TY - JOUR
T1 - Treating depressive symptoms among veterans in primary care
T2 - A multi-site RCT of brief behavioral activation
AU - Funderburk, Jennifer S.
AU - Pigeon, Wilfred R.
AU - Shepardson, Robyn L.
AU - Wade, Michael
AU - Acker, John
AU - Fivecoat, Hayley
AU - Wray, Laura O.
AU - Maisto, Stephen A.
N1 - Funding Information:
The views in this article are those of the authors and do not reflect the views or official policy of the Department of Veterans Affairs or other departments of the U.S. government. This work supported a Health Services Research and Development Service grant ( IIR 14-047-1 ) to Drs. Funderburk and Pigeon (multi-PIs) as well as a VA Center of Excellence for Suicide Prevention pilot grant and resources of the VA Center for Integrated Healthcare and the VA Center of Excellence for Suicide Prevention. Dr. Shepardson is supported by the Department of Veterans Affairs , Veterans Health Administration , Health Services Research and Development Service (HSR&D) as a VA HSR&D Career Development awardee (grant number 15-262 ) at the Center for Integrated Healthcare. The funding sources had no role in the study design; collection, analysis, and interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication. We would also like to acknowledge the various contributors to the success of this trial, including: Derek Hopko (consultation on manual development); the many members of our research assessment, intervention, and fidelity teams; and the healthcare providers in the primary care clinics who helped with recruitment and usual care delivery.
Publisher Copyright:
© 2021
PY - 2021/3/15
Y1 - 2021/3/15
N2 - Background: Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effective than primary care behavioral health treatment-as-usual (TAU) in reducing depressive symptoms and improving quality of life and functioning. Methods: Parallel-arm, multi-site randomized controlled trial. 140 Veterans were randomized to BA-PC or TAU and completed assessments at baseline, 6 weeks, 12 weeks, and 24 weeks. Results: Reductions in depressive symptoms were observed in both groups between baseline and 3-weeks prior to any treatment, with continued reductions among those in the BA-PC condition through 12-weeks. However, there was no significant condition X time interaction at 12-weeks. Quality of life and mental health functioning were significantly improved for those in the BA-PC condition, compared to TAU, at 12 weeks. Limitations: Generalizability to a broader population may be limited as this sample consisted of veterans. Although engagement in TAU matched other prior work, it was lower than engagement in BA-PC, which also may compromise results. Conclusions: Although this study found that both TAU and BA-PC participants showed a decline in depressive symptoms, improvements in functioning and quality of life within those assigned to BA-PC, strong treatment retention and feasibility of BA-PC, and significant reductions in depressive symptoms among those with more severe baseline depressive symptoms are encouraging and support continued research on BA-PC. This trial was registered in clinicaltrials.gov as Improving Mood in Veterans in Primary Care (NCT02276807).
AB - Background: Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effective than primary care behavioral health treatment-as-usual (TAU) in reducing depressive symptoms and improving quality of life and functioning. Methods: Parallel-arm, multi-site randomized controlled trial. 140 Veterans were randomized to BA-PC or TAU and completed assessments at baseline, 6 weeks, 12 weeks, and 24 weeks. Results: Reductions in depressive symptoms were observed in both groups between baseline and 3-weeks prior to any treatment, with continued reductions among those in the BA-PC condition through 12-weeks. However, there was no significant condition X time interaction at 12-weeks. Quality of life and mental health functioning were significantly improved for those in the BA-PC condition, compared to TAU, at 12 weeks. Limitations: Generalizability to a broader population may be limited as this sample consisted of veterans. Although engagement in TAU matched other prior work, it was lower than engagement in BA-PC, which also may compromise results. Conclusions: Although this study found that both TAU and BA-PC participants showed a decline in depressive symptoms, improvements in functioning and quality of life within those assigned to BA-PC, strong treatment retention and feasibility of BA-PC, and significant reductions in depressive symptoms among those with more severe baseline depressive symptoms are encouraging and support continued research on BA-PC. This trial was registered in clinicaltrials.gov as Improving Mood in Veterans in Primary Care (NCT02276807).
KW - Behavioral Activation
KW - Depression
KW - Intervention
KW - Primary Care
KW - RCT
KW - Veterans
UR - http://www.scopus.com/inward/record.url?scp=85099804930&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099804930&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2021.01.033
DO - 10.1016/j.jad.2021.01.033
M3 - Article
C2 - 33516082
AN - SCOPUS:85099804930
SN - 0165-0327
VL - 283
SP - 11
EP - 19
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -