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Behavioral activation comparable to guided self-help for depression with intellectual disability

BeatIt, a behavioral intervention delivered via a manualized approach to increase activity and patient engagement, had comparable efficacy to StepUp, a guided self-help intervention, for individuals with intellectual disabilities and depression.

“Although psychological therapies have become established first-line interventions for depression in the general population, this has not been the case for adults with intellectual disabilities, because of the additional complexities involved in making these interventions accessible to adults with cognitive and verbal communication impairments. Awareness of the inequity in provision of psychological therapies has grown, but substantial limitations remain in the existing evidence base and in its implementation,” Andrew Jahoda, PhD, of the University of Glasgow, United Kingdom, and colleagues wrote.

To determine clinical and cost-effectiveness of BeatIt, a behavioral activation intervention, for individuals with depression and intellectual disabilities, researchers conducted a multicenter, single-blind, randomized, controlled trial with a follow-up at 4 months and 12 months after randomization. Study participants with mild-to-moderate intellectual disabilities and depression were randomly assigned to receive BeatIt (n = 84) or StepUp (n = 77).

BeatIt was delivered in 12 sessions and focused on increasing activity, scheduling activity and addressing barriers to engagement in activity. The intervention ended with a plan to maintain or continue progress. StepUp was delivered in eight sessions.

At 12 months, Glasgow Depression Scale for individuals with a Learning Disability (GDS-LD) scores were comparable between participants who received BeatIt (12.03 points) or StepUp (12.43 points), with a mean difference of 0.26 points.

At 12 months, participants who received BeatIt exhibited a mean change in GDS-LD scores of –4.2 points, compared with –4.5 points among those who received StepUp.

BeatIt was not cost-effective compared with StepUp; however, economic analyses indicated significant uncertainty.

“The successful delivery of this trial, carried out in existing services, shows the possibility of training professional groups, who are already working with people who have intellectual disabilities and depression, to deliver focused psychological interventions such as behavioral activation and guided self-help,” the researchers wrote. “This implementation work is a priority and might help to address the inequities faced by people with intellectual disabilities, who often do not have access to psychological therapies for commonly occurring mental health problems.” – by Amanda Oldt

Disclosures: Jahoda reports receiving grant funding from the National Institute for Health Research. Please see the study for all other authors’ relevant financial disclosures.