INTRODUCTION Effective non-pharmacological treatment options for depression in older adults are lacking. OBJECTIVE The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated. METHODS In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up. RESULTS Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p < 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24). CONCLUSIONS BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.

中文翻译：

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初级保健中抑郁老年人的行为激活与常规治疗：一项务实的整群随机对照试验。

引言 老年人抑郁症缺乏有效的非药物治疗方案。目的 评估心理健康护士 (MHN) 对初级保健中抑郁老年人的行为激活 (BA) 与常规治疗 (TAU) 相比的有效性。方法 在这项多中心整群随机对照试验中，59 个初级保健中心 (PCC) 被随机分为 BA 和 TAU。同意并具有临床相关抑郁症状 (PHQ-9 ≥ 10) 的老年（≥65 岁）成年人 (n = 161) 参与。干预措施是由 MHN 主导的为期 8 周的个人 BA 计划和无限制的 TAU，其中全科医生遵循国家指南。主要结局是第 9 周以及第 3、6、9 和 12 个月随访时的自我报告抑郁症 (QIDS-SR16)。结果 2016年7月4日至2020年9月21日期间招募的来自BA 21个PCC的96名参与者和来自TAU 16个PCC的65名参与者的数据被纳入意向治疗分析。治疗后，BA 参与者报告的抑郁症状严重程度显着低于 TAU 参与者（QIDS-SR16 差异 = -2.77，95% CI = -4.19 至 -1.35），p < 0.001；组间效应量 = 0.90；95% CI = 0.42-1.38）。这种差异一直持续到 3 个月的随访（QIDS-SR16 差异 = -1.53​​，95% CI = -2.81 至 -0.26，p = 0.02；组间效应大小 = 0.50；95% CI = 0.07-0.92 ）但未达 12 个月随访 [QIDS-SR16 差异 = -0.89（-2.49 至 0.71）]，p = 0.28；组间效应大小 = 0.29（95% CI = -0.82 至 0.24）。结论 在初级保健中，与 TAU 相比，在治疗后和 3 个月的随访中，BA 可以更大程度地减轻老年人的抑郁症状，但在 6 至 12 个月的随访中则不然。