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Guided self-help for depression in autistic adults: the ADEPT feasibility RCT.
Health Technol Assess. 2019 12; 23(68):1-94.HT

Abstract

BACKGROUND

Co-occurring depression frequently occurs in autism. Evidence-based psychological interventions have been successfully adapted to treat co-occurring anxiety, but there is little evidence about the usefulness of adapted cognitive-behavioural therapy for depression. To the authors' knowledge, to date there have been no randomised trials investigating the usefulness of low-intensity cognitive-behavioural therapy for depression in autism.

OBJECTIVES

The objectives of the study were to (1) develop a low-intensity psychological intervention for depression adapted for autism, (2) assess the feasibility and patient and therapist acceptability of the intervention, (3) estimate the rates of recruitment and retention for a full-scale randomised controlled trial and (4) identify an appropriate measure of depression to be used in a full-scale randomised controlled trial.

DESIGN

The study comprised a randomised controlled trial (n = 70) with a nested qualitative evaluation (n = 21). Seventy eligible and consenting participants were randomly allocated to guided self-help or to treatment as usual.

SETTING

Adult autism services in two NHS regions.

PARTICIPANTS

Adults with a diagnosis of autism spectrum disorder with depression, that is, a Patient Health Questionnaire-9 items score of ≥ 10. People who had attended more than six sessions of cognitive-behavioural therapy in the previous 6 months were excluded.

INTERVENTIONS

The low-intensity intervention (guided self-help) comprised materials for nine individual sessions, based on behavioural activation adapted for autism, facilitated by therapist guides (coaches) who were graduate-level psychologists who attended training and regular supervision. Treatment as usual was standard NHS care for depression.

MAIN OUTCOME MEASURES

Outcomes were measured 10, 16 and 24 weeks post randomisation using self-report and interview measures of depression, anxiety, obsessive-compulsive symptoms, social function and quality of life, and a health-care and service use questionnaire. As this was a feasibility study also designed to identify the most appropriate measure of depression, it was not possible to specify the primary outcome measure or outcome point a priori.

RESULTS

The aims of the study were met in full. The guided self-help intervention was feasible and well received by participants and coaches. The majority of allocated participants attended the intervention in full. The most practical outcome point was determined to be 16 weeks. There were differential rates of attrition across the treatment groups: 86% of the guided self-help group remained in the study at 24 weeks, compared with 54% of treatment as usual group. The qualitative study suggested that guided self-help had enhanced credibility with participants at the point of randomisation. Inter-rater reliability of the interview measure of depression was less than adequate, limiting the conclusions that can be drawn from the prespecified sensitivity to change analyses.

CONCLUSIONS

The intervention was feasible and well received. Although this feasibility study was not a fully powered trial, it provided some evidence that the guided self-help intervention was effective in reducing depressive symptoms. A full-scale clinical effectiveness and cost-effectiveness trial of the intervention is warranted.

FUTURE WORK

Improvements to the intervention materials as a result of qualitative interviews. Stakeholder consultation to consider future trial design, consider strategies to improve retention in a treatment as usual arm and select a self-report measure of depression to serve as the primary outcome measure.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN54650760.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 68. See the NIHR Journals Library website for further project information. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.

Authors+Show Affiliations

Centre for Applied Autism Research, Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, UK.Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.Centre for Applied Autism Research, Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, UK.Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.Newcastle Cognitive and Behavioural Therapies Centre, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.BASS Adult Autism Service, Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK.Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK.School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK.Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31856942

