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.
(In press).
Preview |
Text
understanding-the-effects-of-a-complex-psychological-intervention-on-symptoms-of-depression-in-goa-india-findings-from-a-causal-mediation-analysis.pdf - Published Version Download (483kB) | Preview |
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.
| Type: | Article |
|---|---|
| Title: | Understanding the effects of a complex psychological intervention on symptoms of depression in Goa, India: findings from a causal mediation analysis |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1192/bjp.2022.116 |
| Publisher version: | https://doi.org/10.1192/bjp.2022.116 |
| Language: | English |
| Additional information: | 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 |
| 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 |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education > IOE - Social Research Institute UCL > Provost and Vice Provost Offices > School of Education UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10156273 |
Loading...
Loading...Loading...| 1. |  United Kingdom | 3 |
| 2. |  Germany | 3 |
| 3. |  China | 3 |
| 4. |  United States | 2 |
| 5. |  Russian Federation | 2 |
| 6. |  India | 2 |
Archive Staff Only
 |
View Item |
