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. Issue Volume 25:Issue e1(2022) (12th October 2022)

• Record Type: Journal Article
• Authors: Littlewood, Elizabeth; McMillan, Dean; Chew Graham, Carolyn; Bailey, Della; Gascoyne, Samantha; Sloane, Claire; Burke, Lauren; Coventry, Peter; Crosland, Suzanne; Fairhurst, Caroline; Henry, Andrew; Hewitt, Catherine; Baird, Kalpita; Ryde, Eloise; Shearsmith, Leanne; Traviss-Turner, Gemma; Woodhouse, Rebecca; Webster, Judith; Meader, Nick; Churchill, Rachel; Eddy, Elizabeth; Heron, Paul; Hicklin, Nisha; Shafran, Roz; Almeida, Osvaldo; Clegg, Andrew; Gentry, Tom; Hill, Andrew; Lovell, Karina; Dexter-Smith, Sarah; Ekers, David; Gilbody, Simon;
• Is Part Of: Evidence-based mental health. Volume 25:Issue e1(2022)
• Page Start: e49
• Page End: e57
• Publication Date: 2022-10-12
• Subjects: Adult psychiatry -- Depression & mood disorders; Psychotherapy -- Periodicals; Psychiatry -- Periodicals; Mental health -- Periodicals; 616.891
• DOI: 10.1136/ebmental-2022-300530
• Languages: English
• ISSNs: 1362-0347

Abstract

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.