VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA; VA VISN 2 Center of Excellence for Suicide Prevention, Finger Lakes VA Medical Center, Canandaigua, NY, USA.
J Affect Disord. 2021 Mar 15;283:11-19. doi: 10.1016/j.jad.2021.01.033. Epub 2021 Jan 14.
Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effective than primary care behavioral health treatment-as-usual (TAU) in reducing depressive symptoms and improving quality of life and functioning.
Parallel-arm, multi-site randomized controlled trial. 140 Veterans were randomized to BA-PC or TAU and completed assessments at baseline, 6 weeks, 12 weeks, and 24 weeks.
Reductions in depressive symptoms were observed in both groups between baseline and 3-weeks prior to any treatment, with continued reductions among those in the BA-PC condition through 12-weeks. However, there was no significant condition X time interaction at 12-weeks. Quality of life and mental health functioning were significantly improved for those in the BA-PC condition, compared to TAU, at 12 weeks.
Generalizability to a broader population may be limited as this sample consisted of veterans. Although engagement in TAU matched other prior work, it was lower than engagement in BA-PC, which also may compromise results.
Although this study found that both TAU and BA-PC participants showed a decline in depressive symptoms, improvements in functioning and quality of life within those assigned to BA-PC, strong treatment retention and feasibility of BA-PC, and significant reductions in depressive symptoms among those with more severe baseline depressive symptoms are encouraging and support continued research on BA-PC. This trial was registered in clinicaltrials.gov as Improving Mood in Veterans in Primary Care (NCT02276807).
行为激活对于在初级保健环境中工作的嵌入式行为健康提供者（BHPs）治疗报告各种抑郁症状的患者非常理想。目前的研究测试了专为初级保健设计的简短版行为激活（两次 30 分钟的预约，两次强化）（BA-PC）是否比初级保健行为健康治疗常规（TAU）更能有效降低抑郁症状，改善生活质量和功能。
平行臂，多地点随机对照试验。140 名退伍军人被随机分配到 BA-PC 或 TAU 组，并在基线、6 周、12 周和 24 周进行评估。
两组在基线和任何治疗前 3 周内均观察到抑郁症状减轻，而在 BA-PC 条件下的患者持续减轻至 12 周。然而，在 12 周时，条件与时间之间没有显著的相互作用。与 TAU 相比，BA-PC 组的生活质量和心理健康功能在 12 周时显著改善。
由于该样本由退伍军人组成，因此可能限制了对更广泛人群的推广。尽管 TAU 的参与度与其他先前的工作相匹配，但与 BA-PC 的参与度相比，其参与度较低，这也可能影响结果。
尽管本研究发现 TAU 和 BA-PC 参与者的抑郁症状均有所下降，但在分配到 BA-PC 的参与者中，功能和生活质量有所改善，BA-PC 的治疗保留率和可行性较强，以及基线抑郁症状较重的患者的抑郁症状显著减轻，这些都令人鼓舞，并支持对 BA-PC 的进一步研究。该试验在 clinicaltrials.gov 上注册为改善初级保健中退伍军人的情绪（NCT02276807）。
