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Research ArticleOriginal Research

Treating Subthreshold Depression in Primary Care: A Randomized Controlled Trial of Behavioral Activation With Mindfulness

Samuel Y. S. Wong, Yu Ying Sun, Aaroy T. Y. Chan, Maria K. W. Leung, David V. K. Chao, Carole C. K. Li, King K. H. Chan, Wai Kwong Tang, Trevor Mazzucchelli, Alma M. L. Au and Benjamin H. K. Yip
The Annals of Family Medicine March 2018, 16 (2) 111-119; DOI: https://doi.org/10.1370/afm.2206
Samuel Y. S. Wong
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Yu Ying Sun
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Aaroy T. Y. Chan
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Maria K. W. Leung
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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David V. K. Chao
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Carole C. K. Li
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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King K. H. Chan
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Wai Kwong Tang
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Trevor Mazzucchelli
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Alma M. L. Au
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Benjamin H. K. Yip
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Wong, Sun, T.Y. Chan, Yip); Fanling Family Medicine Centre, Hospital Authority, Hong Kong, China (Leung); United Christian Hospital, Hospital Authority, Hong Kong, China (Chao); Kowloon East Cluster, Hospital Authority, Hong Kong, China (Li); Kowloon Central Cluster, Hospital Authority, Hong Kong, China (K.H. Chan); Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China (Tang); School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia (Mazzucchelli); Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Au)
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Abstract

PURPOSE We undertook a randomized controlled trial to assess the efficacy of group-based behavioral activation with mindfulness (BAM) for treating subthreshold depression in primary care in Hong Kong.

METHODS We recruited adult patients aged 18 years or older with subthreshold depression from public primary care clinics and randomly assigned them to a BAM intervention group or a usual care group. The BAM group was provided with eight 2-hour weekly BAM sessions by trained allied health care workers. Patients in the usual care group received usual medical care with no additional psychological interventions. The primary outcome was depressive symptoms measured by the Beck Depression Inventory-II at 12 months. Secondary outcomes included incidence of major depressive disorder at 12 months. We assessed quality of life, activity and circumstances change, functional impairment, and anxiety at baseline, end of intervention, 5 months, and 12 months.

RESULTS We randomly allocated 115 patients to the BAM intervention and 116 patients to usual care. At 12 months, compared with usual care peers, BAM patients had a slightly more favorable change in levels of depressive symptoms on the Beck Depression Inventory-II (between-group mean difference in score = −3.85; 95% CI, −6.36 to −1.34; Cohen d = −0.46, 95% CI, −0.76 to −0.16). Incidence of major depressive disorder was lower with BAM (10.8% vs 26.8%, P = .01), whereas groups did not differ significantly on other secondary outcomes at 12 months.

CONCLUSIONS Group BAM appears to be efficacious for decreasing depressive symptoms and reducing the incidence of major depression among patients with subthreshold depression in primary care, although generalizability of our findings may be limited.

  • behavioral activation
  • mindfulness
  • subthreshold depression
  • prevention
  • primary care
  • randomized controlled trial

Footnotes

  • Conflicts of interest: authors report none.

  • Funding support: The authors received funding support from the Health and Medical Research Fund (HMRF), 11120501.

  • Supplementary materials: Available at http://www.AnnFamMed.org/content/16/2/111/suppl/DC1/.

  • Received for publication April 27, 2017.
  • Revision received August 22, 2017.
  • Accepted for publication October 10, 2017.
  • © 2018 Annals of Family Medicine, Inc.
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Treating Subthreshold Depression in Primary Care: A Randomized Controlled Trial of Behavioral Activation With Mindfulness
Samuel Y. S. Wong, Yu Ying Sun, Aaroy T. Y. Chan, Maria K. W. Leung, David V. K. Chao, Carole C. K. Li, King K. H. Chan, Wai Kwong Tang, Trevor Mazzucchelli, Alma M. L. Au, Benjamin H. K. Yip
The Annals of Family Medicine Mar 2018, 16 (2) 111-119; DOI: 10.1370/afm.2206

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Treating Subthreshold Depression in Primary Care: A Randomized Controlled Trial of Behavioral Activation With Mindfulness
Samuel Y. S. Wong, Yu Ying Sun, Aaroy T. Y. Chan, Maria K. W. Leung, David V. K. Chao, Carole C. K. Li, King K. H. Chan, Wai Kwong Tang, Trevor Mazzucchelli, Alma M. L. Au, Benjamin H. K. Yip
The Annals of Family Medicine Mar 2018, 16 (2) 111-119; DOI: 10.1370/afm.2206
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Subjects

  • Domains of illness & health:
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Keywords

  • behavioral activation
  • mindfulness
  • subthreshold depression
  • prevention
  • primary care
  • randomized controlled trial

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