August 2017

In this Issue: Suicide Prevention
» Table of Contents

Behavioral Activation Intervention for Treating Depression in Primary Care Setting

Feature Article

Depressive symptoms are the most common referral problem to integrated mental health providers within Veteran primary care clinics. Although several brief psychotherapies for depression exist in primary care, the most significant barrier to providing them for patients is treatment duration (e.g., range from 6-8 sessions of 30-50 minutes) as it does not match typical treatment formats delivered by mental health providers working in primary care (i.e., one to four 15-30 minute sessions). Therefore, this ongoing HSR&D randomized controlled trial (RCT) will examine the effectiveness of a brief version of an existing efficacious longer treatment for depression, called behavioral activation.

The overarching objectives of this study are to:

• Examine whether a four-session manualized behavioral activation intervention (BA-PC) compared to Treatment as Usual (TAU) is effective in reducing self-reported depressive symptoms and secondary outcomes (i.e., sleep impairment and quality of life);
• Assess patient satisfaction, engagement, and receptivity to a four-session BA-PC; and
• Explore the impact of BA-PC on suicidal ideation.

Veterans for this RCT will be recruited from three VA primary care settings in the Western portion of VISN 2 (Syracuse, Rochester, and Buffalo). The primary inclusion criteria will be a report of depressive symptoms by primary care patients, who are not currently engaged in psychological treatment for depression. A total of 136 Veterans will be targeted for randomization. All Veterans will be assessed every two weeks for changes in mood, and more comprehensive assessments will be completed at 6, 12, and 24 weeks.

Impact: The availability of brief evidence-based therapies that can be efficiently delivered in primary care settings could significantly enhance the care of ~29% of Veterans in primary care, who suffer from moderate to severe depressive symptoms. Testing a four-session manualized primary-care based, brief behavioral activation intervention will help to establish the effectiveness of a brief BA intervention suited to primary care, while also providing a four-session model for providers to follow. Moreover, given the interrelationship between depressive symptoms and suicidal thoughts/behaviors–and the need for identified interventions for Veterans reporting suicidal thoughts/behaviors in primary care, this study may identify a potentially useful intervention to reduce suicide risk.

Principal Investigators: Jennifer Funderburk, PhD, an HSR&D affiliate investigator and part of the VISN 2 Center for Integrated Healthcare (CIH), and Wilfred Pigeon, PhD, an HSR&D affiliate investigator and part of the VISN 2 Center of Excellence for Suicide Prevention.

Behavioral Activation Intervention for Treating Depression in Primary Care Setting project abstract