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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Date data sharing statement initially provided
Type of registration
Retrospectively registered

Titles & IDs
Public title
The MIRROR1 pilot study: treatMent of depressIon among older people living in Regional and RemOte aReas
Scientific title
Randomised controlled trial to determine whether a greater proportion of older people with Major Depression living in remote and regional Western Australia who receive a Behavioural Activation intervention experience remission of the Depressive Episode, compared with usual care.
Secondary ID [1] 286655 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Depression 294989 0
Condition category
Condition code
Mental Health 295252 295252 0 0

Study type
Description of intervention(s) / exposure
Self-help behavioural activation (BA) remotely supported by telephone vs usual care

Participants randomised to BA will be mailed a specifically-designed self-help workbook titled "Helping you to maintain a positive mood in older age". The workbook is based on clear principles of an evidence-supported psychological treatment for depression in later life. It outlines relevant information about depression and offers guidance on how to identify depressive symptoms and take action to improve mental well-being. In particular, the booklet outlines how to monitor activities, keep a balance between activities and recognise the connection between activity and mood.

To offer support to participants and optimise adherence to the intervention, a behavioural activation therapist will telephone participants on 3 occasions throughout the course of the 8 week program (first call within 2 weeks of randomisation than at week 4 and week 8) with a 4 week interval period between each call. The approximate duration of these telephone sessions will be 30 minutes and participants will be asked to complete activities from the workbook during the 4 week interval period. The BA therapist will encourage participants to complete all relevant activities and participants can spend as much time as they wish completing each relevant stage through the workbook.
Intervention code [1] 291798 0
Treatment: Other
Intervention code [2] 296076 0
Comparator / control treatment
Standard Medical Care - Usual care received from the participants General Practitioner and any other care the participant may be receiving from other services.

Control participants will receive a copy of the Behavioural Activation self-help booklet at the end of the study. This will be once the final participant recruited into the study has returned their 26 week follow up health & lifestyle questionnaire which assesses severity of depressive and anxiety symptoms as measured by the Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001) and the brief measure for assessing Generalized Anxiety Disorder (GAD-7) (Spitzer et al., 2006),
Control group

Primary outcome [1] 294999 0
Remission of the Major Depressive episode as assessed by administration of Module A (Mood episodes) of the Structured Clinical Interviews for DSM Disorders -1, Research Version. (SCID - 1).

Timepoint [1] 294999 0
12 weeks post randomisation

Secondary outcome [1] 314552 0
Severity of depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9)

Timepoint [1] 314552 0
12 and 26 weeks post randomisation

Secondary outcome [2] 328244 0
Severity of anxiety symptoms, as measures by the Brief Measure for Assessing Generalized Anxiety Disorder (GAD-7).
Timepoint [2] 328244 0
12 and 26 weeks
Secondary outcome [3] 328245 0
Health-related quality of life, as measured by the 12-item Short-Form health survey; SF-12)
Timepoint [3] 328245 0
12 and 26 weeks

Key inclusion criteria
- Aged 65 years or over
- Screens positive on at least one of two questions known as the "Whooley" depression screening questions: low mood and decreased interest or enjoyment in usual activities.
- Resides in inner (RA2)or outer regional (RA3) or remote (RA4) Western Australia according to the Australian Standard Geographic Classification - Remoteness Areas (ASGC-RA) Classification 2011
-The presence of a Major Depressive Episode according to DSM-V (SCID 1)
- Fluent in written and spoken english
Minimum age
65 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
- Active suicidal plan
- Current or past history of psychosis
- Sensory impairment that interferes with effective communication over the phone or with reading font size 14
- Clinically significant cognitive impairment as evidenced by a score lower than 27 on the Telephone Interview for Cognitive Status(TICSm)(Knopman et al, 2010)
- Plans to move residence during the follow up period
- Does not reside in inner or outer regional or remote Western Australia

Study design
Purpose of the study
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
20,000 randomly selected men and women from the Western Australian electoral roll aged 65 years or over residing in regional and remote Western Australia will be posted a project information sheet, consent form, health screening questionnaire (including the Whooley questions assessing low mood and loss of interest/pleasure), and replied paid envelope.

Respondents who return their questionnaires and respond in the affirmative to one of two of the “Whooley” questions contained within the screening questionnaire will be contacted by study staff to confirm eligibility, answer any questions and complete assessment for the presence of a Major Depressive episode utilising the SCID- I. The TICSm will also be administered to ascertain evidence of cognitive impairment.

