scholarly journals Mitigating the psychological impacts of COVID-19 restrictions: The Behavioural Activation in Social Isolation (BASIL) pilot randomised controlled trial to prevent depression and loneliness among older people with long term conditions

2021 ◽  
Author(s):  
Simon Gilbody ◽  
Elizabeth Littlewood ◽  
Dean McMillan ◽  
Carolyn Chew-Graham ◽  
Della Bailey ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Social Isolation ◽  
Pilot Trial ◽  
Mean Difference ◽  
Behavioural Activation ◽  
Long Term Conditions ◽  
Psychological Impacts

Background Older adults with long-term conditions have become more socially isolated (often due to advice to shield to protect them from COVID-19) and are thus at particular risk of depression and loneliness. There is a need for brief scalable psychosocial interventions to mitigate the psychological impacts of social isolation. Behavioural Activation is a plausible intervention, but a trial is needed. Methods We undertook an external randomised pilot trial (ISRCTN94091479) designed to test recruitment, retention and engagement with, and the acceptability and preliminary effects of the intervention. Participants aged ≥ 65 years with two or more long-term conditions were recruited between June and October 2020. Behavioural Activation was offered to intervention participants (n=47), and control participants received usual care (n=49). Findings Remote recruitment was possible and 45/47 (95.7%) randomised to the intervention completed one or more sessions (median 6 sessions). 90 (93.8%) completed the one month follow-up, and 86 (89.6%) completed the three month follow-up. The between-group comparison for the primary clinical outcome at one month was an adjusted between group mean difference of -0.50 PHQ-9 points (95% CI -2.01 to 1.01), but only a small number of participants had completed the intervention at this point. At three months, the PHQ-9 adjusted mean difference was 0.19 (95% CI -1.36 to 1.75). When we examined loneliness, the between-group difference in the De Jong Gierveld Loneliness scale at one month was 0.28 (95% CI -0.51 to 1.06), and there was statistically significant between group difference at three months (-0.87; 95% CI -1.56 to -0.18). Participants who withdrew had minimal depressive symptoms at entry. Interpretation Behavioural Activation is a plausible intervention to mitigate the psychological impacts of COVID-19 isolation for older adults. The intervention can be delivered remotely and at scale, but should be reserved for older adults with evidence of depressive symptoms. The significant reduction in loneliness is unlikely to be a chance finding, and this will now be confirmed in a fully powered RCT. Funding This study was funded by National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) RP-PG-0217-20006

scholarly journals Behavioural activation to prevent depression and loneliness among socially isolated older people with long-term conditions: The BASIL COVID-19 pilot randomised controlled trial

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003779
Author(s):  
Simon Gilbody ◽  
Elizabeth Littlewood ◽  
Dean McMillan ◽  
Carolyn A. Chew-Graham ◽  
Della Bailey ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Behavioural Activation ◽  
Long Term Conditions ◽  
Socially Isolated ◽  
Randomised Controlled

