eprintid: 10156273
rev_number: 8
eprint_status: archive
userid: 699
dir: disk0/10/15/62/73
datestamp: 2022-09-27 15:27:04
lastmod: 2022-09-27 15:27:04
status_changed: 2022-09-27 15:27:04
type: article
metadata_visibility: show
sword_depositor: 699
creators_name: Seward, Nadine
creators_name: Vansteelandt, Stijn
creators_name: Moreno-Agostino, Dario
creators_name: Patel, Vikram
creators_name: Araya, Ricardo
title: Understanding the effects of a complex psychological intervention on symptoms of depression in Goa, India: findings from a causal mediation analysis
ispublished: inpress
divisions: B14
divisions: J81
divisions: B16
divisions: UCL
keywords: Science & Technology, Life Sciences & Biomedicine, Psychiatry, Low- and middle-income countries, psychosocial interventions, depressive disorders, task-sharing, behavioural activation, COMMON MENTAL-DISORDERS, PRIMARY-CARE, THERAPY, HEALTH
note: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re- use, distribution and reproduction, provided the original article is properly cited.
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
abstract: BACKGROUND: Understanding how and under what circumstances a highly effective psychological intervention, improved symptoms of depression is important to maximise its clinical effectiveness. AIMS: To address this complexity, we estimate the indirect effects of potentially important mediators to improve symptoms of depression (measured with the Patient Health Questionnaire (PHQ-9)) in the Healthy Activity Program trial. METHOD: Interventional in(direct) effects were used to decompose the total effect of the intervention on PHQ-9 scores into the direct and indirect effects. The following indirect effects were considered: characteristics of sessions, represented by the number of sessions and homework completed; behavioural activation, according to an adapted version of the Behavioural Activation for Depression Scale - Short Form; and extra sessions offered to participants who did not respond to the intervention. RESULTS: Of the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.1, bias-corrected 95% CI -3.2 to -1.5), 34% was mediated through improved levels of behavioural activation (mean difference: -0.7, bias-corrected 95% CI -1.2 to -0.4). There was no evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment. CONCLUSIONS: Findings from our robust mediation analyses confirmed the importance of targeting behavioural activation. Contrary to published literature, our findings suggest that neither the number of sessions nor proportion of homework completed improved outcomes. Moreover, in this context, alternative treatments other than extra sessions should be considered for patients who do not respond to the intervention.
date: 2022-08-25
date_type: published
publisher: Royal College of Psychiatrists
official_url: https://doi.org/10.1192/bjp.2022.116
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1973891
doi: 10.1192/bjp.2022.116
medium: Print-Electronic
pii: S0007125022001167
lyricists_name: Moreno Agostino, Dario
lyricists_id: DMORE92
actors_name: Moreno Agostino, Dario
actors_id: DMORE92
actors_role: owner
funding_acknowledgements: 091834 [Wellcome Trust Senior Research Fellowship]
full_text_status: public
publication: British Journal of Psychiatry
article_number: PII S0007125022001167
pages: 7
event_location: England
citation:        Seward, Nadine;    Vansteelandt, Stijn;    Moreno-Agostino, Dario;    Patel, Vikram;    Araya, Ricardo;      (2022)    Understanding the effects of a complex psychological intervention on symptoms of depression in Goa, India: findings from a causal mediation analysis.                   British Journal of Psychiatry      , Article PII S0007125022001167.  10.1192/bjp.2022.116 <https://doi.org/10.1192/bjp.2022.116>.    (In press).    Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10156273/1/understanding-the-effects-of-a-complex-psychological-intervention-on-symptoms-of-depression-in-goa-india-findings-from-a-causal-mediation-analysis.pdf