Seward Nadine, Peters Tim J, Loh Wen Wei, Nakamura Carina Akemi, McMillan Dean, Gilbody Simon, Araya Ricardo, Scazufca Marcia
Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 18 De Crespigny Park, London SE5 8AF, UK; School of Health and Social Science, University of Edinburgh, Old Medical School, Elsie Inglis Quadrangle, Teviot Pl, Edinburgh EH8 9AG, UK.
Bristol Dental School, University of Bristol, 1 Trinity Quay, Avon Street, Bristol BS2 0PT, UK.
J Affect Disord. 2025 Mar 1;372:191-199. doi: 10.1016/j.jad.2024.12.024. Epub 2024 Dec 3.
The PROACTIVE trial was a task-shared, stepped and collaborative care, psychosocial intervention based on psychoeducation and behavioural activation in 715 participants (60-94 years; mean (SD) 68·6 (6.9) years; 74·1 % female), that was highly effective at improving recovery from depression among older adults in Brazil. Here we investigate mediators of the intervention's effectiveness.
Causal mediation analysis using interventional indirect effects, simultaneously decomposed the total effect of PROACTIVE on recovery from depression (PHQ-9 < 10) into multiple indirect effects including: dose of intervention (numbers of sessions and activities completed); social support (Luben Social Network Scale); perceived loneliness (UCLA questionnaire); and additional sessions offered to participants who did not respond during the initial phase of the stepped care intervention.
Of the intervention's total effect (difference in probability of recovery from depression between the intervention and control arms 0·216 [bias-corrected 95 % CI: 0·149, 0·291]): 13 % was mediated through reduced loneliness (0·028 [0·013, 0·046]); and 25 % through attending additional sessions for participants who did not initially respond to the intervention (0·055 [0·007, 0·102]).
Due to limitations in our sample size our study may lack power to detect some nuances such as interactions between different mediators.
Our findings emphasise the importance of a home-based intervention to improve depression outcomes where participants are encouraged to self-select activities to mitigate against loneliness. Importantly, our findings suggest that the intervention's stepped-care component offering additional sessions to participants who did not experience an early response shows promise in ensuring a sustained recovery from depression.
“积极主动”试验是一项任务分担、分阶段协作护理的心理社会干预措施，基于心理教育和行为激活，涉及715名参与者（年龄在60 - 94岁之间；平均（标准差）68.6（6.9）岁；74.1%为女性），该干预措施在改善巴西老年人抑郁症康复方面非常有效。在此，我们研究该干预措施有效性的中介因素。
使用干预间接效应进行因果中介分析，将“积极主动”干预措施对抑郁症康复（患者健康问卷 - 9得分＜10）的总体效应同时分解为多个间接效应，包括：干预剂量（完成的疗程数和活动数）；社会支持（鲁本社会网络量表）；感知到的孤独感（加利福尼亚大学洛杉矶分校问卷）；以及为在分阶段护理干预初始阶段无反应的参与者提供的额外疗程。
在该干预措施的总体效应中（干预组与对照组之间抑郁症康复概率的差异为0.216[偏差校正95%置信区间：0.149，0.291]）：13%是通过降低孤独感介导的（0.028[0.013，0.046]）；25%是通过为最初对干预无反应的参与者提供额外疗程介导的（0.055[0.007，0.102]）。
由于我们样本量的限制，我们的研究可能缺乏检测一些细微差别（如不同中介因素之间的相互作用）的能力。
我们的研究结果强调了家庭干预对改善抑郁症结局的重要性，在这种干预中鼓励参与者自行选择活动以减轻孤独感。重要的是，我们的研究结果表明，该干预措施的分阶段护理部分为未早期起效的参与者提供额外疗程，在确保抑郁症持续康复方面显示出前景。
