Nakamura Carina Akemi, Seward Nadine, Peters Tim J, Nadaleto Didone Thiago Vinicius, Moretti Felipe Azevedo, Oliveira da Costa Marcelo, Queiroz de Souza Caio Hudson, Macias de Oliveira Gabriel, Souza Dos Santos Monica, Aragoni Pereira Luara, Mendes de Sá Martins Mariana, van de Ven Pepijn, Hollingworth William, Araya Ricardo, Scazufca Marcia
Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Lancet Reg Health Am. 2024 Oct 7;39:100897. doi: 10.1016/j.lana.2024.100897. eCollection 2024 Nov.
Subthreshold depression is a risk factor for major depression and is associated with increased morbidity and mortality, especially in older adults. There is emerging evidence that digital interventions, including self-help interventions, may reduce depressive symptoms. We aimed to evaluate the effectiveness of a mobile messaging intervention at reducing subthreshold depressive symptoms among older adults in Brazil.
PRODIGITAL was a single blind, two-arm, individually randomised controlled trial conducted in 46 primary care clinics in the city of Guarulhos, Brazil. Individuals aged 60+ years were contacted by phone following a randomly ordered list for a screening assessment. Those who presented with anhedonia and/or depressed mood (Patient Health Questionnaire (PHQ)-2≥1), and who subsequently scored between 5 and 9 on the PHQ-9 were invited to participate. The intervention arm received the 'Viva Vida' digital self-help intervention consisting of automated multi-media messages sent via WhatsApp. Forty-eight audio and visual messages based on psychoeducation and behavioural activation were automatically delivered over six weeks. The control arm received a single message containing information about depression. The primary outcome was the difference in mean PHQ-9 scores between treatment arms at the three-month follow-up. All primary analyses were performed according to allocated arm with imputed data. The trial is registered with ReBEC, RBR-6c7ghfd.
Participants were recruited between 8 September 2021 and 19 August 2022. Of the 454 participants enrolled, 223 were randomised to the intervention arm, 231 to the control arm. Participants' mean age was 65.3 years (SD 5.0) and 64.0% (n = 292) were female. A total of 385 (84.8%) completed the three-month follow-up assessment; no difference in mean PHQ-9 scores between the treatment arms was observed (adjusted difference: -0.61; 95% CI: -1.75, 0.53; = 0.29).
These results demonstrate that the Viva Vida digital self-help intervention did not help to improve subthreshold depressive symptoms amongst older adults. Further research is needed to understand why this self-help intervention was not effective in this population, and to explore how it might be adapted to achieve this goal.
São Paulo Research Foundation and UK Joint Global Health Trials.
阈下抑郁是重度抑郁的一个危险因素，与发病率和死亡率增加相关，尤其是在老年人中。越来越多的证据表明，包括自助干预在内的数字干预可能会减轻抑郁症状。我们旨在评估移动信息干预对减轻巴西老年人阈下抑郁症状的有效性。
PRODIGITAL是一项单盲、双臂、个体随机对照试验，在巴西瓜鲁柳斯市的46家初级保健诊所进行。按照随机排序的名单通过电话联系60岁及以上的个体进行筛查评估。那些出现快感缺失和/或情绪低落（患者健康问卷（PHQ）-2≥1），且随后在PHQ-9上得分在5至9分之间的人被邀请参与。干预组接受“Viva Vida”数字自助干预，该干预由通过WhatsApp发送的自动化多媒体信息组成。基于心理教育和行为激活的48条音频和视频信息在六周内自动发送。对照组收到一条包含抑郁症相关信息的单一信息。主要结局是在三个月随访时治疗组之间PHQ-9平均得分的差异。所有主要分析均根据分配的组别并使用插补数据进行。该试验已在ReBEC注册，注册号为RBR-6c7ghfd。
参与者于2021年9月8日至2022年8月19日招募。在454名登记的参与者中，223人被随机分配到干预组，231人被随机分配到对照组。参与者的平均年龄为65.3岁（标准差5.0），64.0%（n = 292）为女性。共有385人（84.8%）完成了三个月的随访评估；未观察到治疗组之间PHQ-9平均得分的差异（调整后差异：-0.61；95%置信区间：-1.75，0.53；P = 0.29）。
这些结果表明，“Viva Vida”数字自助干预无助于改善老年人的阈下抑郁症状。需要进一步研究以了解这种自助干预在该人群中无效的原因，并探索如何对其进行调整以实现这一目标。
圣保罗研究基金会和英国联合全球健康试验。
