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Intellectual DisabilitiesNCT06851741

Behavioural Activation and Severe Learning Disabilities

A study testing Behavioural Activation for depression (BeatIt2) in people with Intellectual Disabilities and Depression, run by NHS Greater Glasgow and Clyde.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Research shows that people with severe learning disabilities get depressed at least as often as the wider population. Psychological therapies are recommended to treat depression, and some of these have been adapted for those people with learning disabilities who can talk about their problems. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Intellectual Disabilities, Depression
What is being tested?
Behavioural Activation for depression (BeatIt2)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
No sites listed yet
Study dates
4 Mar 2025to 1 Nov 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Administratively defined severe/profound learning disabilities, confirmed by carer report using the Vineland Adaptive Behaviour Scales 3rd edition. A severe/profound learning disability will be confirmed by an ABC composite score of 50 or below (Sparrow et al., 2016). Individuals with severe/profound learning disabilities can be characterised by high support needs, limited or no expressive or receptive verbal communication, and significant impairments across adaptive functioning skills.
  • 18 years old and over
  • Clinically significant unipolar depression, meeting the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities
  • Has a family member or paid carer who has supported them for a minimum of 6 months to complete the screening and baseline visits OR is able to obtain information for the previous 4 months prior to randomisation. The carer, or another named individual, should be available for weekly-fortnightly treatment sessions with the practitioner, and should currently provide a minimum of 10 hours support per week to the participant.

Who cannot join

  • Mild/moderate learning disabilities
  • A presentation judged by the research team as likely to interfere with the successful engagement with the intervention (e.g. severe agitation, late-stage dementia, uncontrolled epilepsy).

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

Andrew Professor Jahoda, BSc Hons, MPhil, PhD contact

0141 330 4988

Andrew.Jahoda@glasgow.ac.uk

About this study

Official title: Behavioural Activation for Depression in Adults with Severe Learning Disabilities. a Feasibility Randomised Controlled Study of Behavioural Activation with Treatment As Usual (TAU) Vs TAU Alone

Research shows that people with severe learning disabilities get depressed at least as often as the wider population. Psychological therapies are recommended to treat depression, and some of these have been adapted for those people with learning disabilities who can talk about their problems. No research has properly tested a psychological therapy for people with severe learning disabilities and any mental health problem. The investigators recently completed a study that tested a psychological therapy (behavioural activation) for people with mild learning disabilities and depression. Behavioural activation improves people's mood by helping them to re-engage in activity that has meaning and purpose for them, rather than relying on talking or thinking skills. Because of this behavioural activation might be promising for people with severe learning disabilities and depression. Along with PAMIS, an organisation for families of people with more profound disabilities, the investigators have adapted the therapy for this group. The investigators now want to find out if it would be possible to carry out a research project about whether behavioural activation works for depressed adults with severe learning disabilities. This is called a feasibility study. The investigators would see if it is possible to recruit 50 adults with severe learning disabilities, and if they are willing to be randomly placed in a group who get behavioural activation or a group who get usual help from services. Other information about running a study would be collected, including about keeping in contact with participants and what measures are needed to find out if change is happening.

Read the detailed description

People with severe and profound learning disabilities have significant lifelong impairment of general intelligence (IQ<40 with associated adaptive skill deficits). They have high support needs and limited or no verbal communication.

Prevalence of depression is increasing for people with learning disabilities (from 12.6% in 2016/17 to 14.5% in 2021/22 in England). The main treatment in use is medication, and antidepressant use is rising.

The 2016 NICE guideline on mental health problems in people with learning disabilities found the only available evidence on psychological interventions for depression was very low quality for specially adapted Cognitive Behavioural Therapy (CBT), and only for people with mild/moderate learning disabilities. Only three RCTs (total n=130) and three controlled before-and-after studies (total n=130) of CBT were identified for all mental health conditions. There was no evidence for people with severe learning disabilities, and CBT is not accessible to people with significant communication and cognitive limitations. The NICE included research recommendations for psychosocial intervention RCTs for people with severe learning disabilities and mental health problems.

Behavioural Activation (BA) uses behavioural principles to treat depression and is probably more accessible to people with severe learning disabilities than wholly talking therapies like CBT. The core aims of BA are: i) to reduce general avoidance of activity, commonly associated with depression, and ii) to increase engagement in valued and purposeful activity. In the general population, BA is at least as effective as antidepressant medications and superior or non-inferior to CBT, pill-placebo, and treatment as usual; and has effects as lasting as CBT following treatment termination.

