Effect of behavioural activation for individuals with post-stroke depression: A systematic review and meta-analysis

Objectives Post-stroke depression (PSD) affects one third of stroke survivors and substantially impacts recovery, so it is important to identify effective treatments for PSD. Behavioural activation (BA), a relatively simple intervention, has demonstrated efficacy in the treatment of adults with unipolar depression. However, its use and efficacy in the treatment of PSD has not been documented in a systematic review. This systematic review and meta-analysis considers: What effect does BA have on reducing depression symptoms in individuals diagnosed with PSD? Method MEDLINE, Embase, Emcare, Cochrane Library, and PsycINFO, were searched for randomised controlled trials (RCTs) published in English, on 13 July 2021. To chart the data, we employed a customized extraction sheet. The Cochrane Collaboration risk-of-bias 2 tool was used to determine study quality. Results Two papers, written by the same lead authors, met the inclusion criteria. The Communication and Low Mood trial and the Behavioural Activation Therapy for Post-Stroke Depression trial were conducted in the United Kingdom and published in 2012 and 2019, respectively. Meta-analysis showed BA was associated with a decrease in depression symptoms in patients with PSD relative to treatment as usual (standard mean difference (SMD) -0.54; 95% confidence interval (CI) -0.90 to -0.18). Conclusion BA may be more effective when compared to treatment as usual in reducing depression symptoms in individuals with PSD. Although our meta-analysis found positive effects of BA, the evidence is inconclusive due to the small number of studies. High-quality RCTs are needed to confirm the benefits of BA in PSD. Strengths and limitations of this study ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This review received no specific grant from any funding agency, commercial or not-for-profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This review relied on previously published material and did not require ethical approval. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data that support the findings of this study are available on request from the corresponding author.