Background Older adults, including those with long-term conditions (LTCs), are vulnerable to social isolation. They are likely to have become more socially isolated during the Coronavirus Disease 2019 (COVID-19) pandemic, often due to advice to “shield” to protect them from infection. This places them at particular risk of depression and loneliness. There is a need for brief scalable psychosocial interventions to mitigate the psychological impacts of social isolation. Behavioural activation (BA) is a credible candidate intervention, but a trial is needed. Methods and findings We undertook an external pilot parallel randomised trial (ISRCTN94091479) designed to test recruitment, retention and engagement with, and the acceptability and preliminary effects of the intervention. Participants aged ≥65 years with 2 or more LTCs were recruited in primary care and randomised by computer and with concealed allocation between June and October 2020. BA was offered to intervention participants (n = 47), and control participants received usual primary care (n = 49). Assessment of outcome was made blind to treatment allocation. The primary outcome was depression severity (measured using the Patient Health Questionnaire 9 (PHQ-9)). We also measured health-related quality of life (measured by the Short Form (SF)-12v2 mental component scale (MCS) and physical component scale (PCS)), anxiety (measured by the Generalised Anxiety Disorder 7 (GAD-7)), perceived social and emotional loneliness (measured by the De Jong Gierveld Scale: 11-item loneliness scale). Outcome was measured at 1 and 3 months. The mean age of participants was aged 74 years (standard deviation (SD) 5.5) and they were mostly White (n = 92, 95.8%), and approximately two-thirds of the sample were female (n = 59, 61.5%). Remote recruitment was possible, and 45/47 (95.7%) randomised to the intervention completed 1 or more sessions (median 6 sessions) out of 8. A total of 90 (93.8%) completed the 1-month follow-up, and 86 (89.6%) completed the 3-month follow-up, with similar rates for control (1 month: 45/49 and 3 months 44/49) and intervention (1 month: 45/47and 3 months: 42/47) follow-up. Between-group comparisons were made using a confidence interval (CI) approach, and by adjusting for the covariate of interest at baseline. At 1 month (the primary clinical outcome point), the median number of completed sessions for people receiving the BA intervention was 3, and almost all participants were still receiving the BA intervention. The between-group comparison for the primary clinical outcome at 1 month was an adjusted between-group mean difference of −0.50 PHQ-9 points (95% CI −2.01 to 1.01), but only a small number of participants had completed the intervention at this point. At 3 months, the PHQ-9 adjusted mean difference (AMD) was 0.19 (95% CI −1.36 to 1.75). When we examined loneliness, the adjusted between-group difference in the De Jong Gierveld Loneliness Scale at 1 month was 0.28 (95% CI −0.51 to 1.06) and at 3 months −0.87 (95% CI −1.56 to −0.18), suggesting evidence of benefit of the intervention at this time point. For anxiety, the GAD adjusted between-group difference at 1 month was 0.20 (−1.33, 1.73) and at 3 months 0.31 (−1.08, 1.70). For the SF-12 (physical component score), the adjusted between-group difference at 1 month was 0.34 (−4.17, 4.85) and at 3 months 0.11 (−4.46, 4.67). For the SF-12 (mental component score), the adjusted between-group difference at 1 month was 1.91 (−2.64, 5.15) and at 3 months 1.26 (−2.64, 5.15). Participants who withdrew had minimal depressive symptoms at entry. There were no adverse events. The Behavioural Activation in Social Isolation (BASIL) study had 2 main limitations. First, we found that the intervention was still being delivered at the prespecified primary outcome point, and this fed into the design of the main trial where a primary outcome of 3 months is now collected. Second, this was a pilot trial and was not designed to test between-group differences with high levels of statistical power. Type 2 errors are likely to have occurred, and a larger trial is now underway to test for robust effects and replicate signals of effectiveness in important secondary outcomes such as loneliness. Conclusions In this study, we observed that BA is a credible intervention to mitigate the psychological impacts of COVID-19 isolation for older adults. We demonstrated that it is feasible to undertake a trial of BA. The intervention can be delivered remotely and at scale, but should be reserved for older adults with evidence of depressive symptoms. The significant reduction in loneliness is unlikely to be a chance finding, and replication will be explored in a fully powered randomised controlled trial (RCT). Trial registration ISRCTN94091479.

scholarly journals Interventions against Social Isolation of Older Adults: A Systematic Review of Existing Literature and Interventions

Geriatrics ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 82
Author(s):  
Jaya Manjunath ◽  
Nandita Manoj ◽  
Tania Alchalabi
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Social Isolation ◽  
Term Care ◽  
Effective Interventions ◽  
The Social ◽  
Follow Up Studies ◽  
Health Studies

Social isolation is widespread among older adults, especially those confined to living in nursing homes and long-term care facilities. We completed a systematic review evaluating the effectiveness of 20 interventions used to combat social isolation in older adults. A scoring mechanism based on the Joanna Briggs Appraisal Checklist was utilized to determine the quality of the studies. Searches were conducted in “MedLine”, “PubMed”, “PsycINFO” and “Aging and Mental Health”. Studies completed on group and person-centered interventions against social isolation were the highest quality as the social isolation experienced by older adults decreased after the intervention, and this effect continued in follow-up studies. Other interventions such as volunteering-based interventions also alleviated isolation; however, follow-up studies were not completed to determine long-term efficacy. Given the increase in social isolation faced by older persons during the pandemic, our review can be utilized to create effective interventions to reduce social isolation.

scholarly journals Kinect Adventures versus physical exercise on depressive symptoms of older adults: A pilot study

