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

Objectives

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

Design

Pre-post intervention study.

Setting

Three National Health Service (NHS) organisations in the North of England.

Participants

Forty-five men aged ≥ 18 years working in a frontline NHS role scoring in the subclinical range (5-14) on the PHQ-9 (depression) and/or the GAD-7 (anxiety) at baseline.

Interventions

A tailored Behavioural Activation treatment programme consisting of up to eight telephone support sessions over a period of 4–6 weeks, accompanied by a Behavioural Activation 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 Behavioural Activation 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

ISRCTN 48636092

Strengths and limitations of this study

• This is the first study to evaluate the impact and acceptability of a Behavioural Activation intervention for improving depression and anxiety in men using a gendered lens, contributing novel findings of relevance wider than the study context.

• The use of the TFA to inform data collection and analysis enabled a theoretically informed, systematic evaluation of the acceptability of the intervention.

• Rich data were gathered from qualitative interviews with a large sample of male participants and coaches who supported intervention delivery, including participant non-completers.

• Participants were a self-selecting sample of men who may have been particularly motivated to take part in the intervention. It is possible their views on the acceptability of the Behavioural Activation (BALM) intervention are more positive than the wider population of male NHS staff. Our sample also lacked ethnocultural diversity and representation of some NHS staff groups, particularly ancillary roles, that limits the transferability of the findings.

• The quasi-experimental research design is not sufficiently reliable to make causal inferences.