Skip to main content

Behavioural activation for depression in older people: systematic review and meta-analysis

  • Vasiliki Orgeta (a1), Janina Brede (a1) and Gill Livingston (a1)

Behavioural activation is an effective treatment for depression in the general adult population but it is unclear whether it is effective for older people.


To systematically review randomised controlled trials (RCTs) of behavioural activation for depression in older people.


We searched Medline, EMBASE, PsycINFO, CINAHL and online trial registers for RCTs of behavioural activation for depression in older people.


Eighteen trials were included in the meta-analyses. Behavioural activation reduced mean depression scores for older people living in the community as a stand-alone treatment: standardised mean difference (SMD) −0.72, 95% Cl −1.04 to −0.41. It was also effective as part of a multicomponent intervention (SMD −0.44, 95% CI −0.56 to −0.32).


Behavioural activation significantly reduces depressive symptoms in older people in the community; however, given that most studies are small and with significant bias results should be interpreted with caution. Further high-quality trials of behavioural activation for this age group are needed.

Corresponding author
Dr Vasiliki Orgeta, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Email:
Hide All

Declaration of Interest

V.O. and G.L. are principal investigators of an ongoing trial.

Hide All
1 Rodda, J, Walker, Z, Carter, J. Depression in older adults. BMJ 2011; 343: d5219.
2 Meeks, TW, Vahia, IV, Lavretsky, H, Kulkarni, G, Jeste, DV. A tune in ‘a minor’ can ‘b major’: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011; 129: 126–42.
3 Koenig, HG. Differences in psychosocial and health correlates of major and minor depression in medically ill older adults. J Am Geriatr Soc 1997; 45: 1487–95.
4 Schoevers, RA, Geerlings, MI, Beekman, AT, Penninx, BW, Deeg, DJ, Jonker, C, et al. Association of depression and gender with mortality in old age. Results from the Amsterdam Study of the Elderly (AMSTEL). Br J Psychiatry 2000; 177: 336–42.
5 Vasiliadis, HM, Dionne, PA, Preville, M, Gentil, L, Berbiche, D, Latimer, E. The excess healthcare costs associated with depression and anxiety in elderly living in the community. Am J Geriatr Psychiatry 2013; 21: 536–48.
6 Knochel, C, Alves, G, Friedrichs, B, Schneider, B, Schmidt-Rechau, A, Wenzler, S, et al. Treatment-resistant late-life depression: challenges and perspectives Curr Neuropharmacol 2015; 13: 577–91.
7 Smit, F, Ederveen, A, Cuijpers, P, Deeg, D, Beekman, A. Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Arch Gen Psychiatry 2006; 63: 290–6.
8 Lewinsohn, PM, Hoberman, HM, Teri, L, Hautzinger, M. An integrative theory of depression. In Theoretical Issues in Behavior Therapy (eds Reiss, S, Bootzin, RR): 331–59. Academic Press, 1985.
9 Lewinsohn, PM, Munoz, RF, Youngren, MA, Zeis, AM. Control Your Depression. Prentice Hall, 1986.
10 Fiske, A, Wetherell, JL, Gatz, M. Depression in older adults. Annu Rev Clin Psychol 2009; 5: 363–89.
11 Richards, DA, Ekers, D, McMillan, D, Taylor, RS, Byford, S, Warren, FC, et al. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet 2016; 388: 871–80.
12 Dimidjian, S, Barrera, M, Martell, C, Munoz, RF, Lewinsohn, PM. The origins and current status of behavioral activation treatments for depression. Annu Rev Clin Psychol 2011; 7: 138.
13 Farrand, P. Behavioural activation self-help for well-being in people with dementia (ISRCTN42017211). ISRCTN Registry, 2015 (
14 Raue, P. Peer to peer delivery of behavioral activation (NCT02292849). 2014,
15 Clignet, F, van Meijel, B, van Straten, A, Cuijpers, P. The systematic activation method as a nursing intervention in depressed elderly: a protocol for a multi-centre cluster randomized trial. BMC Psychiatry 2012; 12: 144.
16 Orgeta, V. IDEA: Intervention to prevent depressive symptoms and promote well-being in early stage dementia (ISRCTN75503960). ISRCTN Registry, 2015 (
17 Overend, K, Lewis, H, Bailey, D, Bosanquet, K, Chew-Graham, C, Ekers, D, et al. CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2014; 15: 451.
18 Mitchell, N, Hewitt, C, Adamson, J, Parrott, S, Torgerson, D, Ekers, D, et al. A randomised evaluation of CollAborative care and active surveillance for Screen-Positive EldeRs with sub-threshold depression (CASPER): study protocol for a randomized controlled trial. Trials 2011; 12: 225.
19 Dong, X, Chen, R, Wong, E, Simon, MA. Suicide prevention in Chinese older adults (NCT02096432). 2014,
20 Gallagher, DE, Thompson, LW. Treatment of major depressive disorder in older adult outpatients with brief psychotherapies. Psychotherapy: Theory, Research and Practice 1982; 19: 482–90.
