Dr David Hamilton, Associate Professor Jane McGillivray, Professor Marita McCabe, Dr Mavis Kershaw
School of Psychology, Deakin University
beyondblue Victorian Centre of Excellence
Project completion year
Research has demonstrated that individuals with intellectual disability are vulnerable to depression and their risk may be greater than for people in the general population. There is growing evidence that cognitive therapies are suitable for individuals with intellectual disability, particularly those in the mild range, who have symptoms of depression. This study extended earlier beyondblue-funded work.
The 58 participants (aged 18 to 65, and each with a mild intellectual disability) were assessed for symptoms of depression before and after treatment, eight months after treatment, and again 12 months after treatment.
The project also extended the Think happy, Feel happy, Be happy program – a group program in which participants are encouraged to feel comfortable in sharing their experiences and to learn coping skills – to include a module to help staff identify risk factors or symptoms of depression in people with intellectual disabilities and to refer them to GPs for mental healthcare.
Staff at agencies that provide services to people with mild intellectual disability in community-based settings were trained in the Think happy, Feel happy, Be happy program. The effect of this staff-administered program on symptoms of depression in people with intellectual disability was assessed, as was the level of referral to GPs.
The staff-administered cognitive behavioural program for early intervention and treatment of depression in individuals with mild intellectual disability was confirmed to be effective. The participants in the cognitive behavioural program, which also included referral to GPs, reported fewer depressive symptoms and less negative thinking compared with their experiences before the program and when compared to the group receiving only referral to GPs. These effects were maintained at both the eight and 12 month follow-ups.
The screening checklist to identify symptoms or risk factors for depression was valuable.
Some staff members were reluctant to refer identified participants to GPs for mental health services, with the most common reasons being that they did not want to “upset” participants or family members or did not feel qualified to make such referrals. Some participants did not pursue referrals.
Implications for policy, practice and further research
It is important that people with mild intellectual disability are screened for symptoms of depression and its risk factors, and that individuals indicating vulnerability have access to cognitive behavioural treatment programs. It is recommended that staff at community-based agencies undertake routine screening of individuals with mild intellectual disabilities, using a screening checklist.
Further research could determine which components of the Think happy, Feel happy, Be happy program are most effective, and if any elements might be discarded or improved. However, the results confirm that the program is effective and can be delivered by trained staff from disability agencies in community-based settings. It is recommended that staff in these agencies are trained in cognitive behavioural strategies and are able to provide group programs for individuals at risk.
Access to GPs remains important. The difficulties associated with referring individuals with mild intellectual disability who have symptoms of depression suggest a need for further training of the agency staff and GPs, with the latter perhaps requiring education about treatment options beyond medication.
Other topics recommended for further study include the value of screening participants to determine if they are suitable for cognitive behavioural approaches, how best to educate GPs to recognise and treat depression among people with intellectual disabilities, and whether the Think happy, Feel happy, Be happy program could be adapted to help young adults with other disorders, such as autism spectrum disorders, that are known to increase the risk of anxiety or depression.
McGillivray, JA, McCabe, M.P. and Kershaw, MM. 2007, Depression in people with intellectual disability: An evaluation of a staff-administered treatment program, Research in Developmental Disabilities, 29(6) 524-536