The investigators aim to examine the feasibility of completing a two arm RCT of an adapted version of behavioural activation for people with severe to profound intellectual disabilities (BeatIt2), with participants randomised to BeatIt2 alongside treatment as usual (TAU) or to TAU alone.

Research questions concern: i) recruitment, ii) retention 12 months post-randomisation, iii) outcome measures with greatest utility in detecting meaningful change, and iv) whether adverse events occur.

A process evaluation will also be carried out, bringing together evidence on: v) acceptability of the intervention across families, paid carers and services, vi) fidelity of therapy delivery and adherence to the manual, vii) feasibility of collecting service use and quality of life data from adults with severe learning disabilities from both arms of the study (to test the feasibility of a later health economic study), and viii) the mechanisms of change and how the context of the intervention affects implementation.

Being tested
Behavioural Activation for depression (BeatIt2)
Keywords
Intellectual disability, Depression
Medical subject headings
Intellectual Disability, Depression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Behavioural Activation for depression (BeatIt2)Behavioural

    It is a structured, time limited, manualised psychological therapy, developed to treat those with learning disabilities and depressive symptoms.

    There is an initial training session for carers regarding their role in the treatment, then 12 sessions with the person with a learning disability and their carer, held weekly or fortnightly, spanning approximately 6 months.

    Activities are carried out with the individuals with learning disabilities at each session and elements of the intervention are delivered via carers. The three main phases are: i) assessment and socialisation into the intervention and establishing a relationship with the person with the disability, ii) working towards change, and iii) finishing therapy. The first phase includes assessment of the person's pattern of daily activity, barriers and facilitators to engaging in activity, and examining the link between activity and mood. Specific attention is given to the role of communication and how scaffolding can be provid

Study groups in NCT06851741
Study groupRoleWhat they receive
BeatIt2 for depression alongside Treatment as usual (TAU)ExperimentalBeatIt2 treatment manual and materials are developed and modelled for people with severe/profound learning disabilities. They are designed to be delivered to the person alongside a family or paid carer providing them with regular support, on an outreach basis. It is a structured, time limited, manualised psychological therapy, developed to treat those with learning disabilities and depressive symptoms. There is an initial training session for carers regarding their role in the treatment, then 12 sessions with the person with a learning disability and their carer, held weekly or fortnightly, spanning approximately 6 months. Activities are carried out with the individuals with learning disabilities at each session and elements of the intervention are delivered via carers. The three main phases are: i) assessment and socialisation into the intervention and establishing a relationship with the person with the disability, ii) working towards change, and iii) finishing therapy.
Receives: Behavioral: Behavioural Activation for depression (BeatIt2)
Treatment as usualNo interventionThis will include the existing treatments available in NHS and social care for adults with learning disability with depression, including anti-depressants, mood stabilizers, and any available nursing and psychological supports/interventions. Additionally, for all those in the study, the investigators will provide their General Practitioner and specialist services with a summary of the NICE guidelines on treatment of depression for adults with learning disabilities.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intellectual Disabilities Depression Scale (IDDS)

    This is a 38-item behavioural checklist derived from DSM-III-R criteria, designed to measure the frequency of identified depressive behaviours within a four-week period. Minimum possible score is 0 and maximum possible score is 228. Higher scores indicate a higher frequency of depressive symptoms.

    Measured: Baseline, 4, 6, 8, 12 months post-baseline

Secondary outcomes (10)
  1. Anxiety Depression and Mood Scale (ADAMS)

    This scale is the only one that has been shown to be a reliable and valid measure of anxiety in adults with severe/profound intellectual disabilities. Since the investigators are already using two measures of depressive symptoms, only the anxiety sub-scale of the Anxiety, Depression and Mood Scale will be used in this study. Seven items will be used from the original 28-item measure. These items comprise the 'generalised anxiety' subscale, with informants reporting on their observations of these symptoms in the last 2 weeks. Items are scored on a four-point Likert scale that combines frequency and severity of symptoms. Minimum possible score is 0 and maximum possible score is 42. Higher scores indicate a higher frequency and severity of anxiety symptoms.

    Measured: Baseline & 12 months post-baseline

  2. Index of Community Involvement

    This 16-item scale provides a measure of participation in social and community based activities during the previous 4 weeks. Minimum possible score is 0 and maximum is 80. Higher scores indicate a higher frequency of engagement in community activities.

