Autor(es)

Seward, Nadine ; Peters, Tim J. ; Loh, Wen Wei ; Nakamura, Carina Akemi ; Mcmillan, Dean ; Gilbody, Simon ; Araya, Ricardo ; Scazufca, Marcia

• Tipo de documento: Artigo Científico
• Fonte: Journal of Affective Disorders; v. 372, p. 9-pg., 2024-12-06.

Resumo

Background: The PROACTIVE trial was a task-shared, stepped and collaborative care, psychosocial intervention based on psychoeducation and behavioural activation in 715 participants (60-94 years; mean (SD) 68<middle dot>6 (6.9) years; 74<middle dot>1 % female), that was highly effective at improving recovery from depression among older adults in Brazil. Here we investigate mediators of the intervention's effectiveness. Methods: Causal mediation analysis using interventional indirect effects, simultaneously decomposed the total effect of PROACTIVE on recovery from depression (PHQ-9 < 10) into multiple indirect effects including: dose of intervention (numbers of sessions and activities completed); social support (Luben Social Network Scale); perceived loneliness (UCLA questionnaire); and additional sessions offered to participants who did not respond during the initial phase of the stepped care intervention. Results: Of the intervention's total effect (difference in probability of recovery from depression between the intervention and control arms 0<middle dot>216 [bias-corrected 95 % CI: 0<middle dot>149, 0<middle dot>291]): 13 % was mediated through reduced loneliness (0<middle dot>028 [0<middle dot>013, 0<middle dot>046]); and 25 % through attending additional sessions for participants who did not initially respond to the intervention (0<middle dot>055 [0<middle dot>007, 0<middle dot>102]). Limitations: Due to limitations in our sample size our study may lack power to detect some nuances such as interactions between different mediators. Conclusions: Our findings emphasise the importance of a home-based intervention to improve depression outcomes where participants are encouraged to self-select activities to mitigate against loneliness. Importantly, our findings suggest that the intervention's stepped-care component offering additional sessions to participants who did not experience an early response shows promise in ensuring a sustained recovery from depression. (AU)

• Processo FAPESP: 17/50094-2 - Cluster randomised controlled trial for late life Depression in socieconomically deprived areas of São Paulo, Brazil
• Beneficiário: Marcia Scazufca
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 18/19343-9 - Ensaio clínico controlado e randomizado para idosos com depressão residentes em áreas desprivilegiadas de São Paulo, Brasil
• Beneficiário: Carina Akemi Nakamura
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 22/05107-7 - Intervenções psicossociais para o manejo de sintomas depressivos em idosos na atenção básica no Brasil
• Beneficiário: Carina Akemi Nakamura
• Modalidade de apoio: Bolsas no Exterior - Estágio de Pesquisa - Pós-Doutorado