Participants who fulfill criteria for the diagnosis of a Major Depressive episode will be randomly assigned to one of two groups:

Standard Medical Care or Standard Medical Care and Behavioural Activation Intervention

Due to the nature of the study, participants in the intervention group and the behaviour therapist facilitating their efforts will not be blinded to group allocation. Research staff assessing end points (SCID-1) will be blinded and will not have access to information detailing the participant's group status.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Group allocation will occur according to a list of random numbers generated by computer. The list will be generated and centrally maintained by the University of Western Australia's Centre for Software Practice, which will have no direct contact with participants.
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?

The people assessing the outcomes
Intervention assignment
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis

Recruitment status
Stopped early
Data analysis
No data analysis planned
Reason for early stopping/withdrawal
Participant recruitment difficulties
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 3862 0
Royal Perth Hospital - Perth
Recruitment postcode(s) [1] 9636 0
6000 - Perth

Funding & Sponsors
Funding source category [1] 291232 0
Name [1] 291232 0
University of western Australia - School of Medicine - Division Psychiatry
Address [1] 291232 0
WA Centre for Health & Ageing
Level 6 MRF Building
50 Rear Murray Street
Perth WA 6000
Country [1] 291232 0
Primary sponsor type
UWA Medical School - Division Psychiatry
WA Centre for Health & Ageing
Level 6 MRF Building
50 Rear Murray Street
Perth WA 6000
Secondary sponsor category [1] 290085 0
Name [1] 290085 0
WA Centre for Health & Ageing
Address [1] 290085 0
Level 6
48 Murray Street
Perth, WA 6000
Country [1] 290085 0

Ethics approval
Ethics application status
Ethics committee name [1] 292791 0
Department of Health HREC
Ethics committee address [1] 292791 0
Level 1 C Block
189 Royal Street
East Perth WA 6004
Ethics committee country [1] 292791 0
Date submitted for ethics approval [1] 292791 0
Approval date [1] 292791 0
Ethics approval number [1] 292791 0
Ethics committee name [2] 296087 0
The University of Western Australia HREC
Ethics committee address [2] 296087 0
35 Stirling Highway
Crawley WA 6009
Perth, Australia
Ethics committee country [2] 296087 0
Date submitted for ethics approval [2] 296087 0
Approval date [2] 296087 0
Ethics approval number [2] 296087 0

Brief summary
Symptoms of low mood and depression are common in later life and can include; feeling sad, empty or down, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, poor concentration and thoughts about death. There is now evidence that depression is 23% more frequent among people living in regional Australia than in the city, possibly because of difficulty accessing relevant health services.

When feeling low, a person’s motivation to do things can decrease. Some may find that they give up hobbies or activities previously enjoyed, and over time might end up doing very little. This can lead to a further decline in mood and start a vicious cycle that can be difficult to break. One of the ways of overcoming depression and low mood is by changing behaviour, such as gradually increasing activity levels. The results of several studies show that the more activities people engage in the better they feel. Behavioural Activation (BA) interventions encourage participants to meaningfully increase their engagement in activities with the aim of improving mood and sense of achievement.

The current pilot study is seeking to test out (pilot) whether a supported self-help behavioural activation intervention designed for older Western Australians living in regional and remote areas is effective at decreasing the severity of depression amongst those who are depressed. The results will be used to improve the program and make it ready for a full clinical trial so that definitive evidence of the effectiveness of the intervention can be obtained.

Specific aim of definitive trial:
To determine if a greater proportion of older adults with Major Depression living in regional Western Australia randomly assigned to the BA intervention, compared to Standard Care, experience remission of symptoms after 12 weeks.

Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 57058 0
Prof Osvaldo P Almeida
Address 57058 0
W.A. Centre for Health and Ageing
Ainslie House
Level 6 /48 Murray St
Perth WA 6000
Country 57058 0
Phone 57058 0
+61 (8)9224 2855
Fax 57058 0
+61 (8) 9224 8009
Email 57058 0
Contact person for public queries
Name 57059 0
Prof Osvaldo Almeida
Address 57059 0
W.A. Centre for Health and Ageing
Ainslie House
Level 6 /48 Murray St
Perth WA 6000
Country 57059 0
Phone 57059 0
+61 (8) 9224 2855
Fax 57059 0
+61 (8) 9224 8009
Email 57059 0
Contact person for scientific queries
Name 57060 0
Prof Osvaldo P Almeida
Address 57060 0
W.A. Centre for Health and Ageing
Ainslie House
Level 6 /48 Murray St
Perth WA 6000
Country 57060 0
Phone 57060 0
+61 (8) 9224 2855
Fax 57060 0
+61 (8) 9224 8009
Email 57060 0

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No/undecided IPD sharing reason/comment
No data will be shared without consent from individual participants and also due to confidentiality and security reasons.
What supporting documents are/will be available?
No other documents available
Summary results
No Results