Melville, C.A. et al. (2023) Predictors and moderators of the response of adults with intellectual disabilities and depression to behavioural activation and guided self-help therapies. Journal of Intellectual Disability Research, 67(10), pp. 986-1002. (doi: 10.1111/jir.13063) (PMID:37344986)
![[img]](https://eprints.gla.ac.uk/style/images/fileicons/text.png) |
Text
300115.pdf - Published Version Available under License Creative Commons Attribution. 218kB |
Abstract
Background No previous studies have reported predictors and moderators of outcome of psychological therapies for depression experienced by adults with intellectual disabilities (IDs). We investigated baseline variables as outcome predictors and moderators based on a randomised controlled trial where behavioural activation was compared with guided self-help. Methods This study was an exploratory secondary data analysis of data collected during a randomised clinical trial. Participants (n = 161) were randomised to behavioural activation or guided self-help and followed up for 12 months. Pre-treatment variables were included if they have previously been shown to be associated with an increased risk of having depression in adults with IDs or have been reported as a potential predictor or moderator of outcome of treatment for depression with psychological therapies. The primary outcome measure, the Glasgow Depression Scale for Adults with Learning Disabilities (GDS-LD), was used as the dependant variable in mixed effects regression analyses testing for predictors and moderators of outcome, with baseline GDS-LD, treatment group, study centre and antidepressant use as fixed effects, and therapist as a random effect. Results Higher baseline anxiety (mean difference in outcome associated with a 1 point increase in anxiety 0.164, 95% confidence interval [CI] 0.031, 0.297; P = 0.016), lower performance intelligence quotient (IQ) (mean difference in outcome associated with a 1 point increase in IQ 0.145, 95% CI 0.009, 0.280; P = 0.037) and hearing impairment (mean difference 3.449, 95% CI 0.466, 6.432; P = 0.024) were predictors of poorer outcomes, whilst greater severity of depressive symptoms at baseline (mean difference in outcome associated with 1 point increase in depression −0.160, 95% CI −0.806, −0.414; P < 0.001), higher expectation of change (mean difference in outcome associated with a 1 point increase in expectation of change −1.013, 95% CI −1.711, −0.314; p 0.005) and greater percentage of therapy sessions attended (mean difference in outcome with 1 point increase in percentage of sessions attended −0.058, 95% CI −0.099, −0.016; P = 0.007) were predictors of more positive outcomes for treatment after adjusting for randomised group allocation. The final model included severity of depressive and anxiety symptoms, lower WASI performance IQ subscale, hearing impairment, higher expectation of change and percentage of therapy sessions attended and explained 35.3% of the variance in the total GDS-LD score at 12 months (R2 = 0.353, F4, 128 = 17.24, P < 0.001). There is no evidence that baseline variables had a moderating effect on outcome for treatment with behavioural activation or guided self-help. Conclusions Our results suggest that baseline variables may be useful predictors of outcomes of psychological therapies for adults with IDs. Further research is required to examine the value of these potential predictors. However, our findings suggest that therapists consider how baseline variables may enable them to tailor their therapeutic approach when using psychological therapies to treat depression experienced by adults with IDs.
| Item Type: | Articles |
|---|---|
| Additional Information: | This independent research study was funded by the UK National Institute for Health Research Health Technology Assessment Programme. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McConnachie, Professor Alex and Fulton, Ms Lauren and Williams, Professor Christopher and Jahoda, Professor Andrew and Briggs, Professor Andrew and Appleton, Ms Kim and Mcmeekin, Dr Nicola and Scott, Miss Katie and Cooper, Professor Sally-Ann and Melville, Professor Craig and Zhang, Miss Rui Qi |
| Creator Roles: | Melville, C.Conceptualization, Methodology, Funding acquisition, Writing – original draft Cooper, S.-A.Conceptualization, Funding acquisition, Writing – review and editing Mcmeekin, N.Writing – review and editing Appleton, K.Project administration, Data curation, Writing – review and editing Scott, K.Investigation, Writing – review and editing Fulton, L.Investigation, Data curation, Writing – review and editing McConnachie, A.Conceptualization, Funding acquisition, Formal analysis, Writing – review and editing, Methodology Zhang, R. Q.Methodology, Funding acquisition, Formal analysis, Writing – review and editing Williams, C.Conceptualization, Funding acquisition, Writing – review and editing Briggs, A.Conceptualization, Funding acquisition, Writing – review and editing Jahoda, A.Conceptualization, Methodology, Funding acquisition, Supervision, Writing – original draft |
| Authors: | Melville, C.A., Hatton, C., Beer, E., Hastings, R.P., Cooper, S.-A., Mcmeekin, N., Dagnan, D., Appleton, K., Scott, K., Fulton, L., Jones, R.S.P., McConnachie, A., Zhang, R., Knight, R., Knowles, D., Williams, C., Briggs, A., and Jahoda, A. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
| Journal Name: | Journal of Intellectual Disability Research |
| Publisher: | Wiley |
| ISSN: | 0964-2633 |
| ISSN (Online): | 1365-2788 |
| Published Online: | 21 June 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in Journal of Intellectual Disability Research 67(10): 986–1002 |
| Publisher Policy: | Reproduced under a Creative Commons licence |
University Staff: Request a correction | Enlighten Editors: Update this record
Funder and Project Information
Funder and Project Information