The Effectiveness of a Nurse-led Behavioral Activation Intervention in Hospitalized Depressed Elderly: a Pragmatic Cluster-randomized Clinical Trial.

Background: Approximately 10% of the elderly suffer from Major Depressive Disorder (MDD). The purpose of this study is to examine the effectiveness of a nurse-led behavioral activation program (the Systematic Activation Method), in depressed elderly. Methods: A cluster-randomized clinical trial in which ten hospital units were randomized as either an experimental unit or control unit (care-as-usual). Data was collected at baseline (T0), eight weeks later (post intervention=T1), and six months later (follow-up=T2). Primary outcome was severity of depressive symptoms. For the analysis multilevel linear models were used. We calculated the size of the effects with Hedges’ g (and their 95% confidence intervals). Results: 55 patients were included (n=30 experimental, n=25 control). The results showed that there were moderate post-intervention effects of the Systematic Activation Program in the reduction of depressive symptoms (g=0.35), but these effects were not statistically significant. Conclusions: : The inclusion of patients was lower than calculated in the power analysis. A more intensive focus on applying motivational techniques and tailored implementation strategies might increase treatment effects on the patients. Trial registration: Dutch Trial Register NTR 1809.