Effectiveness of Behavioral Activation Group Therapy for Patients With Depression at the Community in Thanh Hoa

Depressive symptom severity were measured with the 9-item Patient Health Questionnaire (PHQ-9), which is a self-report instrument assessing the frequency of core depressive symptoms over the past two weeks. Each item is rated on a 4-point scale from 0 to 3, yielding a total score ranging from 0 to 27, with higher scores indicating greater symptom severity. The PHQ-9 has been widely used and psychometrically evaluated across diverse populations, including in Vietnam. Internal consistency in the present sample was acceptable, with Cronbach's alpha of 0.71.

Psychological distress was assessed using the 5-item Brief Symptom Rating Scale (BSRS-5). The BSRS-5 captures common distress symptoms experienced during the previous week, including sleep disturbance, anxiety or tension, irritability, depressed mood, and feelings of inferiority. Items are rated from 0 to 4, producing a total score from 0 to 20, with higher scores indicating more severe distress. The BSRS-5 has demonstrated good reliability and validity in prior studies and has been applied among patients with depression. In this study, Cronbach's alpha for the BSRS-5 was 0.70.

Behavioral activation was measured using the Behavioral Activation for Depression Scale-Short Form (BADS-SF). The BADS-SF is a 9-item measure designed to capture change in activation and avoidance over the previous week, which aligns with the core targets of behavioral activation treatment. Items are rated from 0 (not at all) to 6 (completely), yielding a total score from 0 to 54, with higher scores indicating greater behavioral activation and lower avoidance. In this study, internal consistency was acceptable, with Cronbach's alpha of 0.70.

Resilience coping was assessed using the Brief Resilience Coping Scale (BRCS-4). The BRCS-4 includes 4 items reflecting adaptive coping strategies when facing stress or adversity, such as creative problem-solving and the ability to grow through difficult situations. Each item is rated from 1 to 5, resulting in a total score from 4 to 20, with higher scores reflecting greater resilient coping. The instrument was developed and widely applied by Sinclair and Wallston since 2004. The BRCS has shown good psychometric properties in Vietnamese samples. In this study, Cronbach's alpha for the BRCS was 0.82.

Health-related quality of life (HRQoL) was measured using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument. The EQ-5D-5L includes five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety or depression. Each dimension is rated on a 5-point Likert scale, ranging from no problem (1) to extreme problem (5). Health states were converted into a utility score using the Vietnamese EQ-5D-5L value set. Utility scores range from -0.5115 to 1, where 1 represents full health, and higher scores indicate better HRQoL.