Effect of a low-intensity digital intervention on recovery from depression among older adults in Brazil: a randomised clinical trial

Abstract

AbstractImportance: There is an urgent need to provide scalable solutions to treat depression amongst older adults in poorly resourced settings.Objective: To assess the effectiveness of the Viva Vida digital psychosocial intervention for the treatment of depression among older adults.Design: Pragmatic, two-arm, individually randomised controlled trial with a 1:1 allocation ratio.Setting: Twenty-four primary care clinics in Guarulhos, Brazil.Participants: Older adults (60+ years) registered with these clinics were contacted by phone for a screening assessment provided that an active mobile number was available from their primary care records. A two-stage screening for depressive symptomatology with the Patient Health Questionnaire (PHQ) two-items followed by PHQ 9-items was applied. Those who scored ≥ 10 on the PHQ-9 were assessed at baseline and invited to participate. A total of 603 participants were recruited between September 2021 and April 2022, and followed-up to September 2022.Interventions: The Viva Vida psychosocial programme was offered to the intervention arm (n=298). Over six weeks, participants received 48 audio and visual messages based on psychoeducation and behavioural activation sent by WhatsApp. Health professionals were not involved. The control arm received a single message with information about depression (n=305). Both groups received routine primary care.Main outcomes: The primary outcome was recovery from depression (PHQ-9 score<10) at the three-month follow-up. Depression at five months was a secondary outcome.Results: Of 603 participants (mean age, 65.1 years; 451 (74.8%) women), 527 (87.4%) completed the three-month follow-up assessment. At this follow-up, 109 of 257 (42.4%) participants in the intervention arm had recovered from depression, compared with 87 of 270 (32.2%) participants in the control arm (adjusted odds ratio: 1.56; 95% CI: 1.07, 2.27;P=.021). This benefit was not maintained at the five-month follow-up (adjusted odds ratio: 1.02; 95% CI: 0.71, 1.47;P=.892).Conclusions and relevance: These results demonstrate the usefulness in reducing depressive symptoms using a self-help intervention that can be readily integrated into primary care programmes for treating older adults with depression. More research is needed to understand how the intervention can be optimised to maintain benefits in the longer term.Trial Registration: ReBEC registration: RBR-4c94dtn (https://ensaiosclinicos.gov.br/rg/RBR-4c94dtn).Key pointsQuestion: Can a low-intensity digital (self-help) psychosocial intervention delivered by automated WhatsApp audio and visual messages over six weeks improve depression recovery among older adults in Brazil?Findings: In this randomised controlled trial involving 603 older adults with depressive symptomatology, the Viva Vida digital intervention substantially improved recovery from depression compared with enhanced usual care at three months (42.4% versus 32.2%; odds ratio: 1.56). However, this difference was not maintained at five months.Meaning: The Viva Vida programme is a simple and easily scalable strategy, that can be integrated as a first step in the treatment of older adults with depression in primary care.