Remote behavioural activation therapy for depressive symptoms among older adults in resource-limited settings: a protocol for a systematic review and meta-analysis

Abstract

Depressive symptoms represent a severe mental health burden among older adults, particularly in resource-limited settings with scarce mental healthcare resources. Although behavioural activation is an established evidence-based intervention, the efficacy of remote behavioural activation therapy (RBAT), its optimal intervention characteristics, and overall evidence certainty remain systematically unevaluated in this vulnerable population. This systematic review and meta-analysis aims to synthesise evidence from randomised controlled trials (RCTs) to evaluate the efficacy of RBAT. Eligible studies will include RCTs evaluating RBAT among adults aged 60 years or above experiencing depressive symptoms in resource-limited settings. Studies will be identified through systematic searches of PubMed, Web of Science, Embase, CINAHL, PsycINFO and the Cochrane Library from inception to 1 July 2025. The primary outcome is depressive symptom severity measured using validated continuous depression scales. Standardised mean differences with 95% confidence intervals will be pooled using random-effects models. Risk of bias will be assessed using the Cochrane Risk of Bias tool version 2, and the certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation framework. Subgroup analyses and exploratory meta-regression analyses will be performed to examine heterogeneity. This systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In summary, this review will provide a rigorous synthesis of RBAT efficacy for depressive symptoms among older adults living in resource-limited settings. By quantifying the certainty of evidence and identifying key characteristics associated with treatment variations, the findings will clarify the current evidence base, guide future research, and inform scalable digital mental health strategies for these underserved populations. PROSPERO CRD42025627772.