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

Elizabeth Littlewood, Dean McMillan, Carolyn Chew Graham, Della Bailey, Samantha Gascoyne, Claire Sloane, Lauren Burke, Peter Coventry, Suzanne Crosland, Caroline Fairhurst, Andrew Henry, Catherine Hewitt, Kalpita Baird, Eloise Ryde, Leanne Shearsmith, Gemma Traviss-Turner, Rebecca Woodhouse, Judith Webster, Nick Meader, Rachel ChurchillElizabeth Eddy, Paul Heron, Nisha Hicklin, Roz Shafran, Osvaldo Almeida, Andrew Clegg, Tom Gentry, Andrew Hill, Karina Lovell, Sarah Dexter-Smith, David Ekers, Simon Gilbody

Research output: Contribution to journalArticlepeer-review

Abstract

Background Behavioural 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. Objectives We undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trial ISRCTN94091479). We also assimilate these data in a living systematic review (PROSPERO CRD42021298788) of cognitive and/or behavioural interventions. Methods Participants (>= 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. Findings The 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). Discussion We 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 implications Scalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.

Original languageEnglish
Pages (from-to)E49-E57
Number of pages9
JournalEvidence-Based Mental Health
Volume25
Issue numbere1
Early online date12 Oct 2022
DOIs
Publication statusPublished - 12 Oct 2022

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