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