Efficacy and safety of behavioural activation on depression in people with co-occurring non-communicable diseases: systematic review and meta-analysis
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Date
2025
Authors
Yisma, E.
Muyambi, K.
Walsh, S.
Othman, S.
Gray, R.
Tan, K.L.
Steen, M.
Jones, M.
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BJPsych Open, 2025; 11(2):e70-1-e70-12
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Engida Yisma, Kuda Muyambi, Sandra Walsh, Shwikar Othman, Richard Gray, Kuan Liung Tan, Mary Steen, and Martin Jones
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Abstract
Background: People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear. Aims: To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs. Method We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the Cochrane Collaboration’s ‘risk-of-bias 2 tool’. We calculated a random-effects, inverse-variance weighting metaanalysis. Results: Of the 21 386 initial studies, 12 RCTs (with 2144 patients) comparing behavioural activation with any comparator on treatment outcomes for depression with comorbid NCD met the inclusion criteria. Six studies rated as low risk of bias. For short-term follow-ups (up to 6 months), meta-analysis showed behavioural activation had little effect on depression symptom improvement in people with NCDs (Hedges’ g = −0.24; 95% CI, −0.62 to 0.15), compared to comparators, with high heterogeneity (I²= 91.91%). Of the 12 included studies, three RCTs provided data on adverse events occurring during the trial. Conclusions: Evidence from this systematic review is not sufficient to draw clear conclusions about the efficacy and safety of behavioural activation for reducing depression symptoms in people with NCDs. Future reviews need to include more high-quality, welldesigned RCTs to better understand the potential benefits of behavioural activation for comorbid depression.
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© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/lice nses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.