Effect of behavioral activation on time and frequency domain heart rate variability in older adults with subthreshold depression: a cluster randomized controlled trial in Thailand.

BACKGROUND: Increased prevalence of depression highlights the need for effective interventions. Behavioral activation (BA), which can easily be adapted for non-clinical populations, has been the recommended treatment for depression. It is based on a model of psychopathology explaining that losses or chronically low levels of positive reinforcement yield behavioral and emotional changes in depression and that encouraging individuals to increase their engagement in reinforcing activities can improve their mood and enhance their valuable life experiences. Heart rate variability (HRV) provides indices of autonomic function related to depression, but only a few studies have investigated the effect of BA on HRV, particularly among older adults with subthreshold depression. Accordingly, we aimed to investigate the effect of BA on HRV in older adults with subthreshold depression. METHODS: We conducted a 9-month cluster randomized controlled trial in two Health Promoting Hospitals (HPHs). Eighty-two participants were randomized into either intervention (BA with usual care) or control (usual care only) groups, with 41 participants per group. Daily step count was collected weekly during the 12-week BA intervention period, while HRV parameters, including the Standard Deviation of the Normal-to-Normal interval (SDNN), High Frequency (lnHF), Low Frequency (LF), and Low Frequency/High Frequency ratio (LF/HF), were examined at 0, 3, 6 and 9 months. Generalized Estimating Equations (GEEs) were used in the data analysis. RESULTS: Over nine months, the intervention and control groups differed significantly in the unadjusted mean change of HRV, SDNN [7.59 ms (95% CI: 1.67, 13.50)], lnHF [0.44 ms2 (95% CI: 0.04, 0.85)], and LF [0.53 ms2 (95% CI: 0.09, 0.98)], whereas the groups did not differ significantly in LF/HF ratio [0.01 ms2 (95% CI: -0.04, 0.06)]. CONCLUSION: Our results suggest that BA may have a therapeutic effect on depression symptoms of older adults with subthreshold depression via improved HRV. TRIAL REGISTRATION: TCTR20211019003 , thaiclinicaltrials.org, retrospectively registered on 19 October 2021.

Predictive validity of the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program fall risk screening algorithms among community-dwelling Thai elderly.

BACKGROUND: Fall risk screening using multiple methods was strongly advised as the initial step for preventing fall. Currently, there is only one such tool which was proposed by the U.S. Centers for Disease Control and Prevention (CDC) for use in its Stopping Elderly Accidents, Death & Injuries (STEADI) program. Its predictive validity outside the US context, however, has never been investigated. The purpose of this study was to determine the predictive validity (area under the receiver operating characteristic curve: AUC), sensitivity, and specificity of the two-step sequential fall-risk screening algorithm of the STEADI program for Thai elderly in the community. METHODS: A 1-year prospective cohort study was conducted during October 2018-December 2019. Study population consisted of 480 individuals aged 65 years or older living in Nakhon Ratchasima Province, Thailand. The fall risk screening algorithm composed of two serial steps. Step 1 is a screening by the clinician's 3 key questions or the Thai Stay Independent brochure (Thai-SIB) 12 questions. Step 2 is a screening by 3 physical fitness testing tools including Time Up and Go test (TUG), 30-s Chair Stand, and 4-stage balance test. Participants were then followed for their fall incidents. Statistical analyses were conducted by using Cox proportional hazard model. The AUC, sensitivity, specificity, and other relevant predictive validity indices were then estimated. RESULTS: The average age of the participants was 73.3 ± 6.51 years (range 65-95 years), and 52.5% of them were female. The screening based on the clinician's 3 key questions in Step 1 had a high AUC (0.845), with the sensitivity and specificity of 93.9% (95% CI 88.8, 92.7) and 75.0% (95% CI 70.0, 79.6), respectively. Appropriate risk categorization however differed slightly from the original STEADI program. CONCLUSIONS: With some modification, the fall risk screening algorithm based on the STEADI program was applicable in Thai context.

The Stay Independent Brochure as a Screening Evaluation for Fall Risk in an Elderly Thai Population.

INTRODUCTION: The Stay Independent Brochure (SIB) is a widely used fall-risk self-assessment tool, which is part of the Stopping Elderly Accident, Deaths & Injuries (STEADI) program in the US. However, the validity and reliability of the SIB have not been established in an elderly Thai population. OBJECTIVE: To construct a fall risk screening tool based on the SIB in a Thai elderly population and investigate its psychometric effect in a community context. METHODS: A total of 480 elderly participants volunteered to take part in this study from the Nakhon Ratchasima province. In the first part of the study, the original version of the SIB was translated into Thai (total 12 questions) and adapted into a modified version (total 18 questions). The translated SIBs were cross-culturally adapted and tested for content validity, test-retest reliability, inter-rater reliability, construct validity and internal consistency. In the second part of the study, the psychometric properties of the translated SIBs were assessed using test-retest and inter-rater reliability and content and construct validity. RESULTS: The SIBs had good content validity (IOC: 0.80 to 1.00), and the interclass correlation coefficient (ICC) of test-retest and inter-rater reliability was excellent for both SIB versions (ICC 0.89-0.95). The construct validity of 18 questions was tested by principal component factor analysis with varimax rotation and using factor loading greater than 0.4, and yielded 6 factors that explained 59.1% of the variance in fall risk (more than 12 questions). The coefficient alpha was higher than the usually recommended value of 0.70 for the total score of both SIB versions. The convergent validity between the TUG and BBS tests was statistically significant (p<0.001). CONCLUSION: Based on psychometric properties, it is recommended that the two Thai versions of the SIB are an appropriate initial screening tool for the multi-steps fall risk assessment algorithm in predicting falls in an elderly Thai community.