The BASIL+ study, carried out during the pandemic, was the largest of its kind to target and measure loneliness through phone calls
"We now know that loneliness is as bad for your health as smoking 15 cigarettes a day and depression is a silent killer." Professor Simon Gilbody, director, York mental health and addictions research group
Structured telehealth can help prevent loneliness and depression, a new study has found.
The Behavioural Activation in Social Isolation (BASIL+) trial, which was conducted during the pandemic by the University of York and Hull York Medical School and Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust, was the largest trial ever undertaken to target and measure loneliness in this way. It showed that if older people received weekly phone calls over the course of around two months, their mental health and quality of life improved.
The participants were all people over 65 with multiple long-term conditions. There were 435 participants altogether, recruited from across 26 sites in the UK. All were people who had been asked to shield during the height of the Covid-19 pandemic and were seen as at a high risk of loneliness and depression. Participants were randomly assigned to the behavioural activation intervention group or to the control group (which received usual care with signposting). The mean age of participants was 75·7 years, and 270 were female. Participants attended an average of 5·2 (SD 2·9) of eight remote behavioural activation sessions.
The study, published in the Lancet Healthy Longevity, found that over a period of three months, the participants reported a 21% drop in emotional lonelinesss, with the benefits remaining after the phone calls stopped. Levels of depression also reduced significantly and the benefits were more pronounced than that observed in antidepressants.
The results of the BASIL+ study are expected to feed into the World Health Organisation’s commission on social connection, which was launched after loneliness was declared a global public health concern.
The researchers suggest that, in future, “behavioural activation could be used to mitigate depression and the risk of loneliness in the presence of shocks to health systems and populations, such as future pandemics or other shocks that could increase anxiety and depression among vulnerable groups, such as the climate emergency.”
Professor Dean McMillan, professor of clinical psychology at Hull York Medical School and University of York, designed and led the telephone support programme. He said that “an ounce of prevention is worth a pound of cure, and this trial shows how we can prevent both depression and loneliness.”
Professor David Ekers, lead researcher at TEWV, said: “Based on our previous research, we had a good idea what might work. 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.”
He added: “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 Simon Gilbody, director of the York mental health and addictions research group and the lead researcher on the study, 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.”
The trial received £2.6m funding 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.
Professor Lucy Chappell, CEO of the NIHR, 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.”
The BASIL+ study, carried out during the pandemic, is the largest of its kind. It demonstrates how a relatively simple, low-tech intervention – a series of structured phone calls – can me more effective than antidepressants in reducing depression, as well as reducing loneliness. At a time when loneliness is seen as a major public health concern, this is a valuable finding, and suggests scope for future public policy interventions.