21 Thompson, LW, Gallagher, D. Efficacy of psychotherapy in the treatment of late-life depression. Adv Behav Res Ther 1984; 6: 127–39.
22 Cernin, PA, Lichtenberg, PA. Behavioral treatment for depressed mood: a pleasant events intervention for seniors residing in assisted living. Clin Gerontol 2009; 32: 324–31.
23 Moss, K, Scogin, F, Di Napoli, E, Presnell, A. A self-help behavioral activation treatment for geriatric depressive symptoms. Aging Ment Health 2012; 16: 625–35.
24 Scogin, F, Jamison, C, Gochneaur, K. Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol 1989; 57: 403–7.
25 Ciechanowski, P, Wagner, E, Schmaling, K, Schwartz, S, Williams, B, Diehr, P, et al. Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA 2004; 291: 1569–77.
26 Gitlin, LN, Harris, LF, McCoy, MC, Chernett, NL, Pizzi, LT, Jutkowitz, E, et al. A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial. Ann Intern Med 2013; 159: 243–52.
27 Unutzer, J, Katon, W, Callahan, CM, Williams, JW, Hunkeler, E, Harpole, L, et al. Improving mood-promoting access to collaborative treatment, collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002; 288: 2836–45.
28 Gilbody, S, Lewis, H, Adamson, J, Atherton, K, Bailey, D. Effect of collaborative care vs usual care on depressive symptoms in older adults with subthreshold depression: the CASPER randomized clinical trial. JAMA 2017; 317: 728–37.
29 Norton, MJ. Evaluation of a Brief Behavioral Activation Therapy for Depression (BATD) group protocol in an inpatient geriatric psychiatry facility. Dissertation Abstracts International: Section B: The Sciences and Engineering 2010; 71: 7099.
30 Snarski, M, Scogin, F, DiNapoli, E, Presnell, A, McAlpine, J, Marcinak, J. The effects of behavioral activation therapy with inpatient geriatric psychiatry patients. Behav Ther 2011; 42: 100–8.
31 Sood, JR, Cisek, E, Zimmerman, J, Zaleski, EH, Fillmore, HH. Treatment of depressive symptoms during short-term rehabilitation: an attempted replication of the DOUR project Rehabil Psychol 2003; 48: 44–9.
32 Dozeman, E, van Schaik, DJ, van Marwijk, HW, Stek, ML, Beekman, AT, van der Horst, HE. Feasibility and effectiveness of activity-scheduling as a guided self-help intervention for the prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial. Int Psychogeriatr 2011; 23: 969–78.
33 Hyer, L, Yeager, CA, Hilton, N, Sacks, A. Group, individual, and staff therapy: an efficient and effective cognitive behavioral therapy in long-term care. Am J Alzheimers Dis Other Demen 2008; 23: 528–39.
34 Lichtenberg, PA, Kemp-Havican, J, Macneill, SE, Schafer Johnson, A. Pilot study of behavioral treatment in dementia care units. Gerontologist 2005; 45: 406–10.
35 Meeks, S, Looney, SW, Van Haitsma, K, Teri, L. BE-ACTIV: a staff-assisted behavioral intervention for depression in nursing homes. Gerontologist 2008; 48: 105–14.
36 Meeks, S, Van Haitsma, K, Schoenbachler, B, Looney, SW. BE-ACTIV for depression in nursing homes: primary outcomes of a randomized clinical trial. J Gerontol B Psychol Sci Soc Sci 2015; 70: 1323.
37 Verkaik, R, Francke, AL, van Meijel, B, Spreeuwenberg, PM, Ribbe, MW, Bensing, JM. The effects of a nursing guideline on depression in psychogeriatric nursing home residents with dementia. Int J Geriatr Psychiatry 2011; 26: 723–32.
38 Teri, L, Logsdon, RG, Uomoto, J, McCurry, SM. Behavioral treatment of depression in dementia patients: a controlled clinical trial. J Gerontol B Psychol Sci Soc Sci 1997; 52: P15966.
39 Teri, L, Gibbons, LE, McCurry, SM, Logsdon, RG, Buchner, DM, Barlow, WE, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA 2003; 290: 2015–22.
40 Gitlin, LN, Winter, L, Dennis, MP, Hodgson, N, Hauck, WW. A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. JAMA 2010; 304: 983–91.
41 Cuijpers, P, van Straten, A, Bohlmeijer, E, Hollon, SD, Andersson, G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med 2010; 40: 211–23.
42 Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ, Johnson, BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008; 5: e45.
43 National Collaborating Centre for Mental Health. Depression: The NICE Guideline on the Treatment and Management of Depression in Adults. Updated Edition. British Psychological Society/Royal College of Psychiatrists, 2010.
44 Banerjee, S, Hellier, J, Dewey, M, Romeo, R, Ballard, C, Baldwin, R, et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 2011; 378: 403–11.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 169 *
Loading metrics...

Abstract views

Total abstract views: 375 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 20th June 2018. This data will be updated every 24 hours.

Behavioural activation for depression in older people: systematic review and meta-analysis

  • Vasiliki Orgeta (a1), Janina Brede (a1) and Gill Livingston (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *