Professor Carolyn Chew-Graham, a GP and researcher in the mental health of older people based at Keele University, has written a blog for us, about her new research, funded by NIHR, to develop and study an intervention which aims to help old people who have been isolated during the COVID-19 restrictions.
Impact of COVID-19 restrictions on mental health
The loss of familiar structures and routines during the COVID-19 pandemic is taking its toll on our mental health. “Lockdown” and physical distancing measures linked to COVID-19 have meant that many of the activities we used to do are no longer possible. There is concern that these changes to our usual activities will increase mental health difficulties for many.
Depression in older adults
Low mood and depression are common in older adults, and may be related to loss, bereavement, loneliness and social isolation. Depression is more common in people with long-term physical health conditions.
“This intervention will be evaluated to see if depression, anxiety and feelings of loneliness can be reduced or prevented during COVID-19.”
One explanation of this is that the health condition stops the person from undertaking activities that may have previously kept them feeling well. If someone is no longer able to go shopping, meet up with friends, go to the cinema or allotment, or look after grandchildren, they may start to feel low. They are no longer in touch with things in their world that had a naturally ‘anti-depressant’ effect for them.
Thus, older adults, particularly those with long-term conditions, have faced a “triple whammy” during the COVID-19 restrictions.
What might help? Behavioural Activation (BA) is an evidence-based intervention for low mood, and depression.1,2 A simple version of the BA approach is summarised in the figure below.
The basic idea is that if life changes very suddenly, behaviours can struggle to keep up, and people can get cut off from those things in life that are meaningful or important to them, which can lead to low mood and depression.3
“Enforced isolation causes disruption to daily routines, loss of social contact and loneliness which can lead to mental ill-health.”
As the figure below shows, this can set up a cycle that keeps low mood going. The COVID-19 restrictions, “lockdown”, “shielding” and “self-isolation”, may have set off such a cycle in older adults.
One advantage of BA treatment is that it is simple and can be thought of as four strategies – “R2D2”:
- Reintroduce previous behaviours
- Replace ‘old’ behaviours with ‘new’ ones
- Decrease avoidance and withdrawal behaviours
- Develop ways of triggering helpful behaviours
It’s the replacing ‘old’ behaviours with ‘new’ that can be particularly helpful for people with long-term conditions who are experiencing low mood. This approach may be useful for older adults coming out of lockdown, helping them deal with the isolation and loneliness they may have experienced.
Researchers at the Universities of York and Keele, in collaboration with Tees, Esk and Wear Valleys NHS FT (TEWV), Age UK and researchers at the Universities of Leeds and Manchester, have developed and are testing an intervention aimed at preventing and mitigating the onset of depression and loneliness among older adults resulting from the COVID-19 restrictions.
Enforced isolation, whether this is due to ‘shielding’ or ‘self-isolation’, causes disruption to daily routines, loss of social contact and loneliness which can lead to mental ill-health.
The intervention in the BASIL (Behavioural Activation in Social IsoLation) trial will be delivered by trained support workers, over the telephone, with up to eight sessions being offered. Study participants receive a notebook to work through with the support worker.
The impact of this intervention will be evaluated to see if depression can be reduced or prevented during the COVID-19 restrictions, and whether the intervention is acceptable to older adults and to support workers. Researchers will also see if this intervention can reduce anxiety and feelings of loneliness.
The BASIL trial, funded by NIHR (National Institute for Health Research), is led from the University of York by Professor Simon Gilbody, Director of the Mental Health & Addictions Research Group (MHARG) at the University of York, and Professor David Ekers, Clinical Director of Research & Development, TEWV & Honorary Professor, University of York.
Professor Carolyn Chew-Graham, a GP and researcher in the mental health of older people based at Keele University, is leading the evaluation of the intervention. The research team hope that this intervention will be shown to be effective and then delivered at scale in the UK and overseas.
1. Bosanquet K, Adamson J, Atherton K, Bailey D, Baxter C, Beresford-Dent J, Birtwistle J, Chew-Graham CA et al. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. HTA VOLUME 21 ISSUE 67 NOVEMBER 2017 ISSN 1366-5278.
2. Taylor AK, Gilbody S, Bosanquet K, Overend K, Bailey D, Foster D, Helen Lewis H, Chew-Graham CA. How should we implement collaborative care for older people with depression? A qualitative study using Normalisation Process Theory within the CASPER plus trial. BMC Family Practice. (2018) 19:116 https://doi.org/10.1186/s12875-018-0813-7.