2020 ◽  
Vol 33 ◽  
Author(s):  
Jéssica Maria Ribeiro Bacha ◽  
Gisele Cristine Vieira Gomes ◽  
Tatiana Beline de Freitas ◽  
Camila Torriani-Pasin ◽  
Belinda Lange ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Pilot Study ◽  
Video Games ◽  
Physical Exercise ◽  
Pilot Trial ◽  
Exercise Program ◽  
Depression Symptoms ◽  
Post Intervention

Abstract Introduction: Depressive and anxiety disorders are considered the main cause of emotional suffering and decrease of quality of life among older adults. It has been suggested that the practice of physical exercise can be a treatment option for anxiety and depression. Alternative approaches such serious games show promise for reducing depression symptoms. Objective: To compare the effect of virtual reality, in the form of commercially available interactive Kinect Adventures video games, compared to a standard physical exercise program on depressive symptoms of older adults. Method: This is a pilot study, parallel group, single-blind randomized controlled pilot trial that recruited two intervention groups: Interactive Video Game Kinect Adventures (IVG, n=8) versus usual physical exercise program (PEP, n=6). The two groups completed a seven week program with a total of fourteen 60-minute sessions divided into two sessions a week. The IVG completed individual training sessions using the Microsoft Xbox Kinect Adventures games and the PEP performed a group exercise program. Depression symptoms were measured using the Geriatric Depression Scale (GDS-15). This measure was assessed pre-intervention, post intervention and at 30-day follow-up. Results: There was a significant effect of assessment without group effect or interaction between factors, in the GDS-15 (RM-ANOVA, P < 0.0001). Both groups showed improvement in the GDS-15 post intervention assessment that was maintained after 30-day follow-up (Bonferroni post hoc test, P < 0.05). Conclusion: The results of this study suggest that both Interactive Kinect Adventures video games and physical exercise provide beneficial effects on depressive symptoms of older adults.

scholarly journals Short-term mental health sequelae of bereavement predict long-term physical health decline in older adults: US Health and Retirement Study Analysis

2019 ◽  
Author(s):  
Benjamin W. Domingue ◽  
Laramie Duncan ◽  
Amal Harrati ◽  
Daniel W. Belsky
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Physical Health ◽  
Spousal Death ◽  
Health Decline ◽  
Increased Risk ◽  
Mental And Physical Health

AbstractObjectiveDeath of a spouse is a common late-life event with mental- and physical-health sequelae. Whereas mental-health sequelae of spousal death tend to be transient, physical-health sequelae may persist, leading to disability and mortality. Growing evidence linking poor mental health to aging-related disease suggests the hypothesis that transient poor mental health following death of a spouse could be a harbinger of physical health decline. If so, identification of bereavement-related mental health symptoms could provide an opportunity for prevention.MethodsWe analyzed data from N=35,103 individuals followed from 1994-2014 in the US Health and Retirement Study (HRS) and identified N=4,629 who were widowed during follow-up. We tested change in mental and physical health from pre-bereavement through the 5-year period following spousal death.ResultsBereaved spouses experienced an immediate increase in depressive symptoms following their spouses’ deaths but the depressive shock attenuated within one year. Bereaved spouses also experienced increases in disability, chronic-disease morbidity, and hospitalization, which grew in magnitude with time since spousal death, especially among older HRS participants. Bereaved spouses were at increased risk of death compared to HRS participants who were not bereaved. The magnitude of depressive symptoms in the immediate aftermath of spousal death predicted physical-health decline and mortality risk over 5 years of follow-up.ConclusionsBereavement-related depressive symptoms provide an indicator of risk for physical health decline and death in older adults. Screening for depressive symptoms in bereaved older adults may represent an opportunity for intervention to preserve healthy lifespan.Plain Language SummaryThe clinical significance of depressive symptoms during bereavement for long-term health is not well understood. We analyzed longitudinal data tracking mental and physical health of more than 4,000 older adults who were widowed during follow-up. Widows and widowers who experienced more severe depressive symptoms immediately following their spouse’s death were at increased risk for incident disability, chronic disease, hospitalization, and mortality over the five years following their spouse’s death. Transient depressive symptoms related to bereavement may provide a clinical indicator of risk for long-term physical health decline in older adults. Findings motivate increased integration of psychiatric assessment in geriatric care.

