Behavioural activation for low mood and anxiety in male frontline NHS workers (BALM):a pre-post intervention study

OBJECTIVES: To evaluate the impact and acceptability of a tailored, gender-responsive behavioural activation (BA) intervention for improving depression and anxiety in male National Health Service (NHS) frontline workers. DESIGN: Pre-post intervention study. SETTING: Three NHS organisations in the North of England. PARTICIPANTS: 45 men aged ≥18 years working in a frontline NHS role scoring in the subclinical range (5-14) on the Patient Health Questionnaire-9 (PHQ-9) (depression) and/or the Generalised Anxiety Disorder-7 (GAD-7) (anxiety) at baseline. INTERVENTIONS: A tailored BA treatment programme consisting of up to eight telephone support sessions over a period of 4-6 weeks, accompanied by a BA self-help manual. MAIN OUTCOME MEASURES: Self-reported symptom severity of depression, assessed by PHQ-9, and anxiety, assessed by GAD-7, at baseline and 4 and 6 months. Acceptability from the perspectives of male study participants and coaches who delivered the intervention was assessed in a nested qualitative study using the theoretical framework of acceptability (TFA). RESULTS: PHQ-9 and GAD-7 scores decreased from baseline to 4 months on both the PHQ-9 and GAD-7. While scores increased from 4 months to 6 months, the 6-month scores remained below those of the baseline scores. Acceptability of the intervention was high across all constructs of the TFA. The practical and action-oriented strategies of the intervention, and the confidential, flexible, convenient mode of delivery, worked to support men's engagement with the intervention. CONCLUSIONS: Delivery of a tailored, gender-responsive BA intervention was appealing to, and beneficial for, men working in frontline NHS roles with less severe depression and anxiety. The BALM intervention offers promise as a tailored workplace mental health programme that is aligned with men's needs and preferences and can help overcome a reticence to engage with mental health support in NHS staff and beyond. TRIAL REGISTRATION NUMBER: ISRCTN48636092.