Treating depressive symptoms among veterans in primary care: A multi-site RCT of brief behavioral activation

• Published in: Journal of affective disorders Vol. 283; pp. 11 - 19
• Main Authors: Funderburk, Jennifer S., Pigeon, Wilfred R., Shepardson, Robyn L., Wade, Michael, Acker, John, Fivecoat, Hayley, Wray, Laura O., Maisto, Stephen A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2021
• Subjects: Behavioral Activation; Depression; Depression - therapy; Humans; Intervention; Primary Care; Primary Health Care; Quality of Life; RCT; Treatment Outcome; Veterans; Intervention; Behavioral Activation; Depression; RCT; Primary Care; Veterans
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2021.01.033

•Brief behavioral activation (BA-PC) is ideal for integrated primary care settings.•Multi-site randomized controlled trial with 140 Veterans.•Reductions in depressive symptoms observed in both groups.•Quality of life and mental health functioning were significantly improved in BA-PC.•Strong treatment retention and feasibility of BA-PC, but a need for future research. 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. 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. 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. 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. 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).