Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Eur Psychiatry. 2023 Jul 27;66(1):e62. doi: 10.1192/j.eurpsy.2023.2433.
Recovery in mental health care comprises more than symptomatic improvement, but preliminary evidence suggests that only collaborative care may improve functioning of depressed older adults. This study therefore evaluates the effectiveness of behavioural activation (BA) on functional limitations in depressed older adults in primary care.
This study uses data from a multicentre cluster randomised controlled trial in which 59 primary care centres (PCCs) were randomised to BA and treatment as usual (TAU), and 161 consenting older (≥65 years) adults with clinically relevant symptoms of depression participated. Interventions were an eight-week individual BA programme by a mental health nurse (MHN) and unrestricted TAU. The outcome was self-reported functional limitations (WHODAS 2.0) at post-treatment (9 weeks) and at 12-month follow-up.
At the end of treatment, the BA participants reported significantly fewer functional limitations than TAU participants (WHODAS 2.0 difference -3.62, = 0.01, between-group effect size = 0.39; 95% CI = 0.09-0.69). This medium effect size decreases during follow-up resulting in a small and non-significant effect at the 12-month follow-up (WHODAS 2.0 difference = -2.22, = 0.14, between-group effect size = 0.24; 95% CI = -0.08-0.56). MoCA score moderated these results, indicating that the between-group differences were merely driven by those with no cognitive impairment.
Compared to TAU, BA leads to a faster improvement of functional limitations in depressed older adults with no signs of cognitive decline. Replication of these findings in confirmatory research is needed.
心理健康护理中的康复不仅仅是症状的改善，但是初步证据表明，只有协作式护理才能改善老年抑郁症患者的功能。因此，本研究评估了行为激活（BA）对初级保健中抑郁老年患者功能障碍的有效性。
本研究使用了一项多中心集群随机对照试验的数据，其中 59 个初级保健中心（PCC）被随机分配到行为激活（BA）和常规治疗（TAU）组，并且有 161 名同意参加的老年（≥65 岁）有明显抑郁症状的成年人参与。干预措施是由心理健康护士（MHN）进行为期八周的个体 BA 计划和无限制的 TAU。结局是治疗结束时（9 周）和 12 个月随访时的自我报告功能障碍（WHODAS 2.0）。
在治疗结束时，BA 组参与者报告的功能障碍明显少于 TAU 组（WHODAS 2.0 差值-3.62，p=0.01，组间效应大小=0.39；95%CI=0.09-0.69）。这种中等效应在随访期间减小，导致 12 个月随访时的效果较小且无统计学意义（WHODAS 2.0 差值=-2.22，p=0.14，组间效应大小=0.24；95%CI=-0.08-0.56）。MoCA 评分调节了这些结果，表明组间差异仅仅是由没有认知障碍的人驱动的。
与 TAU 相比，BA 可使无认知能力下降迹象的老年抑郁患者的功能障碍更快地改善。需要在确认性研究中复制这些发现。
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