Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care

Abstract

BackgroundTask shifting approaches (rational redistribution of tasks among health workforce teams) to train lay professionals to assist with integrating mental health treatment in primary care has been recommended to close the mental health treatment gap for depression in low- and middle-income countries. This study aims to examine the a new model for depression care in a low-resource environment compared to enhanced treatment at usual (E-TAU).MethodsWe trained non-specialist community health workers (local lay employees of the public health system) to provide Interpersonal Counseling (IPC) to treat depressive symptoms in the Brazilian, São Paulo city, family health strategy (FHS). We conducted a randomized controlled trial involving 86 patients with a current major depressive disorder or dysthymia (based on DSM-IV) recruited from an FHS clinic. Participants were randomized to IPC intervention (n = 43) or E-TAU (n = 43). Participants allocated to IPC received 3–4 sessions provided by community health workers; research psychologists followed the E-TAU participants to facilitate their referral to specialized mental health care within the public system. Reduction of depressive symptoms was assessed using the Hamilton Rating Scale (HDRS-17) and the Patient Health Questionnaire (PHQ-9); minor psychiatric symptomatology (including depression, anxiety and somatoform symptoms) were measured using the Self Reporting Questionnaire (SRQ); and functioning was measured by the Clinical Global Impression Scale over a 2-month period.ResultsIntention-to-treat analysis showed significant improvement on symptoms for both groups over 2 months, without significant differences between them. Per-protocol analysis showed significant better HDRS-17 outcomes for the IPC group.ConclusionsTraining non-specialist community health workers in low- and middle-income countries to provide IPC could be a successful strategy in reducing the burden of depression and also potentially a low-cost and effective alternative to specialist-led services that might not be possible in low income settings.Trial registrationBrazilian Clinical Trials, number RBR-5qhmb5 (trial url: http://www.ensaiosclinicos.gov.br/rg/RBR-5qhmb5/), retrospectively registered after May 1, 2013.

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

“…Task sharing involving key community-based providers might be a promising implementation strategy in low resource settings. Task sharing refers to the process of transferring a task usually delivered by a scarce resource such as a physician to a rapidly trained and less scarce resource such as a health care worker (e.g.s 322,323 ). Rigorous implementation research on task shared CC models is underway and the outcome of this research will hopefully improve our understanding of the quality, safety, effectiveness and acceptability of strategies for mental health problems in LMICs.…”

Is supported self-management for depression effective for adults in community-based settings in Vietnam?: a modified stepped-wedge cluster randomized controlled trial

“…A 2017 review of randomized trials in LMICs showed that lay health workers helped reduce the burden of common mental disorders including depression using a variety of psychological techniques, including psycho education and goal setting [5]. Randomized trials in India [29], Brazil [30], and Zimbabwe [31] have suggested that interventions delivered by lay health workers for common mental disorders are effective. This study contributes to the accumulating evidence on the effectiveness of task-sharing interventions for depression in an LMIC setting, suggesting that both primary care providers and social collaborators can offer an effective psychosocial intervention for depression.…”

Variations in Costs of a Collaborative Care Model for Dementia

“…We excluded healthcare utilization outside of the program (eg, hospitalization, outpatient visits), household costs, and research. We applied a micro‐costing method of measuring resources and associated prices, using monthly budget reports, meeting reports, clinical protocols, and work contract information to quantify resources . We conducted informal semistructured interviews and focus groups to estimate time spent on clinical activities, and conducted a time and motion study during the Continuing Operations period .…”

“…We applied a micro-costing method of measuring resources and associated prices, using monthly budget reports, meeting reports, clinical protocols, and work contract information to quantify resources. 15,16 We conducted informal semistructured interviews and focus groups to estimate time spent on clinical activities, and conducted a time and motion study during the Continuing Operations period. 17 We calculated the proportion of time spent with discrete clinical-related activities for each staff type including time on the phone or e-mail with dyads, preparing and reviewing cases, documenting the encounters, and consulting other providers or supervising/being supervised.…”