Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial

Patel, Vikram; Weiss, Helen A.; Chowdhary, Neerja; Naik, Smita; Pednekar, Sulochana; Chatterjee, Sudipto; Silva, Mary J De; Bhat, Bhargav; Araya, Ricardo; King, Michael; Simon, Gregory E.; Verdeli, Helen; Kirkwood, Betty

doi:10.1016/s0140-6736(10)61508-5

Cited by 608 publications

(525 citation statements)

References 33 publications

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“…In this study, working with community members staff, built confidence, intercultural dialog, and supporting networks. In addition, empathy of LPCWs was highlighted, which is a skill that has been documented as a fundamental for improving the mental health of patients 23,24 . In Buenaventura, LPCWs had experience in religious and community processes, which could explain better results in quantitative analysis compared with Quibdó 9 .…”

Section: Discussionmentioning

confidence: 99%

Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

Osorio-Cuellar

Pacichana-Quinayáz

Bonilla-Escobar

et al. 2017

Ciênc. saúde coletiva

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Section: Discussionmentioning

confidence: 99%

Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

Osorio-Cuellar

Pacichana-Quinayáz

Bonilla-Escobar

et al. 2017

Ciênc. saúde coletiva

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“…An RCT in India (Patel et al, 2010) showed that a collaborative care intervention led by lay counsellors was cost-saving to the health system (Buttorff et al, 2012). A 6–8 session behavioral activation treatment delivered by lay counsellors in primary health care settings in India was also cost effective, reducing depression and improving functioning in people with moderately severe to severe depression (Patel et al, 2017; Weobong et al, 2017).…”

Section: Scaling-up Mental Health Interventions For Refugeesmentioning

confidence: 99%

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

Sijbrandij¹,

Acartürk

Bird³

et al. 2017

European Journal of Psychotraumatology

218

202

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The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria’s neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training,We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.

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“…In other areas of mental health care results from US-developed organisational interventions have not generalised outside the original health-care context. 25 For collaborative care, there was some supportive evidence from other contexts, including the developing world, 26,27 but prior to the CADET trial there has been uncertainty around the standardised effect size in UK trials (SMD 0.24, 95% CI -0.060 to 0.547) and elsewhere. 24 These limited non-US data and the relatively small effect size in trials of patients with depression alone led the UK National Institute for Health and Care Excellence (NICE) 28 to issue a research recommendation that 'The efficacy of organisational interventions, such as chronic disease management programmes or other programmes of enhanced care for depression, should be tested in large-scale multicentre trials in the NHS' (research recommendation 5.6.8.1, p. 103).…”

Section: Collaborative Carementioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

Richards

Bower

Chew‐Graham

et al. 2016

Health Technol Assess

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BackgroundCollaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness.ObjectiveTo determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression.DesignCluster randomised controlled trial.SettingUK primary care practices (n = 51) in three UK primary care districts.ParticipantsA total of 581 adults aged ≥ 18 years in general practice with a currentInternational Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment.InterventionsCollaborative care: 14 weeks of 6–12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice.Main outcome measuresBlinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months.ResultsIn total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31;p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64;p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for recovery 1.88, 95% CI 1.28 to 2.75; number needed to treat 6.5). Quality of mental health but not physical health was significantly better for collaborative care at 4 months but not at 12 months. There was no difference for anxiety. Participants receiving collaborative care were significantly more satisfied with treatment. Differences between groups had disappeared at 36 months. Collaborative care had a mean cost of £272.50 per participant with similar health and social care service use between collaborative care and usual care. Collaborative care offered a mean incremental gain of 0.02 (95% CI –0.02 to 0.06) quality-adjusted life-years (QALYs) over 12 months at a mean incremental cost of £270.72 (95% CI –£202.98 to £886.04) and had an estimated mean cost per QALY of £14,248, which is below current UK willingness-to-pay thresholds. Sensitivity analyses including informal care costs indicated that collaborative care is expected to be less costly and more effective. The amount of participant behavioural activation was the only effect mediator.ConclusionsCollaborative care improves depression up to 12 months after initiation of the intervention, is preferred by patients over usual care, offers health gains at a relatively low cost, is cost-effective compared with usual care and is mediated by patient activation. Supervision was by expert clinicians and of short duration and more intensive therapy may have improved outcomes. In addition, one participant requiring inpatient treatment incurred very significant costs and substantially inflated our cost per QALY estimate. Future work should test enhanced intervention content not collaborative care per se.Trial registrationCurrent Controlled Trials ISRCTN32829227.FundingThis project was funded by the Medical Research Council (MRC) (G0701013) and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership.

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Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial

Cited by 608 publications

References 33 publications

Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

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