People with learning disabilities may experience depression for longer than other people. Chris Hatton worked on a study led by Andrew Jahoda to examine the effects of adapted versions of psychological therapies and whether they should be offered
Key messages
Adults with learning disabilities who are depressed can be helped by adapted versions of psychological therapies that are routinely offered to everyone else.
Psychological therapies can reduce anxiety and help improve the quality of life of adults with learning disabilities who are depressed. These therapies are not expensive and can be delivered to a high standard by community learning disability nurses and a wide range of other professionals, with some training and supervision.
Adapted psychological therapies should be made routinely available to people with learning disabilities and mental health problems.
Background
People with learning disabilities are at least as likely as other people to experience depression; their depression is more likely to be enduring, possibly because it is more likely to go unrecognised.
The National Institute for Health and Care Excellence has issued guidelines on how to help people with learning disabilities and mental health problems (NICE, 2016).
Therapies or psychological interventions, such as cognitive behaviour therapy, behavioural activation and guided self-help, are all recommended for helping people with depression in these guidelines. However, NICE found that there was little evidence about whether adapted versions of these therapies were useful for people with learning disabilities who are depressed.
This research project used a gold standard method Ð the randomised controlled trial (RCT) Ð to compare behavioural activation and guided self-help in people with learning disabilities who are depressed.
Methods One hundred and sixty-one adults with learning disabilities from Scotland, North Wales and North West England who had been diagnosed by the project team as depressed took part in the project. Everyone gave their consent to take part, and had a supporter who knew them well with them in the therapy sessions.
All participants received help; it was randomly decided who would receive behavioural activation and who would get guided self-help. Behavioural activation involved 12 sessions with a trained therapist to help the person take part in more activities and work through any barriers getting in the way. Guided self-help involved eight sessions with a trained therapist working through four booklets focusing on major issues in depression, such sleep and problem solving. Therapists were mainly community learning disability nurses.
Information was collected from participants at three points: before the therapy started; four months afterwards (when the therapy would have finished); and another eight months after that (12 months from the start). Everyone was asked about their depression and other aspects of their life, including what health and social care services they were using.
Findings
Behavioural activation and guided self-help resulted in people both becoming substantially less depressed by the end of their therapy sessions, and staying less depressed eight months after the end of the therapy. This was the same for anxiety, which was reduced and stayed lower.
Quality of life improved over the course of both therapies; this was sustained eight months after the end of therapy.
There were no important differences between behavioural activation and guided self-help Ð both had a positive effect.
Carers also reported their confidence in helping people with emotional difficulties had improved by the end of the therapy sessions; this had not changed eight months afterwards.
Behavioural activation, because it lasted longer, was more expensive (average £1,789 per person) than guided self-help (average £1,019 per person). Relatively speaking, both ways of helping people were not costly given that people were on average using health and social care support costing well over £20,000 per year per person.
Views gathered through in-depth interviews with some of the participants with learning disabilities, their supporters and the therapists showed that almost everyone found the adapted therapies engaging and helpful.
Supporters were generally felt to be useful both in and between the therapy sessions, although social isolation made it hard for some people to find a consistent, reliable supporter.
Audio recordings of a selection of therapy sessions showed that those delivering the therapies, mainly learning disability nurses with little or no experience of doing any therapy work, were providing each therapy to a high standard.
Conclusions
The types of therapies or psychological interventions that are helpful for depressed people generally can be adapted to work just as well for people with learning disabilities.
They can make a difference to both peopleÕs depression and to their lives more generally.
The therapy is not expensive, and can be delivered and done well by community learning disability nurses as long as they are trained and supervised.
There is every reason to make these and similar ways of helping people with learning disabilities and mental health problems much more widely available.
Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial
Aims To compare two ways of helping people with learning disabilities who are depressed – are they helpful in reducing people’s depression and improving people’s lives more generally, and how much do they cost?
Methods A group of 161 adults with learning disabilities and a diagnosis of depression were randomly assigned to receive behavioural activation or guided self-help. Therapists were mainly community learning disability nurses. People were asked about their depression and other aspects of their lives before the therapy started, four months after the start (when the therapy had finished) and one year from the start.
Results and conclusion Both methods improved quality of life and reduced depression, and continued to do so a year after the project started. The therapies are not expensive and can be done well by community learning disability nurses.
Read the report Jahoda et al (2017) Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial. The Lancet Psychiatry; 4(12): 909Ð919. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30426-1/
This project was led by Andrew Jahoda at the University of Glasgow.
National Institute for Health and Care Excellence. NICE Guideline NG54: Mental Health Problems In People with Learning Disabilities: Prevention, Assessment and Management. London: NICE. www.nice.org.uk/ng54