Citation

Russell, Ailsa, et al. "Guided Self-help for Depression in Autistic Adults: the ADEPT Feasibility RCT." Health Technology Assessment (Winchester, England), vol. 23, no. 68, 2019, pp. 1-94.
Russell A, Gaunt D, Cooper K, et al. Guided self-help for depression in autistic adults: the ADEPT feasibility RCT. Health Technol Assess. 2019;23(68):1-94.
Russell, A., Gaunt, D., Cooper, K., Horwood, J., Barton, S., Ensum, I., Ingham, B., Parr, J., Metcalfe, C., Rai, D., Kessler, D., & Wiles, N. (2019). Guided self-help for depression in autistic adults: the ADEPT feasibility RCT. Health Technology Assessment (Winchester, England), 23(68), 1-94. https://doi.org/10.3310/hta23680
Russell A, et al. Guided Self-help for Depression in Autistic Adults: the ADEPT Feasibility RCT. Health Technol Assess. 2019;23(68):1-94. PubMed PMID: 31856942.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Guided self-help for depression in autistic adults: the ADEPT feasibility RCT. AU - Russell,Ailsa, AU - Gaunt,Daisy, AU - Cooper,Kate, AU - Horwood,Jeremy, AU - Barton,Stephen, AU - Ensum,Ian, AU - Ingham,Barry, AU - Parr,Jeremy, AU - Metcalfe,Chris, AU - Rai,Dheeraj, AU - Kessler,David, AU - Wiles,Nicola, PY - 2019/12/21/entrez PY - 2019/12/21/pubmed PY - 2020/10/21/medline KW - AUTISM KW - COGNITIVE–BEHAVIOURAL THERAPY KW - DEPRESSION KW - LOW-INTENSITY INTERVENTION KW - RANDOMISED CONTROLLED TRIAL SP - 1 EP - 94 JF - Health technology assessment (Winchester, England) JO - Health Technol Assess VL - 23 IS - 68 N2 - BACKGROUND: Co-occurring depression frequently occurs in autism. Evidence-based psychological interventions have been successfully adapted to treat co-occurring anxiety, but there is little evidence about the usefulness of adapted cognitive-behavioural therapy for depression. To the authors' knowledge, to date there have been no randomised trials investigating the usefulness of low-intensity cognitive-behavioural therapy for depression in autism. OBJECTIVES: The objectives of the study were to (1) develop a low-intensity psychological intervention for depression adapted for autism, (2) assess the feasibility and patient and therapist acceptability of the intervention, (3) estimate the rates of recruitment and retention for a full-scale randomised controlled trial and (4) identify an appropriate measure of depression to be used in a full-scale randomised controlled trial. DESIGN: The study comprised a randomised controlled trial (n = 70) with a nested qualitative evaluation (n = 21). Seventy eligible and consenting participants were randomly allocated to guided self-help or to treatment as usual. SETTING: Adult autism services in two NHS regions. PARTICIPANTS: Adults with a diagnosis of autism spectrum disorder with depression, that is, a Patient Health Questionnaire-9 items score of ≥ 10. People who had attended more than six sessions of cognitive-behavioural therapy in the previous 6 months were excluded. INTERVENTIONS: The low-intensity intervention (guided self-help) comprised materials for nine individual sessions, based on behavioural activation adapted for autism, facilitated by therapist guides (coaches) who were graduate-level psychologists who attended training and regular supervision. Treatment as usual was standard NHS care for depression. MAIN OUTCOME MEASURES: Outcomes were measured 10, 16 and 24 weeks post randomisation using self-report and interview measures of depression, anxiety, obsessive-compulsive symptoms, social function and quality of life, and a health-care and service use questionnaire. As this was a feasibility study also designed to identify the most appropriate measure of depression, it was not possible to specify the primary outcome measure or outcome point a priori. RESULTS: The aims of the study were met in full. The guided self-help intervention was feasible and well received by participants and coaches. The majority of allocated participants attended the intervention in full. The most practical outcome point was determined to be 16 weeks. There were differential rates of attrition across the treatment groups: 86% of the guided self-help group remained in the study at 24 weeks, compared with 54% of treatment as usual group. The qualitative study suggested that guided self-help had enhanced credibility with participants at the point of randomisation. Inter-rater reliability of the interview measure of depression was less than adequate, limiting the conclusions that can be drawn from the prespecified sensitivity to change analyses. CONCLUSIONS: The intervention was feasible and well received. Although this feasibility study was not a fully powered trial, it provided some evidence that the guided self-help intervention was effective in reducing depressive symptoms. A full-scale clinical effectiveness and cost-effectiveness trial of the intervention is warranted. FUTURE WORK: Improvements to the intervention materials as a result of qualitative interviews. Stakeholder consultation to consider future trial design, consider strategies to improve retention in a treatment as usual arm and select a self-report measure of depression to serve as the primary outcome measure. TRIAL REGISTRATION: Current Controlled Trials ISRCTN54650760. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 68. See the NIHR Journals Library website for further project information. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. SN - 2046-4924 UR - https://www.unboundmedicine.com/medline/citation/31856942/Guided_self_help_for_depression_in_autistic_adults:_the_ADEPT_feasibility_RCT_ L2 - https://doi.org/10.3310/hta23680 DB - PRIME DP - Unbound Medicine ER -