Gilbody, S, Brabyn, S, Mitchell, A, Ekers, D, McMillan, D, Bailey, D, Hems, D, Chew-Graham, CA, Keding, A, Bosanquet, K and collaborative, SHARD (2021) Can We Prevent Depression in At-Risk Older Adults Using Self-Help? The UK SHARD Trial of Behavioral Activation. American Journal of Geriatric Psychiatry, 30 (2). pp. 197-207. ISSN 1064-7481

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BACKGROUND: Treatment of established depression is the dominant approach to care of older adults, but prevention holds much promise. Self-help interventions are a feasible preventive approach, since they are scalable and low cost. There are few trials in this area. Behavioral Activation (BA) is a credible candidate psychological approach, which has been shown to work in therapist led care but not been trialled in a self-help form. AIM: To test the effectiveness of an unguided self-help intervention based on BA for older adults. METHODS: We compared a self-help intervention based on BA for older people (n = 172) to usual care (n = 160) in a pragmatic randomized controlled trial. Outcomes were depression status and severity (PHQ9) and health related quality of life (SF12). The primary timepoint of the primary outcome was depression at 4 months, with longer term follow up at 12 months to test sustained impact of the primary outcome. RESULTS: At 4 months adjusted PHQ-9 scores for BA self-help were 0.79 lower (95% CI: -1.70 to 0.13; p = 0.09) and the proportion of participants with case-level depression was significantly reduced (BA 31/137 (22.6%) versus usual care 41/141 (29.1%); Odds Ratio 0.48; 95% CI: 0.26-0.92; p = 0.03). There was no PHQ-9 difference at 12 months or for health related quality of life at any point (4 or 12 months). DISCUSSION: Self-help using BA for older people at risk of depression is a feasible and scalable intervention with potential short-term benefits in preventing depression.

Item Type: Article
Additional Information: © 2021 The Authors. Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry. This is an open access articleunder the CC BY license (
Uncontrolled Keywords: Depression; older adults; prevention; behavioral activation; RCT
Subjects: B Philosophy. Psychology. Religion > BF Psychology
B Philosophy. Psychology. Religion > BF Psychology > BF173 Psychoanalysis
R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Related URLs:
Depositing User: Symplectic
Date Deposited: 30 Sep 2021 14:12
Last Modified: 13 Apr 2022 10:50

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