The effectiveness of group-based behavioral activation in the treatment of depression: An updated meta-analysis of randomized controlled trial

•Participants who joined the group-based BA showed lower depressive symptoms (MD of BDI-II: −6.06 (95% CI: −8.28 to −3.85 and MD of HRSD: −2.82 (95% CI: −4.62 to −1.02)) than participants randomized to the control group with usual treatment.•The group-based BA also showed significant reduction in anxiety level (MD of BAI: −3.66 (95% CI: −6.11 to −1.22)) but not quality of life.•Showed evidence that group-based BA are cost-effective, flexible depressive treatment methods that can be implemented in any settings, length, size, and taught by trained allied health professionals.•Study revealed an increase in QALY in favor of BA of 0.20 (95% CI 0.01-0.39, P=0.042).•ICER of £5756 per QALY with 97.7% chance that BA was more cost-effective at a threshold value of £20 000.

BackgroundDepression is a common mental health problem associated with significant morbidity and mortality. Amongst various psychological treatments for depression, individual behavioral activation (BA) has been shown to be effective and relatively simple in its delivery by health care providers although its effectiveness as a group based intervention requires further evidence. The objective of this study is to evaluate and update on the effectiveness of group-based BA to relieve symptoms of depression.MethodsA meta-analysis was performed and prospective randomized trials were systematically searched from the OVID databases. The trials comparing group-based BA intervention versus usual care or waitlist controls were included. Depressive symptom measured by various validated scales was the primary outcome. As the interventions can be heterogeneous across the included studies, all analyses were performed by random-effects model.ResultsSeven randomized control trials were identified from the United States, United Kingdom, Sweden and Iran from 2003 to 2013. A total of 240 subjects were randomly assigned to group-based BA, and all participants included met the criteria for moderate to severe depression at baseline with the majority of participants being females. Participants who joined the group-based BA showed lower depressive symptoms (MD of BDI-II: −6.06 (95% CI: −8.28 to −3.85 and MD of HRSD: −2.82 (95% CI: −4.62 to −1.02)) than participants randomized to the control group with usual treatment. The group-based BA also showed significant reduction in anxiety level (MD of BAI: −3.66 (95% CI: −6.11 to −1.22)) but not quality of life according to two studies. Risk of bias was evident amongst the studies as blinding of health providers and patients were not feasible in psychological studies.ConclusionsGroup-based behavioral activation remains promising in relieving depressive symptoms for people with moderate to severe depression from this meta-analysis. Future studies should be higher quality research with larger sample size, longer follow-up periods, and synchronized clinical outcome measures. Patient feedback for group-based behavioral activation can also be further evaluated in order to ensure long term satisfaction and usage in health services.