Online MBCT vs HEP for Depressive Symptoms in Older Adults: RCT (OMH-D RCT)

Online Mindfulness-Based Cognitive Therapy vs Health Enhancement Program for Depressive Symptoms in Older Adults: a Randomized Controlled Trial

In Canada, depression affects more than 300,000 adults over the age of 60, which costs the healthcare system an estimated $5 billion each year. Late-life depression (LLD) is associated with more deaths, more physical and mental health problems. LLD is hard to treat, as many people will not respond to treatment and many will stop taking antidepressant medication due to negative side-effects. Unfortunately, common non-medication treatments like cognitive behavioral therapy are often inaccessible because of long (6-12 months) wait times and high costs. In a previous study, we found that an 8-week group mindfulness-based cognitive therapy (MBCT) program improved depressive symptoms more than regular LLD treatment (i.e. antidepressants and/or support counseling). Now, a larger scale study is required to compare MBCT to an active control group. Furthermore, research and clinical experience during and post-Covid pandemic has shown that older adults are nowadays far less likely to participate in in-person intervention studies but appreciate and tolerate Zoom delivery of behavioral interventions. This study will compare the effects of MBCT versus an active control group, Health Enhancement Program (HEP), both delivered by Zoom, to see if it improves symptoms of depression in older adults. The study team plans to recruit approximately 100-120 participants in across Canada, who will be randomly assigned to 8-weeks of either MBCT or HEP, delivered by Zoom. The investigators will observe if these treatments improve depression as well as cognition by conducting in-person cognitive assessments. Currently there is a lack of affordable and accessible non-medication treatments for LLD that can be scaled to reach many people. If successful, Mindfulness may be a potential solution, as it is easily given in groups and is well-tolerated by older adults with LLD.

Study Overview

• Status: Completed
• Conditions: Older Age; Depression
• Intervention / Treatment: Behavioral: Online Mindfulness Based Cognitive Therapy or Health Education Program

Detailed Description

Depression in older adults is associated with increased mortality, physical comorbidity, and neurocognitive decline. Up to 50-80% of patients are resistant to pharmacotherapy. Although psychotherapies such as cognitive behavioral therapy are effective for depression, such treatments are expensive and difficult to access, often with 6-12 month wait lists in Canada. There is a need for innovative non-pharmacological treatments for depression in older adults that are scalable and potentially cost-effective. Mindfulness-Based Cognitive Therapy (MBCT) stands out as a promising solution due to its scalable group format, good tolerability, and growing evidence of its efficacy in treating depression in adults. As well, clinical and research experience since Covid has shown that older adults have been much less likely to participate in in-person behavioral interventions.

Preliminary data in LLD: Our research group completed an 8-week intervention of MBCT (as an adjunct to treatment as usual =TAU) vs. TAU in older adults with depression +/- anxiety symptoms (N=61). MBCT was superior to TAU in improving depression scores (-7.9 (±4.4) vs. -4.0 (±4.7) point change, U = 179.5, p = 0.002), with a large effect size (d = 0.86). Furthermore, the investigators have conducted a number of pilot studies, which have established that older adults can feasibly use and enjoy behavioral interventions via teleconferencing. This study is the next step for a properly powered Phase III RCT (n=100-120) with an active comparator (HEP: Health Education Program) to establish the effectiveness of this novel intervention for LLD.

Research Aims:

Primary Objective: Using an 8-week RCT, assess whether MBCT improves scores of depressive symptoms scores compared to an active control (Health Enhancement Program (HEP)). Hypothesis 1A: The MBCT group will have a lower score in the Montgomery Asberg Depression Scale (MADRS) at 8-weeks, compared to HEP controls.

Secondary Objective: To investigate the effects of MBCT on cognitive function in older adults experiencing depression. Hypothesis 2A: MBCT will lead to higher scores in executive functioning and processing speed at 8 weeks. Hypothesis 2B: The MBCT group will have higher scores of quality of life (EQ-5D) scores at 8-weeks.

Exploratory Objective: To investigate effects of MBCT on scores of anxiety (GAD-7) and mindfulness presence (Five-Factor Mindfulness Questionnaire (FFMQ) Hypothesis 3A: The MBCT group will have reduced scores in the Generalized Anxiety Disorder 7 (GAD-7) at 8-weeks, compared to HEP controls. Hypothesis 3B: The MBCT group will have a higher score in mindfulness presence (FFMQ), compared to HEP controls.

