Can we mitigate the psychological impacts of social isolation using behavioural activation? Long-term results of the UK BASIL urgent public health COVID-19 pilot randomised controlled trial and living systematic review

• Published in: BMJ mental health 2022-12, Vol.25 (e1), p.e49-e57
• Main Authors: Littlewood, Elizabeth, McMillan, Dean, Chew Graham, Carolyn, Bailey, Della, Gascoyne, Samantha, Sloane, Claire, Burke, Lauren, Coventry, Peter, Crosland, Suzanne, Fairhurst, Caroline, Henry, Andrew, Hewitt, Catherine, Baird, Kalpita, Ryde, Eloise, Shearsmith, Leanne, Traviss-Turner, Gemma, Woodhouse, Rebecca, Webster, Judith, Meader, Nick, Churchill, Rachel, Eddy, Elizabeth, Heron, Paul, Hicklin, Nisha, Shafran, Roz, Almeida, Osvaldo, Clegg, Andrew, Gentry, Tom, Hill, Andrew, Lovell, Karina, Dexter-Smith, Sarah, Ekers, David, Gilbody, Simon
• Format: Article
• Language: English
• Subjects: Adult psychiatry; Behavior modification; Behavior Therapy; Cognitive therapy; Coronaviruses; COVID-19; COVID-19 - prevention & control; Depression; Depression & mood disorders; Humans; Intervention; Loneliness; Medical research; Mental depression; Mental health; Older people; Pandemics; Pilot Projects; Primary care; Psychosocial Interventions; Public Health; Social isolation; Social Isolation - psychology; Systematic review; United Kingdom; Video teleconferencing
• ISSN: 1362-0347; 1468-960X; 2755-9734
• DOI: 10.1136/ebmental-2022-300530

BackgroundBehavioural and cognitive interventions remain credible approaches in addressing loneliness and depression. There was a need to rapidly generate and assimilate trial-based data during COVID-19.ObjectivesWe undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trial ISRCTN94091479). We also assimilate these data in a living systematic review (PROSPERO CRD42021298788) of cognitive and/or behavioural interventions.MethodsParticipants (≥65 years) with long-term conditions were computer randomised to behavioural activation (n=47) versus care as usual (n=49). Primary outcome was PHQ-9. Secondary outcomes included loneliness (De Jong Scale). Data from the BASIL-C19 trial were included in a metanalysis of depression and loneliness.FindingsThe 12 months adjusted mean difference for PHQ-9 was −0.70 (95% CI −2.61 to 1.20) and for loneliness was −0.39 (95% CI −1.43 to 0.65).The BASIL-C19 living systematic review (12 trials) found short-term reductions in depression (standardised mean difference (SMD)=−0.31, 95% CI −0.51 to −0.11) and loneliness (SMD=−0.48, 95% CI −0.70 to −0.27). There were few long-term trials, but there was evidence of some benefit (loneliness SMD=−0.20, 95% CI −0.40 to −0.01; depression SMD=−0.20, 95% CI −0.47 to 0.07).DiscussionWe delivered a pilot trial of a behavioural intervention targeting loneliness and depression; achieving long-term follow-up. Living meta-analysis provides strong evidence of short-term benefit for loneliness and depression for cognitive and/or behavioural approaches. A fully powered BASIL trial is underway.Clinical implicationsScalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.