Randomized Controlled Trial

. 2022 Dec;25(e1):e49-e57.

doi: 10.1136/ebmental-2022-300530. Epub 2022 Oct 12.

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

Elizabeth Littlewood¹, Dean McMillan^{1

2}, Carolyn Chew Graham³, Della Bailey¹, Samantha Gascoyne¹, Claire Sloane¹, Lauren Burke¹, Peter Coventry^{1

4}, Suzanne Crosland¹, Caroline Fairhurst¹, Andrew Henry¹, Catherine Hewitt¹, Kalpita Baird¹, Eloise Ryde^{1

5}, Leanne Shearsmith⁶, Gemma Traviss-Turner⁶, Rebecca Woodhouse¹, Judith Webster⁵, Nick Meader⁷, Rachel Churchill⁸, Elizabeth Eddy⁹, Paul Heron¹, Nisha Hicklin¹⁰, Roz Shafran^{11

12}, Osvaldo Almeida¹³, Andrew Clegg^{6

14}, Tom Gentry¹⁵, Andrew Hill⁶, Karina Lovell¹⁶, Sarah Dexter-Smith⁵, David Ekers^{1

5}, Simon Gilbody^{17

18}

Affiliations

¹ Health Sciences, University of York, York, UK.
² Centre for Health and Population Science, Hull York Medical School, Hull, UK.
³ School of Medicine, Keele University, Keele, UK.
⁴ York Environmental Sustainability Institute, University of York, York, UK.
⁵ Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK.
⁶ Faculty of Medicine and Health, University of Leeds, Leeds, UK.
⁷ Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK.
⁸ Cochrane Common Mental Disorders Group, University of York, York, UK.
⁹ Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
¹⁰ Department of Psychology, Royal Holloway University of London, Egham, UK.
¹¹ PPP, University College London Institute of Child Health, London, UK.
¹² Paediatric Psychology Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
¹³ UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.
¹⁴ Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
¹⁵ Health and Care Policy, Age UK, London, UK.
¹⁶ Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
¹⁷ Health Sciences, University of York, York, UK simon.gilbody@york.ac.uk.
¹⁸ Centre for Health and Population Sciences, Hull York Medical School, York, UK.

PMID: 36223980
PMCID: PMC9811092
DOI: 10.1136/ebmental-2022-300530

Randomized Controlled Trial

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

Elizabeth Littlewood et al. Evid Based Ment Health. 2022 Dec.

. 2022 Dec;25(e1):e49-e57.

doi: 10.1136/ebmental-2022-300530. Epub 2022 Oct 12.

Authors

Affiliations

¹ Health Sciences, University of York, York, UK.
² Centre for Health and Population Science, Hull York Medical School, Hull, UK.
³ School of Medicine, Keele University, Keele, UK.
⁴ York Environmental Sustainability Institute, University of York, York, UK.
⁵ Research and Development Unit, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK.
⁶ Faculty of Medicine and Health, University of Leeds, Leeds, UK.
⁷ Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK.
⁸ Cochrane Common Mental Disorders Group, University of York, York, UK.
⁹ Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
¹⁰ Department of Psychology, Royal Holloway University of London, Egham, UK.
¹¹ PPP, University College London Institute of Child Health, London, UK.
¹² Paediatric Psychology Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
¹³ UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.
¹⁴ Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
¹⁵ Health and Care Policy, Age UK, London, UK.
¹⁶ Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
¹⁷ Health Sciences, University of York, York, UK simon.gilbody@york.ac.uk.
¹⁸ Centre for Health and Population Sciences, Hull York Medical School, York, UK.

PMID: 36223980
PMCID: PMC9811092
DOI: 10.1136/ebmental-2022-300530

Abstract

Background: Behavioural 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.

Objectives: We 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.

Methods: Participants (≥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.

Findings: The 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).

Discussion: We 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 implications: Scalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.

Keywords: Adult psychiatry; Depression & mood disorders.

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Conflict of interest statement

Competing interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests. DE and CCG were committee members for the NICE Depression Guideline (update) Development Group between 2015 and 2022, and SiG was a member between 2015 and 2018. SiG, PC and DM are supported by the NIHR Yorkshire and Humberside Applied Research Collaboration (ARC) and DE is supported by the North East and North Cumbria ARCs. CCG is part funded by West Midland ARC.

Figures

**Figure 1**
Basil CONSORT flow diagram. CONSORT, Consolidated Standards of Reporting Trials.

**Figure 2**
Living meta-analysis of behavioural and cognitive trials targeting loneliness in socially isolated populations. SMD, standardised mean difference.

**Figure 3**
Living meta-analysis of behavioural and cognitive trials targeting depression in socially isolated populations. SMD, standardised mean difference.

See this image and copyright information in PMC

References

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical