Self-help mobile messaging intervention for depression among older adults in resource-limited settings: a randomized controlled trial

Scalable solutions to treat depression in older adults in low-resourced settings are urgently needed. The PRODIGITAL-D pragmatic, single-blind, two-arm, individually randomized controlled trial assessed the effectiveness of a mobile messaging psychosocial intervention in improving depressive symptomatology among older adults in socioeconomically deprived areas of Guarulhos, Brazil. Older adults (aged 60+ years) registered with 24 primary care clinics and identified with depressive symptomatology (9-item Patient Health Questionnaire (PHQ-9) scores ≥10) received the 6-week Viva Vida intervention based on psychoeducation and behavioral activation (n=298) or a single message (n=305). No health professional support was offered. The primary outcome was improvement from depressive symptomatology (PHQ-9 <10) at 3 months. Of the 603 participants enrolled (mean age = 65.1 years; 451 (74.8%) women), 527 (87.4%) completed the follow-up assessment. In the intervention arm, 109 of 257 (42.4%) participants had an improved depressive symptomatology, compared with 87 of 270 (32.2%) participants in the control arm (adjusted odds ratio = 1.57; 95% confidence interval = 1.07–2.29; P = 0.019). No severe adverse events related to trial participation were observed. These results demonstrate the usefulness of a digital messaging psychosocial intervention in the short-term improvement from depressive symptomatology that can potentially be integrated into primary care programs for treating older adults with depression. Brazilian Registry of Clinical Trials registration: ReBEC (RBR-4c94dtn).

Marcia Scazufca, Carina Akemi Nakamura, Nadine Seward, Thiago Vinicius Nadaleto Didone, Felipe Azevedo Moretti, Marcelo Oliveira da Costa, Caio Hudson Queiroz de Souza, Gabriel Macias de Oliveira, Monica Souza dos Santos, Luara Aragoni Pereira, Mariana Mendes de Sá Martins, Pepijn van de Ven, William Hollingworth, Tim J. Peters, Ricardo Araya