Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal

Abstract

Background. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. Methods. A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35–60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. Results. A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4–50.4)]. The difference in BDI scores at T2 between PSY and EUC was −7.43 (95% CI −9.71 to −5.14). Conclusions. Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.

Psychological and social interventions for mental health issues and disorders in Southeast Asia: a systematic review

“…Sixteen studies were conducted in India [ 40 – 56 ]. Eight studies were conducted in Thailand [ 48 , 57 – 63 ], two in Nepal [ 64 , 65 ] and two in Cambodia [ 66 , 67 ]. One was conducted in Indonesia [ 68 ], Timor-Leste [ 69 ] and Sri Lanka [ 70 ].…”

“…(Indu et al 2018) [ 53 ] Depression Quality of Life Community-based depression intervention programme (ComDIP): includes psychoeducation, behavioural activation, relation between negative thoughts and behaviour discussion and drug treatment N = 60 Individual Weekly for 8 weeks In the IG there was a large effect on depressive severity with women with depression (P = 0.01) and quality of life (P = 0.006) was found at 8 weeks versus CG Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal. (Markkula et al 2019) [ 65 ] Depression Anxiety Counselling intervention: emotional support along with problem solving and coping skills development N = 287 Individual Five 45 min appointments, two of which were completed in the first week, with meetings being weekly from weeks two to four IG who received 6 months training, delivered in a primary care setting was effective versus CG at improving depressive and anxiety symptoms at 1 and 6 months (P-Values not reported) Brief cognitive behavioral therapy for depression among patients with alcohol dependence in Thailand (Thapinta et al 2014) [ 48 ] Depression Alcohol dependence CBT N = 80 Group 6 sessions delivered over 3 weeks IG delivered over a 3 week period was effective at reducing depression among Thai general hospital patients with alcohol dependence post intervention (P < .01) and 7 weeks later (P < .01) Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial (Chatterjee et al 2019) [ 55 ] Change in Schizophrenia symptoms and disabilities Adherence to antipsychotic treatment and experience of stigma and discrimination Community care for People with Schizophrenia: individualised treatment plan including clinical review, psychoeducation, medication adherence, health promotion strategies, self-help group referral and community agency engagement N = 282 Individual Delivered in different phases: intensive engagement (0-3 months), stabilization (4–7 months) and maintenance phases (8–12 months) For the IG in the intensive engagement (0-3 months), the stabilization (4–7 months), and the maintenance (8–12 months) vs CG reduced positive and negative symptoms of S...…”

“…EMDR or CBT. The intervention programmes reviewed can be categorised as: lay delivered (n = 7) [ 40 , 41 , 49 , 56 , 64 , 68 , 71 ], yoga, aerobic and/or meditation based (n = 9) [ 42 – 46 , 50 – 52 , 58 ], CBT oriented (n = 8) [ 47 , 48 , 53 , 59 , 61 – 63 , 65 ] health worker delivered (n = 3) [ 54 , 55 , 60 ]. EMDR oriented (n = 2) [ 66 , 69 ] and professional hybrid interventions or programmes (n = 3) [ 57 , 67 , 70 ].…”

“…Markkula et al [ 65 ] developed a counselling intervention, delivered by non-medial health workers, which focussed on providing emotional support along with the development of problem solving and coping skills, in order to reduce psychological distress in a primary care setting in rural Nepal. This intervention, which was delivered individually, consisted of five 45 min appointments, two of which were completed in the first week, with meetings being weekly from weeks two to four.…”

“…This intervention, which was delivered individually, consisted of five 45 min appointments, two of which were completed in the first week, with meetings being weekly from weeks two to four. Markkula et al [ 65 ] (N = 287) found that this intervention was effective versus enhanced usual care at improving depressive and anxiety symptoms at 1 and 6 months (P-Values not reported).…”