TY - JOUR
T1 - Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors
T2 - Two pragmatic randomised controlled trials within primary healthcare in Nepal
AU - Jordans, Mark J.D.
AU - Luitel, Nagendra P.
AU - Garman, Emily
AU - Kohrt, Brandon A.
AU - Rathod, Sujit D.
AU - Shrestha, Pragya
AU - Komproe, Ivan H.
AU - Lund, Crick
AU - Patel, Vikram
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.Aim Evaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).Method Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire - 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.Results Participants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = -5.90, 95% CI -7.55 to -4.25, β = -3.68, 95% CI -5.68 to -1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = -12.21, 95% CI -19.58 to -4.84, β = -10.74, 95% CI -19.96 to -1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).Conclusion Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.Declaration of interest None.
AB - Background Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.Aim Evaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).Method Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire - 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.Results Participants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = -5.90, 95% CI -7.55 to -4.25, β = -3.68, 95% CI -5.68 to -1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = -12.21, 95% CI -19.58 to -4.84, β = -10.74, 95% CI -19.96 to -1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).Conclusion Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.Declaration of interest None.
KW - effectiveness
KW - low- and middle-income settings
KW - Nepal
KW - primary healthcare
KW - Psychological treatment
UR - http://www.scopus.com/inward/record.url?scp=85062348192&partnerID=8YFLogxK
U2 - 10.1192/bjp.2018.300
DO - 10.1192/bjp.2018.300
M3 - Article
C2 - 30678744
AN - SCOPUS:85062348192
SN - 0007-1250
VL - 215
SP - 485
EP - 493
JO - British Journal of Psychiatry
JF - British Journal of Psychiatry
IS - 2
ER -