Behavioural activation for low mood and anxiety in male frontline NHS workers (BALM): a pre-post intervention study

  1. Paul Galdas
  2. Della Bailey
  3. Steve Bell
  4. Katharine Bosanquet
  5. Carolyn Chew-Graham
  6. David Ekers
  7. Simon Gilbody
  8. Elizabeth Littlewood
  9. Michael Mawhinney
  10. Heidi Stevens
  11. Katie Webb
  12. Dean McMillan
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Abstract

To evaluate the impact and acceptability of a tailored, gender-responsive behavioural activation (BA) intervention for improving depression and anxiety in male National Health Service (NHS) frontline workers.

Design

Pre-post intervention study.

Setting

Three NHS organisations in the North of England.

Participants

45 men aged ≥18 years working in a frontline NHS role scoring in the subclinical range (5–14) on the Patient Health Questionnaire-9 (PHQ-9) (depression) and/or the Generalised Anxiety Disorder-7 (GAD-7) (anxiety) at baseline.

Interventions

A tailored BA treatment programme consisting of up to eight telephone support sessions over a period of 4–6 weeks, accompanied by a BA self-help manual.

Main outcome measures

Self-reported symptom severity of depression, assessed by PHQ-9, and anxiety, assessed by GAD-7, at baseline and 4 and 6 months. Acceptability from the perspectives of male study participants and coaches who delivered the intervention was assessed in a nested qualitative study using the theoretical framework of acceptability (TFA).

Results

PHQ-9 and GAD-7 scores decreased from baseline to 4 months on both the PHQ-9 and GAD-7. While scores increased from 4 months to 6 months, the 6-month scores remained below those of the baseline scores. Acceptability of the intervention was high across all constructs of the TFA. The practical and action-oriented strategies of the intervention, and the confidential, flexible, convenient mode of delivery, worked to support men’s engagement with the intervention.

Conclusions

Delivery of a tailored, gender-responsive BA intervention was appealing to, and beneficial for, men working in frontline NHS roles with less severe depression and anxiety. The BALM intervention offers promise as a tailored workplace mental health programme that is aligned with men’s needs and preferences and can help overcome a reticence to engage with mental health support in NHS staff and beyond.

Trial registration number

ISRCTN48636092 .

Article activity feed

  1. Version published to 10.1136/bmjopen-2024-094214
  2. Version published to 10.1101/2025.04.17.25325391 on medRxiv