Behavioral Activation in Nursing Homes to Treat Depression (BAN-Dep): Results From a Clustered, Randomized, 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 journalArticlepeer-review

5 Citations (Scopus)

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 languageEnglish
Pages (from-to)1313-1323
Number of pages11
JournalAmerican Journal of Geriatric Psychiatry
Volume30
Issue number12
DOIs
Publication statusPublished - Dec 2022

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