Methods/Expertise: This study proposes an 8-week randomized controlled trial (RCT) for participants aged 60 years and older who score 10 or more points on the Montgomery Asberg Depression Scale (MADRS). An independent researcher will randomize participants, using computer software, stratified by baseline cognitive scores (T-MoCA: 19-25 and 26+ points), 1:1 to MBCT vs. an active control (HEP), virtually delivered via teleconferencing. This study will be a blinded to allocation (rater, investigator, and clinician) RCT. The investigators will conduct assessments of 1) depression scores (primary objective), 2) quality of life (EQ5D) cognition (neurocognitive battery), and 3) anxiety (GAD-7) and mindfulness (FFMQ) before and after virtually-delivered MBCT or HEP. Outcomes will be assessed at baseline and 8 weeks. The investigators have expertise in late-life mood disorders, mindfulness clinical trials, geriatric psychiatry, cognitive assessment, and biostatistics.

(all additional details can be found by section below)

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Verdun, Quebec, Canada, H4H 1R3
      • Douglas Mental Health University Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Ability to provide informed consent (shown as to be able to explain back to the research assistant the purpose of the study as well as voluntary participation, rights, time commitments, etc.)
• MADRS score ≥ 10 (experiencing symptoms of moderate/severe depression) at baseline.
• Participants who have access to internet and basic digital skills to use their computer/tablet. -- Willing and able to attend ≥75% of MBCT or HEP sessions.
• Adequate understanding of English or French.
• Ability to sit for 90 minutes without discomfort.
• Willing to inform if any change is made to their psychotropic medications and dosage for the first 8 weeks of the study

Exclusion Criteria:

• cognitive deficits at baseline, as defined by T-MoCA score <19.
• diagnosis of post-traumatic stress disorder, bipolar I or II disorder, primary psychotic disorder (e.g. schizophrenia, schizoaffective disorder), and/or severe personality disorder interfering with ability to function in a group setting intervention on a regular basis.
• substance abuse within the past 6 months.
• high suicide risk (e.g., active suicidal ideation and/or recent intent or plan).
• significant visual or hearing impairment
• significant impairments in fine motor skills.
• any medical illnesses that could prevent the participant from engaging in the intervention.
• history of psychiatric hospitalization in the last 3 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Online Mindfulness based Cognitive Therapy; The intervention will consist of 8 online weekly sessions (90-min each) of Mindfulness based Cognitive Therapy, plus daily home practice.	Behavioral: Online Mindfulness Based Cognitive Therapy or Health Education Program; 12 hours of online group training of Mindfulness Based Cognitive Therapy OR 12 hours of online group training of Health Education Program will be provided via teleconferencing. Additional both groups will perform daily home practice.; Other Names: MBCT or HEP
Active Comparator: Online Health Education Program; The active control will consist of 8 online weekly sessions (90-min each) of Health Education Program, plus daily home practice.	Behavioral: Online Mindfulness Based Cognitive Therapy or Health Education Program; 12 hours of online group training of Mindfulness Based Cognitive Therapy OR 12 hours of online group training of Health Education Program will be provided via teleconferencing. Additional both groups will perform daily home practice.; Other Names: MBCT or HEP

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depressive symptoms scores	as measured by the Montgomery Asberg Depression Rating Scale	8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life scores	as measured by the EQ5D It is a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression	8 weeks
Processing Speed	as measured by the Trails Making Test A and WAIS-IV Digit Symbol (SDMT)	8 weeks
Executive Functioning	as measured by the trails Making Test B, WAIS- IV Digit Span and Verbal Fluency Test	8 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exploratory outcomes: anxiety scores	Anxiety as measured by the Generalized Anxiety Disorder-7 scale	8 weeks
Exploratory outcome: Mindfulness Presence Scores	Mindfulness Presence as measured by the Five Facets of Mindfulness Questionnaire (FFMQ)	8 weeks

Collaborators and Investigators

• Sponsor: Lady Davis Institute
• Collaborators: Douglas Mental Health University Institute

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2023
• Primary Completion (Actual): December 31, 2024
• Study Completion (Actual): February 2, 2025

Study Registration Dates

• First Submitted: September 11, 2023
• First Submitted That Met QC Criteria: December 19, 2023
• First Posted (Actual): January 3, 2024

Study Record Updates

• Last Update Posted (Actual): May 25, 2025
• Last Update Submitted That Met QC Criteria: May 21, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Depression
• Other Study ID Numbers: 2024-884

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: No IPD available. Group, deidentified data may be requested directly to the PI by email.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No