Investigating a Social Identity Based Intervention in Its Treatment of Depression: A Randomised Control Trial

Depression is a burdensome mental health condition which impacts on psychological, social and cognitive function. Given its high prevalence and relapse rates, research investigating improvements in current treatment and outcome remains a priority. Recent research, informed by the Social Identity Approach to Health, has highlighted the important role that social identity plays in the development and maintenance of depression, with the implication being that a social identity based treatment may improve outcomes. However, interventions that target social connectedness, and social identity processes in particular, are lacking. Groups4Health (G4H) addresses this gap, offering a theory derived intervention that targets social disconnection. Findings from an initial pilot study showed its potential to improve depression specifically through building and strengthening social identity. The present study aims to extend on these findings to further evaluate its effectiveness in its treatment of depression. Two studies were conducted. The first was a further pilot to investigate G4H’s potential effects on neuropsychological test performance (in areas of concentration/working memory, memory and executive functioning) and empathy in depression, in a pre-post study design. Fifty-eight adults screened for depression and psychological distress completed G4H over five sessions. The most consistent finding was the improved attention/working memory and this measure was therefore included in the RCT. No evidence of improvements in memory and executive functioning were found. Given that impairment in these domains have been reported in the literature, these measures were replaced with other memory and executive functioning measures with greater sensitivity. There were significant improvements in aspects of empathy (Perspective Taking and Empathic Concern). Following standard practice to include all the subscales, the entire empathy measure was included in the RCT. The second study built on the first, and sought to evaluate the efficacy of G4H in a randomized controlled trial (RCT) as indexed primarily by depression symptoms, neuropsychological test performance, social connectedness and quality of life. Multiple group membership and empathy were investigated as potential mechanisms underlying change. Here, eighty-four were assessed for eligibility and seventy-three depressed participants were randomly allocated to treatment (G4H) and waitlist control groups. Baseline measurement was completed prior to group allocation, and repeated at two months post treatment. Forty-four participants completed the study with twenty-nine lost to follow-up. Of note, there was a disproportionate loss of the more severely depressed participants during the waitlist period in the control group. Results showed no significant difference between groups on any measure, with both the treatment and control group showing some evidence of improvement over the period of intervention. Though, due to the pattern in attrition, the control group were no longer representative of the sample initially recruited and were significantly less depressed than the G4H group. Analysis of pre-post scores among the more severely depressed G4H group showed a significant improvement in depression symptoms, loneliness, people’s sense of connectedness to multiple groups, concentration/working memory, and phonemic fluency. The mechanism of change was not explored given the small sample size. Nevertheless, the RCT provided limited evidence of the efficacy of G4H, with the study limited by problems in attrition and sample size. The theoretical and practical implications of study findings are discussed, along with suggestions for future research based on learnings from the current program of research