scholarly journals Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

2021 ◽  
pp. 1-8
Author(s):  
Bin Yu ◽  
Andrew Steptoe ◽  
Yongjie Chen ◽  
Xiaohua Jia
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Episodic Memory ◽  
Cognitive Decline ◽  
Social Isolation ◽  
Mental Status ◽  
Chinese Older Adults ◽  
Confounding Variables

Abstract Background Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults. Methods This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up. Results Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = −0.03, p < 0.01; mental status: β = −0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = −0.05, p < 0.001; mental status: β = −0.03, p < 0.01) even after controlling for loneliness and all confounding variables. Conclusions Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

scholarly journals Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis

2021 ◽  
pp. 1-11
Author(s):  
Maxi Weber ◽  
Sarah Schumacher ◽  
Wiebke Hannig ◽  
Jürgen Barth ◽  
Annett Lotzin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Stress Disorder ◽  
Psychological Treatment ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Long Term Outcomes ◽  
Psychological Treatments

Abstract Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.

scholarly journals Challenging the “jolly fat” hypothesis among older adults: High body mass index predicts increases in depressive symptoms over a 5-year period

2016 ◽  
Vol 23 (1) ◽  
pp. 48-58 ◽  
Author(s):  
Peter Joseph Dearborn ◽  
Michael A Robbins ◽  
Merrill F Elias
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Depressive Symptoms ◽  
Body Mass ◽  
Functional Limitations ◽  
High Body Mass Index ◽  
Obesity Prevalence ◽  
Community Based ◽  
Objectively Measured

Several investigators have observed lowered risk of depression among obese older adults, coining the “jolly fat” hypothesis. We examined this hypothesis using baseline and a 5-year follow-up body mass index, depressive symptoms, and covariates from 638 community-based older adults. High objectively measured body mass index and functional limitations predicted increased future depressive symptoms. However, symptoms did not predict future body mass index. Self-reported body mass index showed similar associations despite underestimating obesity prevalence. Results did not differ on the basis of gender. Results for this study, the first longitudinal reciprocal risk analysis between objectively measured body mass index and depressive symptoms among older adults, do not support the “jolly fat” hypothesis.

scholarly journals Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up

2017 ◽  
Vol 44 ◽  
pp. 16-21 ◽  
Author(s):  
Michael H. Antoni ◽  
Jamie M. Jacobs ◽  
Laura C. Bouchard ◽  
Suzanne C. Lechner ◽  
Devika R. Jutagir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Depressive Symptoms ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Long Term Survival

Subjective Age and Late-Life Functional Status: Mediating and Moderating Effects

2021 ◽  
Author(s):  
Joel R Petashnick ◽  
Amit Shrira ◽  
Yaakov Hoffman ◽  
Yuval Palgi ◽  
Gitit Kavé ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Functional Status ◽  
Objective Measure ◽  
Later Life ◽  
Underlying Mechanism ◽  
Integrative Model ◽  
Subjective Age ◽  
Longitudinal Relationships

Abstract Objectives The present study examined the longitudinal relationships between subjective age (SA) and future functional status in later life, via depressive symptoms. Additionally, we assessed the role of subjective nearness to death (SNtD) as a potential moderator within these pathways. Methods Older adults (average age 81.14 at T1) were interviewed once a year for three consecutive years (N=224 at T1, N=178 at T2, and N=164 at T3), Participants reported their SA, SNtD, depressive symptoms, and functional status. Additionally, grip strength was employed as an objective measure of functional status. Results Data analysis revealed distinct pathways leading from T1 SA to T3 functional status through T2 depressive symptoms. Moreover, T1 SNtD was found to significantly moderate most of these indirect pathways, so that the mediation model of T1 SA-T2 depressive symptoms-T3 functional status was mostly significant among those who felt closer to death. Discussion The findings contribute to our understanding of the underlying mechanism through which SA predicts long-term functioning sequelae by underscoring the indirect effect of depressive symptoms. They further indicate the importance of gauging the effects of SNtD on these longitudinal relationships. Present results may further contribute to establishing an integrative model for predicting long-term functional outcomes based on older adults' earlier subjective views of aging.

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