Effect of behavioural activation for individuals with post-stroke depression: A systematic review and meta-analysis

Abstract

ABSTRACTObjectivesPost-stroke depression (PSD) affects one third of stroke survivors and substantially impacts recovery, so it is important to identify effective treatments for PSD. Behavioural activation (BA), a relatively simple intervention, has demonstrated efficacy in the treatment of adults with unipolar depression. However, its use and efficacy in the treatment of PSD has not been documented in a systematic review. This systematic review and meta-analysis considers: What effect does BA have on reducing depression symptoms in individuals diagnosed with PSD?MethodMEDLINE, Embase, Emcare, Cochrane Library, and PsycINFO, were searched for randomised controlled trials (RCTs) published in English, on 13 July 2021. To chart the data, we employed a customized extraction sheet. The Cochrane Collaboration risk-of-bias 2 tool was used to determine study quality.ResultsTwo papers, written by the same lead authors, met the inclusion criteria. The Communication and Low Mood trial and the Behavioural Activation Therapy for Post-Stroke Depression trial were conducted in the United Kingdom and published in 2012 and 2019, respectively. Meta-analysis showed BA was associated with a decrease in depression symptoms in patients with PSD relative to treatment as usual (standard mean difference (SMD) -0.54; 95% confidence interval (CI) -0.90 to -0.18).ConclusionBA may be more effective when compared to treatment as usual in reducing depression symptoms in individuals with PSD. Although our meta-analysis found positive effects of BA, the evidence is inconclusive due to the small number of studies. High-quality RCTs are needed to confirm the benefits of BA in PSD.Strengths and limitations of this studyThis review followed PRISMA guidelines with a protocol published in advance of the review being conducted.This is the first review to consider whether BA is effective in reducing PSD.We focused on depression as a single primary outcome; other outcome measures, such as quality of life, could have been considered.Based on the review questions inclusion was limited to experimental designs. Other designs provide additional insights into the application of BA to PSD that is beyond the scope of this study.Our review was restricted to studies published in English and did not examine grey literature; therefore, some studies may not have been included.