Effectiveness of behavioral activation in treating thai older adults with subthreshold depression residing in the community

Abstract

Background: In recent years, behavioral activation (BA) has attracted increased interest aan effective depression treatment. However, empirical evidence supporting its effectivenesin non-Western countries is currently limited. Objective: To examine the effectiveness of BA in reducing depressive symptoms, stressand anxiety among Thai older adults with subthreshold depression. Methods and Subjects: A clustered randomized controlled trial was conducted in two healtpromoting hospitals (HPHs) in the Samut Songkhram province of Thailand. One hospital waused for the intervention (BA+usual care group) and the other for the control (usual care-onlgroup). Each HPH randomly selected 41 eligible older adults residing in their jurisdictions to takpart in the study. Mental health outcomes were assessed using the Thai Geriatric DepressioScale (TGDS) and Depression Anxiety Stress Scales (DASS). The BA effectiveness waevaluated using generalized estimating equations (GEE) at a group level and the reliable changindex (RCI) at the individual level. Results: Over 9 months, the adjusted mean change in depression (TGDS) scores [−2.47 (95% CI: −3.84, −1.00)], mental health status (DASS), specifically depression and stress score [−1.4and −1.87 (95% CI: −2.43, −0.50 and −2.94, −0.79, respectively)], improved significantly in thBA+usual care group compared to the usual care-only group, whereas anxiety score improvesignificantly only at 6 months [−0.87 (95% CI: −1.52, −0.23)]. Additional RCI analysis showethat BA was directly associated with 14.63 to 24.39% points increase in the reliable improvemenof depressive outcome compared to the usual care-only group. Conclusion: This study showed that the BA effectively improved depression, stress, ananxiety in older adults with subthreshold depression in a Thai community setting. Futurresearch should evaluate the longer-term effectiveness of BA in diverse populatiogroups.