DIGITAL MONITORING OF SLEEP, MEALS, AND PHYSICAL ACTIVITY AS A PREVENTIVE INTERVENTION FOR DEPRESSION IN OLDER BEREAVED ADULTS: A PILOT STUDY ON FEASIBILITY, ACCEPTABILITY, AND SYMPTOM IMPROVEMENT

Introduction Following the death of a spouse, many older adults have difficulty performing self-care activities. For example, they may feel no reason to wake up, eat meals, or go to bed on a regular schedule. Disruptions of these key social “time cues”, or zeitgebers, in turn decrease the stability of circadian rhythms, placing these individuals at high risk for major depressive disorder (MDD) and other adverse health consequences related to poor self-care. Preserving the stability of individuals’ time cues (sleep, meals, and physical activity) after the death of a spouse may reduce depression symptoms, thereby preventing the onset of MDD and promoting a healthy adaptation to bereavement. The purpose if this study is to examine the feasibility and acceptability of a behavioral intervention that is grounded in the circadian timing system and its impact on depression symptoms in older spousally bereaved adults. Methods We developed the Widowed Elders’ Lifestyle after Loss (WELL), a pilot randomized controlled prevention trial of digital monitoring of sleep, meals, and physical activity for older spousally-bereaved adults who were at high risk for MDD. The design of WELL builds on prior studies addressing circadian rhythms in bereaved adults for the reduction of depression symptoms. The intervention arm involved 12 weeks of behavioral self-monitoring using a tablet-based app (designed by the STS), in which older adults aged 60+ track the timing and regularity of sleep, meals, and physical activities. Participants in the intervention arm also received weekly motivational health coaching. Participants were assessed at baseline, directly after the 12-week intervention period, and then at 3, 6, and 9 months post-intervention using structured diagnostic interviews and symptom rating scales. Participants in the enhanced usual care arm who reported new depression symptoms were referred to their primary care physician, as in the intervention arm. The primary outcomes of the trial were feasibility and acceptability of intervention components. The secondary outcomes were change in depression symptoms. Actigraphic technology was used to examine the 24-hour rest-activity rhythm – a downstream indicator of the circadian clock – as a mediator of depression outcomes. Results WELL randomized 50 participants, 96.2% of eligible and 34.5% of all older adults screened. Participants in the treatment arms were similar at baseline in structured self-reports. WELL was rated highly by participants; 88% were compliant in digital monitoring and 96% were retained over follow-up. One comment speaks for many in that “WELL helped organize my life.” Depression symptom burden in the intervention arm significantly declined over follow-up, compared to enhanced usual care. There was a significant increase in the regularity of participants’ rest-activity rhythm from pre- to post-intervention. The significant increase in rhythm regularity was correlated with reductions in depression symptoms, as measured by the Hamilton Rating Scale for Depression. These data will be used in confirmatory clinical trial of efficacy. Conclusions A behavioral intervention that is based on the circadian timing system, using both digital monitoring and motivational health coaching, appears to be feasible and acceptable to participants. An intervention that targets the regularity of day- and nighttime activities may reduce depression in older spousally-bereaved adults. The methodological innovations of this project may advance the field of late-life depression prevention. This research was funded by Supported in part by NIH MH103467