ABSTRACT
Background Older adults were more likely to be socially isolated during the COVID-19 pandemic, with risk of depression and loneliness. Behavioural Activation (BA) could feasibly maintain mental health in the face of COVID isolation. Methods We undertook a multicentre randomised controlled trial [BASIL+ ISRCTN63034289] of BA to mitigate depression and loneliness among older people. BA was offered by telephone to intervention participants (n=218). Control participants received usual care, with existing COVID wellbeing resources (n=217). Findings Participants engaged with 5.2 (SD 2.9) of 8 remote BA sessions. Adjusted mean difference (AMD) for depression (PHQ-9) at 3 months [primary outcome] was -1.65 (95% CI -2.54 to -0.75, p<0.001). There was an effect for BA on emotional loneliness at 3 months (AMD -0.37, 95% CI -0.68 to -0.06, p=0.02), but not social loneliness (AMD -0.05, 95% CI -0.33 to 0.23, p=0.72). Other secondary outcomes at 3 months were anxiety (GAD-7: AMD -0.67, 95% CI -1.43 to 0.09, p=0.08) and quality of life (SF12 mental component: AMD 1.99, 95% CI 0.22 to 3.76, p=0.03; physical component: AMD -0.50, 95% CI -2.14 to 1.10, p=0.53). BASIL+ trial results were incorporated into a living systematic review [PROSPERO CRD42021298788], and we found strong evidence of an impact of behavioural and/or cognitive strategies on depression [random effects pooled standardised mean difference -0.32, 95% CI -0.48 to -0.16, 10 studies, n=1,210 participants] and loneliness [random effects pooled standardised mean difference -0.44, 95%CI -0.64 to -0.24, 13 studies, n=1,421 participants] in the short-term (<6 months). Interpretation BA is an effective intervention that reduces depression and some aspects of loneliness in the short term. This adds to the range of strategies to improve population mental health, particularly among older adults with multiple long-term conditions. These results will be helpful to policy makers in preventing depression and loneliness beyond the pandemic. Funding NIHR RP-PG-0217-20006
Subject(s)
Anxiety Disorders , Adjustment Disorders , Depressive Disorder , COVID-19ABSTRACT
BackgroundEvaluating public trust and vaccine willingness may contribute to the effectiveness of pandemic response policies and plans. This is particularly important in developing countries, such as those in the Caribbean region. This study aimed to evaluate public trust in information sources, confidence in institutions and COVID-19 vaccine willingness in Trinidad and Tobago. MethodsA cross-sectional online survey was conducted amongst the general population in Trinidad and Tobago from November 10th to December 7th 2020. The survey instrument was a validated questionnaire developed by the World Health Organisation (WHO) and adapted to the local setting. Descriptive statistics and regression analyses were used to analyse the data. ResultsOf the 623 responses analysed, 46.2% thought they were likely to contract COVID-19 while 37.7% considered themselves at high risk of contracting the illness. The most trusted sources of information included health workers (53.9%) and the ministry of health (42.4%). Each one unit increase in trust in the medical sector lowered the odds of believing misinformation and conspiracy theories. Overall, 62.6% of respondents said they would take the COVID-19 vaccine if available and recommended. Regression analyses showed those who agreed that everyone should adhere to the national immunization schedule and those who would take the flu vaccine, were 2.92 (p<0.001) and 3.68 times (p<0.001) as likely to take the vaccine, respectively.ConclusionOur study found that increasing trust in health sources, confidence in medical sector, adherence to the national immunisation schedule and acceptance of the flu vaccine may increase COVID-19 vaccine willingness rates. These results may guide public health response activities and identify areas for prioritisation and improvement.