    Measured: Baseline & 12 months post-baseline

  3. Index of Participation in Domestic Life

    This scale measures participation in 13 household tasks during the previous 4 weeks. Minimum possible score is 0 and maximum possible score is 26. Higher scores indicate higher levels of independent participation in domestic tasks.

    Measured: Baseline & 12 months post-baseline

  4. EQ-5D-5L

    This proxy report questionnaire assesses the participants' health related quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has five levels: no problems, slight problems, moderate problems, severe problems and extreme problems. Possible minimum score is 5 and possible maximum score is 25. Higher scores indicate more problems in these domains. There is an additional visual analogue scale with endpoints of 'the worst health you can image' and 'the best health you can image' on a 0 to 100 scale.

    Measured: Baseline & 12 months post-baseline

  5. The Behaviour Problems Inventory - Short form (BPI-S)

    The BPI-S is an informant-based behaviour rating instrument for adults with intellectual disabilities who display challenging behaviour. It is a 30-item measure which includes three subscales: Self-Injurious Behaviour (14 items), Stereotyped Behaviour (24 items), and Aggressive/Destructive Behaviour (11 items). This measure assesses both severity and frequency. The frequency of the BPI-S measure is rated on a 5-point Likert scale ranging from 0 (never/no problem) to 4 (hourly). The severity of the self-injurious and aggressive/destructive behaviour is rated on a 3-point Likert scale starting from 1 (mild) to 3 (severe). Possible minimum and maximum scores are 0 - 56 (self-injurious behaviours), 0 - 70 (aggressive/destructive behaviours), and 0 - 48 (stereotyped behaviours). Higher scores indicate a higher frequency and severity of problem behaviours.

    Measured: Baseline & 12 months post-baseline

  6. Emotional Difficulties Self-Efficacy Scale

    This is a flexible five item scale to assess carer (parents and paid carer) perceptions of their self-efficacy in specific support domains relating to children and adults with intellectual disability or autism. Minimum possible score is 0 and maximum possible score is 80. Higher scores indicate higher perceived self-efficacy.

    Measured: Baseline & 12 months post-baseline

  7. Warwick Edinburgh Mental Wellbeing Scale

    This seven item self-report measure of mental wellbeing has strong internal consistency (Cronbach's alpha = 0.88 - 0.93) and has proven to have good construct validity, with significant correlations with scores from other standardised measures of mental health and wellbeing, the PHQ-9 and GAD-7. The possible minimum score is 13 and possible maximum score is 65. Higher scores indicate higher levels of wellbeing.

    Measured: Baseline & 12 months post-baseline

  8. Client Service Receipt Inventory (CSRI)

    CSRI is a validated tool to measure total package resource use and has been used in evaluations involving people with learning disabilities. It records items such as contacts with community-based primary care, other health or social services, educational services, and outpatient and inpatient attendances. Unit costs for most of these are available.

    Measured: Baseline, 4, 6, 8, 12 months post-baseline

  9. Medication Inventory

    Medication use will be recorded, and any changes in use of medication over the course of the intervention and during follow-up will be noted to determine if there are treatment differences between the two arms of the study. In combination with the CSRI, medication use will also be costed.

    Measured: Baseline, 4, 6, 8, 12 months post-baseline

  10. The Mood Interest and Pleasure Questionnaire

    This comprises 12 items from two subscales (mood, and interest and pleasure) and requires proxy respondents to indicate how often a particular symptom has occurred within the last 2 weeks. Possible minimum and maximum scores for each sub-scale are 0 - 24. Lower scores indicate lower mood and lower levels of interest and pleasure. The mood interest and pleasure questionnaire (Ross et al., 2008; Ross \& Oliver, 2003) short form shows high internal con sistency (Cronbach alpha coefficients: total = .88; mood = .79; inter est and pleasure = .87) (Ross et al., 2008)

    Measured: Baseline and 12-months post-baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Feb 2025
  2. Study start4 Mar 2025 (estimated)
  3. Primary completion1 Sep 2026 (estimated)
  4. Study completion1 Nov 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06851741
Sponsor's protocol ID
GN22MH146
Status last verified
Nov 2024
First submitted
10 Feb 2025
Last updated
28 Feb 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Behavioural Activation for depression (BeatIt2) in people with Intellectual Disabilities and Depression, run by NHS Greater Glasgow and Clyde.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 28 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Andrew Professor Jahoda, BSc Hons, MPhil, PhD (0141 330 4988, Andrew.Jahoda@glasgow.ac.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intellectual Disabilities Depression Scale (IDDS) (time frame: Baseline, 4, 6, 8, 12 months post-baseline). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2025.

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