Article Figures & Data
Figures
- Figure 1
Flow chart of the randomized controlled trial.
BAM = behavioral activation with mindfulness.
Tables
Characteristic Total (N=231) BAM Group (n=115) Usual Care Group (n=116) Test Statistic, t or χ2 Age, mean (SD), y 54.0 (12.0) 55.3 (10.4) 52.7 (13.3) 1.676 Sex, No. (%) Male 16 (6.9) 6 (5.2) 10 (8.6) 1.038 Female 215 (93.1) 109 (94.8) 106 (91.4) Education, No. (%) Primary or less 72 (31.2) 36 (31.3) 36 (31.0) 0.423 Middle school 113 (48.9) 58 (50.4) 55 (47.4) Diploma or more 46 (19.9) 21 (18.3) 25 (21.6) Occupation, No. (%) Housewife 89 (38.5) 44 (38.3) 45 (38.8) 1.176 Retired 54 (23.4) 24 (20.9) 30 (25.9) Employed or self-employed 74 (32.0) 39 (33.9) 35 (30.2) Part-time or other 14 (6.1) 8 (7.0) 6 (5.2) Marital status, No. (%) Single 38 (16.7) 16 (14.0) 22 (19.3) 8.899a Married 166 (72.8) 92 (80.7) 74 (64.9) Live alone 24 (10.5) 6 (5.3) 18 (15.8) Income, No. (%) <$5,000 75 (33.2) 39 (34.5) 36 (31.9) 1.128 $5,000-$10,000 51 (22.6) 24 (21.2) 27 (23.9) $10,000–$20,000 74 (32.7) 35 (31.0) 39 (34.5) >$20,000 26 (11.5) 15 (13.3) 11 (9.7) PHQ-9 score, mean (SD)b 7.35 (1.41) 7.38 (1.40) 7.32 (1.43) 0.342 Health conditions, No. (%) Diabetes 26 (11.3) 15 (13.0) 11 (9.5) 0.733 Hypertension 91 (39.4) 51 (44.3) 40 (34.5) 2.354 Rheumatoid arthritis 30 (13.0) 16 (13.9) 14 (12.1) 0.174 Cancer 18 (7.8) 13 (11.3) 5 (4.3) 3.932a Outcome Time Point BAM Group, Mean (SD) (n=115) Usual Care Group, Mean (SD) (n=116) Modified Intention-to-Treat Analysis Imputed Data Analysis Per-Protocol Analysis Between-Group Difference (95% CI) P Value Between-Group Difference (95% CI) P Value Between-Group Difference (95% CI) P Value BDI-II scorea,b T0 19.18 (8.35) 17.68 (9.52) – – – T1 15.41 (9.53) 17.28 (9.83) −3.57 (−5.38 to −1.78) <.001 −3.21 (−5.02 to −1.40) <.001 −3.78 (−5.93 to −1.63) .001 T2 15.04 (10.29) 16.57 (10.47) −2.97 (−5.35 to −0.59) .02 −2.32 (−4.65 to 0.01) .051 −3.29 (−5.84 to −0.74) .01 T3 14.45 (10.40) 16.90 (10.84) −3.85 (−6.36 to −1.34) .003 −3.06 (−5.48 to −0.64) .01 −3.96 (−6.58 to −1.35) .003 SF-12: PCS scoreb,c T0 40.19 (8.66) 41.75 (9.75) – – – – T1 40.16 (8.86) 41.26 (9.96) 0.22 (−1.70 to 2.13) .82 −0.03 (−1.92 to 1.86) .97 0.50 (−1.89 to 2.88) .68 T2 39.61 (8.98) 40.00 (9.46) 0.72 (−1.68 to 3.13) .55 0.21 (−2.04 to 2.45) .86 0.29 (−2.31 to 2.90) .83 T3 39.19 (8.67) 40.15 (10.20) 0.18 (−2.30 to 2.65) .89 −0.10 (−2.44 to 2.25) .94 −0.10 (−2.71 to 2.51) .94 SF12: MCS scoreb,c T0 40.24 (8.81) 40.99 (10.11) – – – T1 42.96 (9.62) 40.95 (9.84) 3.22 (1.09 to 5.35) .003 2.99 (0.85 to 5.13) .006 3.09 (0.48 to 5.70) .02 T2 42.02 (9.27) 41.33 (8.87) 1.43 (−1.05 to 3.91) .26 1.12 (−1.24 to 3.48) .35 1.85 (−0.87 to 4.58) .18 T3 42.81 (10.00) 42.24 (9.14) 1.41 (−1.22 to 4.04) .29 1.12 (−1.33 to 3.58) .37 1.27 (−1.50 to 4.04) .37 ACCQ scored T0 13.87 (6.58) 13.31 (5.90) – – – T1 17.30 (6.14) 14.63 (6.44) 2.62 (1.13 to 4.11) .001 2.47 (0.98 to 3.97) .001 2.41 (0.59 to 4.24) .01 T2 16.20 (6.62) 16.09 (7.31) 0.13 (−1.75 to 2.00) .90 0.42 (−1.43 to 2.28) .65 −0.26 (−2.34 to 1.82) .81 T3 17.07 (7.11) 16.11 (7.26) 1.01 (−1.08 to 3.09) .34 1.15 (−0.87 to 3.17) .26 1.12 (−1.12 to 3.36) .32 SDS scoreb,e T0 11.70 (9.23) 11.03 (8.68) – – – T1 11.58 (9.39) 10.87 (8.69) 0.24 (−1.98 to 2.46) .83 0.37 (−1.80 to 2.54) .74 0.49 (−2.14 to 3.11) .71 T2 9.14 (8.14) 9.92 (8.59) −1.27 (−3.63 to 1.08) .29 −0.38 (−2.59 to 1.84) .74 −1.72 (−4.28 to 0.84) .19 T3 10.58 (9.30) 11.15 (9.91) −1.23 (−3.83 to 1.37) .35 −0.62 (−2.99 to 1.76) .61 −1.21 (−3.93 to 1.50) .38 STAI-S scoref T0 48.03 (9.42) 47.71 (10.17) – – – T1 46.26 (11.54) 47.68 (9.33) −2.18 (−4.44 to −0.08) .059 −1.87 (−4.15 to 0.41) .11 −1.19 (−3.83 to 1.46) .38 T2 46.27 (10.54) 47.37 (9.41) −1.64 (−4.17 to 0.89) .20 −1.30 (−3.73 to 1.13) .29 −1.65 (−4.45 to 1.15) .25 T3 45.99 (10.43) 47.70 (10.56) −2.50 (−5.20 to 0.19) .07 −1.72 (−4.30 to 0.86) .19 −2.08 (−4.97 to 0.81) .16 STAI-T scoref T0 47.76 (8.18) 46.87 (8.70) – – – T1 46.75 (9.38) 47.43 (8.15) −1.56 (−3.48 to 0.36) .11 −1.25 (−3.13 to 0.63) .19 −1.73 (−3.98 to 0.53) .13 T2 46.47 (8.92) 47.22 (8.52) −1.69 (−3.87 to 0.49) .13 −1.15 (−3.18 to 0.88) .26 −1.97 (−4.31 to 0.38) .099 T3 47.17 (8.97) 48.14 (8.48) −1.99 (−4.27 to 0.30) .09 −1.40 (−3.65 to 0.84) .22 −1.80 (−4.14 to 0.53) .13 ACCQ = Activity and Circumstantial Change Questionnaire; BAM = behavioral activation with mindfulness; BDI-II: Beck Depression Inventory-II; MCS = mental component summary; PCS = physical component summary; SDS = Sheehan Disability Scale; SF-12 = 12-item Medical Outcomes Study Short-Form Health Survey; STAI-S = State Trait Anxiety Inventory–State; STAI-T = State Trait Anxiety Inventory–Trait; T0 = baseline; T1 = end of intervention; T2 = 5-month follow-up; T3=12-month follow-up.
Note: Major depressive disorder at T3 was present in 9 patients (10.8%) in the BAM group and 26 patients (26.8%) in the usual care group (P =.01). Analysis conducted using observed data, and P value obtained by logistic regression analysis with cancer history and marital status as covariates.
↵a Possible range for total scores is 0 to 63; higher scores indicate more severe depression.
↵b P values for group effect were calibrated by analysis of covariance (ANCOVA) approach, with baseline value, cancer history, and marital status as covariates.
↵c Possible range is 0 to 100; higher scores indicate better self-reported health.
↵d Possible range is 8 to 40; higher scores indicate greater positive change.
↵e Possible range is 0 to 40; higher scores indicate more functional impairment.
↵f Possible range is 20 to 80; higher scores indicate greater anxiety.
Supplemental Appendixes
Supplemental Appendix, Table, Figures
Files in this Data Supplement:
- Supplemental data: Appendixes - PDF File
The Article in Brief
Treating Subthreshold Depression in Primary Care: A Randomized Controlled Trial of Behavioral Activation With Mindfulness
Samuel Y. S. Wong , and colleagues
Background Subthreshold (minor) depression is common among primary care patients. The aim of this study was to evaluate the effectiveness of group behavioral activation focused on mindfulness training to treat subthreshold depression in primary care.
What This Study Found Among primary care patients with subthreshold depression, mindfulness meditation training reduces the incidence of major depression and improves depression symptoms. A randomized controlled trial of adults with subthreshold depression compared a usual care group in which there was no psychological intervention (n=116) with a behavioral activation group focused on mindfulness training (n=115). Intervention participants were invited to attend weekly two-hour mindfulness training sessions for eight consecutive weeks. At 12 months, there was a statistically significant difference in the incidence of major depressive disorder between groups (11 percent in the mindfulness group compared to 27 percent in usual care). Mindfulness training also had a small effect in reducing depression symptoms. Other secondary outcomes demonstrated no significant change.
Implications
- The authors suggest that, for patients with subthreshold depression who have not had a major depressive episode in the past six months, mindfulness training is a feasible method of preventing major depression.
- The authors plan future research into the cost-effectiveness, health service use implications, and acceptability of mindfulness training.
