The MIRROR2 pilot study: prevention of Major depressIon among older people living in Regional and RemOte aReas of Western Australia

INTERVENTION: Self‐help behavioural activation (BA) remotely supported by telephone vs usual care. Participants randomised to BA will be mailed a specifically‐designed self help workbook titled "Helping you to maintain a positive mood in older age". The workbook is based on clear principles of an evidence supported psychological treatment for depression in later life. It outlines relevant information about depression and offers guidance on how to identify depressive symptoms and take action to improve mental wellbeing. In particular, the booklet outlines how to monitor activities, keep a balance between activities and recognise the connection between activity and mood. To offer support to participants and optimise adherence to the intervention, a behavioural activation therapist will telephone participants on 3 occasions throughout the course of the 8 week program (first call within 2 weeks of randomisation than at week 4 and week 8) with a 4 week interval period between each call. The approximate duration of these telephone sessions will be 20‐30 minutes and participants will be asked to complete activities from the workbook during the 4 week interval periods. The BA therapist will encourage participants to complete all relevant activities and participants can spend as much time as they wish completing each relevant stage through the work book. CONDITION: Depression PRIMARY OUTCOME: Onset of a Major Depressive Episode as assessed by Module A (Mood episodes) of the Structured Clinical Interviews for DSM Disorders ‐ 1, Research Version. (SCID ‐ 1). SECONDARY OUTCOME: Health‐related quality of life as measured by the health‐related quality of life (SF‐12 short form health survey). Severity of anxiety symptoms, as per the brief measure for assessing Generalized Anxiety Disorder (GAD‐7). Severity of depressive symptoms, as measured by the Patient Health Questionnaire (PHQ–9). INCLUSION CRITERIA: ‐ Aged 65 years or over ‐ Screens positive on at least one of two questions known as the "Whooley" depression screening questions: low mood and decreased interest or enjoyment in usual activities. ‐ Resides in inner (RA2) or outer regional (RA3) or remote (RA4) Western Australia according to the Australian Standard Geographic Classification ‐ Remoteness Areas (ASGC‐RA) Classification 2011