU - Lautenschlager, Nicola T

PY - 2022/12/1

Y1 - 2022/12/1

N2 - OBJECTIVES: To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs).METHODS: Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%).CONCLUSIONS: Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.

AB - OBJECTIVES: To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs).METHODS: Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%).CONCLUSIONS: Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.

U2 - 10.1016/j.jagp.2022.05.009

DO - 10.1016/j.jagp.2022.05.009

M3 - Article

C2 - 35680539

SN - 1064-7481

VL - 30

SP - 1313

EP - 1323

JO - American journal of geriatric psychiatry

JF - American journal of geriatric psychiatry

IS - 12

ER -