To Activate or Not to Activate: An Integral Question for Self-Guided Behavioral Activation Interventions for Older Adults with Sub-Clinical Depression

Global statistics suggest that although nearly 15% of older adults by the age of 65 meet criteria for a major depressive episode, many other older adults face sub-threshold levels of depression that still cause functional impairment and reduced quality of life. Despite concerns with polypharmacy, psychotropic medications continue to be a widely used intervention for depression among this population even in the presence of effective non-pharmacological evidence-based treatments such as behavioral activation (BA). Therefore, innovation is needed in research aimed at developing, implementing, and evaluating non-pharmacological scalable interventions to treat clinical and sub-clinical depression among older adults with and without comorbidities. To investigate this important issue, Gilbody et al. explored the effectiveness of an unguided self-help behavioral activation intervention (Self-Help for those At Risk for Depression - SHARD) to prevent and or mitigate depressive symptoms in older adults with sub-threshold depression living in the United Kingdom. Participants who met eligibility criteria were randomized to receive either a specifically designed SHARD workbook focused on skills associated with BA or standard of care as usual. Although there were no significant differences in quality-of-life scores at 4 months or 12 months post-intervention between groups, the odds of being depressed were more than halved for older adults who had received the SHARD BA workbook compared to those in the control group ·at 4 months, but not 12 months post-intervention.