Can Psychological care delivered over phone effectively combat loneliness and depression?

The study, led by a team based at the University of York and Hull York Medical School and at Tees, Esk and Wear Valleys NHS Foundation Trust, found levels of depression reduced significantly and the benefits were greater than those seen for antidepressants.

Participants in the study reported their levels of emotional loneliness fell by 21% over a three-month period and the benefits remained after the phone calls had ceased, suggesting an enduring impact.

The Behavioural Activation in Social Isolation trial (BASIL+ trial) started within months of the 2020 pandemic and was the largest trial ever undertaken to target and measure loneliness in this way. The study, published in the journal The Lancet (Healthy Longevity), represents a rapid advance in evidence to understand what works in preventing loneliness.

People invited to take part in the BASIL+ study were aged over 65 with multiple long-term conditions. They had been asked to shield during COVID and were at a high risk of loneliness and depression.

The trial was supported by a £2.6M award from the National Institute for Health and Care Research (NIHR) and was the only mental health trial prioritised by the NHS as part of its Urgent Public Health programme - a cornerstone of its fight against COVID. Hundreds of older people were recruited to the trial from 26 sites across the UK during the COVID pandemic of 2020-21.

Politicians and policy makers have become increasingly aware of the importance of loneliness, but have struggled to know “what works” in its prevention. The World Health Organization has just declared loneliness to be a ‘Global Health concern’ and has launched an international commission on the problem. It is anticipated that the results of the BASIL+ trial will feed into this process, since BASIL+ is the largest trial ever undertaken to combat loneliness. The Jo Cox Commission, established in memory of the murdered politician, estimates that 9 million people are affected by loneliness in the UK and there is a cross governmental strategy to tackle loneliness, with a Ministerial appointment.

The research was jointly led by Professor Simon Gilbody from the University of York and Hull York Medical School and Professor David Ekers from Tees, Esk and Wear Valleys NHS Foundation Trust. Professor Gilbody said: “We now know that loneliness is as bad for your health as smoking 15 cigarettes a day and depression is a silent killer. All of us working on the BASIL+ trial had older parents and relatives who became socially isolated during lockdown.”

“Based on our previous research, we had a good idea what might work”, Professor Ekers added. “With the support of the NHS and the NIHR we were able to test this in a large rigorous trial. The results are now available and this is very exciting. The UK led the world with the vaccine discovery trials. Similarly in mental health we have advanced the science of ‘what works’ in the area of loneliness, and we have learned much from the dark days of the pandemic.’”

Professor Ekers, Honorary Professor at the Mental Health and Addictions Research Group at the University of York and Professor Dean McMillan, Professor of Clinical Psychology at Hull York Medical School and University of York designed and led the telephone support programme. Professor McMillan said “an ounce of prevention is worth a pound of cure, and this trial shows how we can prevent both depression and loneliness”.

Professor Lucy Chappell, CEO of the National Institute for Health and Care Research, which funded the study, said: "These results are an important step forward in understanding what works in tackling and preventing loneliness and depression. The research is also a great example of how public money allows researchers, healthcare professionals and the public to work together across institutions and organisations to deliver results that will really make a difference to people's health and wellbeing."

Dr Liz Littlewood, the BASIL+ trial manager from the Department of Health Sciences, University of York, added: “This is what the UK does well and it shows how the NHS, Universities and third sector organisations were able to work in partnership during the pandemic to tackle the big health challenges.”

Reference:

Prof Simon Gilbody, Elizabeth Littlewood, Dean McMillan, Lucy Atha, Della Bailey, Kalpita Baird, Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): a pragmatic randomised controlled trial, The Lancet Healthy Longevity, https://doi.org/10.1016/S2666-7568(23)00238-6,