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.

IF 6.6 2区医学 Q1 PSYCHIATRY

Evidence Based Mental Health Pub Date : 2022-12-01 Epub Date: 2022-10-12 DOI:10.1136/ebmental-2022-300530

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 Churchill, Elizabeth Eddy, Paul Heron, Nisha Hicklin, Roz Shafran, Osvaldo Almeida, Andrew Clegg, Tom Gentry, Andrew Hill, Karina Lovell, Sarah Dexter-Smith, David Ekers, Simon Gilbody

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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.

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我们能否通过行为激活来减轻社会孤立的心理影响？英国BASIL紧急公共卫生新冠肺炎试点随机对照试验和活体系统回顾的长期结果。

背景：行为和认知干预仍然是解决孤独和抑郁的可靠方法。在COVID-19期间，有必要快速生成和吸收基于试验的数据。目的：我们对抑郁症和孤独症的行为激活（一种短暂的行为干预）进行了平行试点RCT（社交孤立中的行为激活，BASIL-19试验ISRCTN94091479）。我们还在认知和/或行为干预的活体系统综述（PROSPERO CRD42021298788）中吸收了这些数据。方法：将患有长期疾病的参与者（≥65岁）随机分为行为激活组（n=47）和照例护理组（n=49）。主要转归为PHQ-9。次要结果包括孤独（德容量表）。BASIL-19试验的数据被纳入抑郁和孤独的荟萃分析中。研究结果：PHQ-9的12个月调整后平均差异为-0.70（95%CI-2.61-1.20），孤独的调整后平均差为-0.39（95%CI-1.43-0.65）。BASIL-C9生活系统综述（12项试验）发现，抑郁（标准化平均差异（SMD）=-0.31，95%CI-0.51--0.11）和孤独（SMD=-0.48，95%CI-0.70-0.27）的短期减少。很少有长期试验，但有证据表明有一些益处（孤独SMD=-0.20，95%CI-0.40至-0.01；抑郁SMD=-0.20%，95%CI-0.47至0.07）。讨论：我们进行了一项针对孤独和抑郁的行为干预的试点试验；实现长期随访。Living荟萃分析为认知和/或行为方法对孤独和抑郁的短期益处提供了强有力的证据。一项全功率BASIL试验正在进行中。临床意义：在生活系统综述的基础上，应将可扩展的行为和认知方法视为应对抑郁和孤独的人群水平策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Evidence Based Mental Health PSYCHIATRY-

CiteScore

18.10

自引率

7.70%

发文量

期刊介绍： Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. Published by the British Psychological Society, the Royal College of Psychiatrists and the BMJ Publishing Group the journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Clinicians assess the relevance of the best studies and the key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.Evidence-Based Mental Health is a multidisciplinary, quarterly publication.