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Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial

  • Janine G. Walker (a1), Andrew J. Mackinnon (a2), Philip Batterham (a1), Anthony F. Jorm (a2), Ian Hickie (a3), Affrica McCarthy (a1), Michael Fenech (a4) and Helen Christensen (a5)...



Few randomised controlled trials (RCTs) have examined potential preventive agents in high-risk community populations.


To determine whether a mental health literacy intervention, the promotion of physical activity, or folic acid plus vitamin B12 reduce depression symptoms in community-dwelling older adults with elevated psychological distress.


An RCT with a completely crossed 2 × 2 × 2 factorial design: (400 mcg/d folic acid + 100 mcg/d vitamin B12 v. placebo)×(physical activity v. nutrition promotion control) × (mental health literacy v. pain information control). The initial target sample size was 2000; however, only 909 adults (60–74 years) met the study criteria. Interventions were delivered by mail with telephone calls. The main outcome was depressive symptoms on the Patient Health Questionnaire (PHQ–9) at 6 weeks, 6, 12 and 24 months. The registration number is NCT00214682.


The drop-out rate was low (13.5%) from randomisation to 24-month assessment. Neither folic acid + B12 (F(3,856) = 0.83, P = 0.476) nor physical activity (F(3,856) = 1.65, P = 0.177) reduced depressive symptoms at any time point. At 6 weeks, depressive symptoms were lower for the mental health literacy intervention compared with its control condition (t(895) = 2.04, P = 0.042).


Mental health literacy had a transient effect on depressive symptoms. Other than this, none of the interventions significantly reduced symptoms relative to their comparator at 6 weeks or subsequently. Neither folic acid plus B12 nor physical activity were effective in reducing depressive symptoms.


Corresponding author

Janine G. Walker, PhD, Centre for Mental Health Research, Australian National University, Building 63 Eggleston Road, Acton, Australian Capital Territory, 0200 Australia. Email:


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This study was supported by beyondblue: the national depression initiative and the Australian Government Department of Health and Ageing. H.C. is supported by NHMRC Fellowship 525411. J.G.W. is supported by NHMRC Capacity Building Grant 418020.

Declaration of interest




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Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial

  • Janine G. Walker (a1), Andrew J. Mackinnon (a2), Philip Batterham (a1), Anthony F. Jorm (a2), Ian Hickie (a3), Affrica McCarthy (a1), Michael Fenech (a4) and Helen Christensen (a5)...
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