Preliminary results of adapting the stepped care model for depression management in Vietnam

Abstract

BackgroundDepression is the leading burden of mental disease, especially in low-and-middle-income countries like Vietnam. The Stepped Care Model is a promising approach to managing depression in the community with low resources. This is the first study that implemented the adapted Stepped Care Model for depression management in the Vietnamese context and evaluated the initial effectiveness of this community-based intervention in the Thai Nguyen community.Materials and methodsA quasi-experimental study with a 3-month follow-up was conducted in 10 selected communes in Thai Nguyen province. The most important modifications in the Stepped Care Model for depression management were the screening focused on the high-risk individuals living in the community; the combination of 8-session group psychotherapy with animation activities at commune health stations (CHS); and using psychotherapy as first-line treatment. From August 2020 to January 2021, quantitative data were collected using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form. The descriptive analyses were performed to describe the demographic characteristics and the change in the questionnaires' mean score at the baseline and 3-month follow-up.ResultsA total of 1,891 people were approached in the community, of which 359 voluntary people met the study criteria and attended group psychotherapy. During group psychotherapy, the average PHQ-9 scores gradually decreased, and after the 8th session, this figure dropped by 2.65 times compared to the beginning. After 3 months, the percentage of the group with mild-moderate depression shrank from 95.5 to 9.3%, and there were no more severe cases. Moreover, life satisfaction increased by 32% and the anxiety level significantly dropped according to Q-LES-Q-SF and GAD-7 accordingly.ConclusionThe preliminary results after 3-month follow-up showed that the Stepped Care Model with group psychotherapy at the CHS was promising to manage the depression in the community. This task shifting approach with limited resources should be further disseminated and studied for long-term effectiveness in low-and-middle-income countries like Vietnam.

Pilot implementation of group-based psychotherapy led by nonspecialists for lung cancer patients with depression at Vietnam National Cancer Hospital

“…The previous studies about collaborative care using BA principles found remarkable outcomes in depressive symptoms in other populations [34], [42], [43]. Moreover, the similar application of available nonspecialists and task-shifting in depression care was proven to be signi cant with low cost in Vietnam and many other LMICs [18], [32], [44]. In cancer care, the nurse-led psychosocial support based on cognitive behavioral therapy was also proven to be more effective compared to standard care in breast cancer patients [45].…”

“…The intervention for lung cancer patients in this study was adapted from a previous group-based psychotherapy program for depressed people in the community in Vietnam with promising outcomes, higher acceptance, and cultural adapatation [32]. The manual basically was based on the communitybased psychotherapy for depression in Partners in Care program in the US and the MANAS program in India using the task-shifting with low cost [33], [34].…”

Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam

“…Thus, there is a need for effective screening, management and referral of pregnant women with mental health conditions, which arguably can inform improvements in the responsiveness of Vietnam’s health system to the needs and expectations of women with maternal mental health conditions ( Abrams et al ., 2016 ). A model for task sharing was piloted in Vietnam, where non-specialized healthcare personnel were trained to deliver low-cost depression care, including psychological education and providing antidepressant medications with the support of mental health specialists ( Do et al ., 2022 ).…”