Jennifer S Funderburk1, Wilfred R Pigeon2, Robyn L Shepardson3, Michael Wade4, John Acker4, Hayley Fivecoat5, Laura O Wray6, Stephen A Maisto3. 1. VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: Jennifer.Funderburk@va.gov. 2. Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA; VA VISN 2 Center of Excellence for Suicide Prevention, Finger Lakes VA Medical Center, Canandaigua, NY, USA. 3. VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA. 4. VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA. 5. VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 6. VA Center for Integrated Healthcare, Western New York VA Medical Center, Buffalo, NY, USA; Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA.
Abstract
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).
RCT Entities:
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).