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Title: | Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial. | Authors: | Smith I.;Melville C.;Thomas G.;Jahoda A.;Hastings R.;Hatton C.;Cooper S.-A.;Dagnan D.;Zhang R.;McConnachie A.;McMeekin N.;Appleton K.;Jones R.;Scott K.;Fulton L.;Knight R.;Knowles D.;Williams C. ;Briggs A.;MacMahon K.;Lynn H. | Institution: | (Jahoda, Cooper, Zhang, McConnachie, McMeekin, Appleton, Scott, Fulton, Williams, Briggs, Melville) Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom (Hastings, Knight) Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, United Kingdom (Hastings) Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia (Hatton, Knowles, Smith) Faculty of Health and Medicine, University of Lancaster, Lancaster, United Kingdom (Dagnan) Cumbria Partnership NHS Foundation Trust and University of Lancaster, Lancaster, United Kingdom (Jones) School of Psychology, Bangor University, Bangor, United Kingdom (MacMahon) School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom (Lynn) Learning Disability Services, NHS Ayrshire and Arran, Ayrshire, United Kingdom (Thomas) Specialist Learning Disability Psychological Services, South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Stafford, United Kingdom | Issue Date: | 6-Dec-2017 | Copyright year: | 2017 | Publisher: | Elsevier Ltd | Place of publication: | United Kingdom | Publication information: | The Lancet Psychiatry. 4 (12) (pp 909-919), 2017. Date of Publication: December 2017. | Abstract: | Background Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). Methods We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Findings Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12.03 [SD 7.99] GDS-LD points for BeatIt vs 12.43 [SD 7.64] GDS-LD points for StepUp; mean difference 0.26 GDS-LD points [95% CI -2.18 to 2.70]; p=0.833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change -4.2 GDS-LD points [95% CI -6.0 to -2.4], p<0.0001; StepUp, mean change -4.5 GDS-LD points [-6.2 to -2.7], p<0.0001), with large effect sizes (BeatIt, 0.590 [95% CI 0.337-0.844]; StepUp, 0.627 [0.380-0.873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3.6-6.8% of participants' total support costs. No treatment-related or trial-related adverse events were reported. Interpretation This study is, to our knowledge, the first large randomised controlled trial assessing individual psychological interventions for people with intellectual disabilities and mental health problems. These findings show that there is no evidence that BeatIt is more effective than StepUp; both are active and potentially effective interventions. Funding National Institute for Health Research.Copyright © 2017 Elsevier Ltd | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/S2215-0366%2817%2930426-1 | Link to associated publication: | Click here for full text options | PubMed URL: | 29153873 [http://www.ncbi.nlm.nih.gov/pubmed/?term=29153873] | ISSN: | 2215-0366 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/38272 | Type: | Article | Subjects: | scoring system Glasgow Anxiety Scale for people with Intellectual Disability *guided self help intervention Index of Community Involvement Index of Participation in Domestic Life Intellectual Disabilities Depression Scale Social Support Questionnaire clinical effectiveness single blind procedure treatment outcome United Kingdom Adaptive Behavior Scale Behavior Problems Inventory Short Form *behavioral activation intervention Emotional Difficulties Self Efficacy Scale EuroQol five dimensions questionnaire Glasgow Depression Scale for People with a Learning Disability adult article *behavior therapy clinical assessment tool controlled study *cost effectiveness analysis *depression/dm [Disease Management] *depression/th [Therapy] female follow up health care cost human *intellectual impairment intention to treat analysis intermethod comparison major clinical study male multicenter study outcome assessment pilot study priority journal psychotherapy randomized controlled trial intention to treat analysis intermethod comparison major clinical study male multicenter study outcome assessment pilot study priority journal psychotherapy randomized controlled trial scoring system clinical effectiveness treatment outcome United Kingdom clinical assessment tool *behavior therapy Article adult single blind procedure controlled study *cost effectiveness analysis *depression / *disease management / *therapy female follow up health care cost human *intellectual impairment |
Type of Clinical Study or Trial: | Randomised controlled trial |
Appears in Collections: | Articles |
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