Depressive symptoms are the most common referral problem to integrated mental health providers within Veteran primary care clinics. Although there exist several empirically-based brief psychotherapies for depression in primary care, the most significant barrier to providing those psychotherapies is treatment duration (e.g., the treatments 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., 1-4 15-30 minute sessions). Therefore, this HSR&D study titled, RCT of Behavioral Activation for Depression and Suicidality in Primary Care, 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: 1) examine whether a 4-session manualized behavioral activation intervention (BA-PC) compared to Treatment as Usual (TAU) is effective in reducing self-reported depressive symptoms and subjective secondary outcomes such as sleep impairment and quality of life; 2) examine patient satisfaction, engagement, and receptivity to a 4-session BA-PC; and 3) explore the impact of BA-PC on suicidal ideation.
The study will achieve these objectives using a randomized, controlled trial study design that has two conditions (4-session BA-PC and Treatment as Usual). Veterans will be recruited from three VA primary care settings in the Western portion of VISN 2 (Syracuse, Rochester, and Buffalo). The primary inclusion criteria for the study 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 2 weeks for changes in mood and more comprehensive assessments will be completed at 6, 12, and 24 weeks.
A total of 140 Veterans have been enrolled. Recruitment has ended and follow-up is continuing for another 24 weeks.
The availability of brief evidence-based therapies that can be efficiently delivered in primary care settings could significantly enhance care of ~29% of Veterans in primary care, those endorsing moderate to severe depressive symptoms. Testing a 4-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 4-session model for providers to follow. To the extent that BA-PC improves other associated features of depression, such as sleep and quality of life outcomes, it may significantly reduce health consequences and service utilization for these Veterans. 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. Findings from the trial may also help to inform wider clinical dissemination of BA-PC, including increased implementation of BA-PC at other VA sites, as well as further examination as to whether specific subgroups respond more positively or negatively to BA-PC relative to usual care.
None at this time.
Mental, Cognitive and Behavioral Disorders
Treatment - Efficacy/Effectiveness Clinical Trial