The effect of VISHRAM, a grass-roots community-based mental health programme, on the treatment gap for depression in rural communities in India: a population-based study

Shidhaye, Rahul; Murhar, Vaibhav; Gangale, Siddharth PhD; Aldridge, Luke R.; Shastri, Rahul; Parikh, Rachana; Shrivastava, Ritu; Damle, Suvarna; Raja, Tasneem; Nadkarni, Abhijit; Patel, Vikram

doi:10.1016/s2215-0366(16)30424-2

Cited by 68 publications

(71 citation statements)

References 21 publications

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“…For example, in a cross-national study of 21 countries, 65% of persons meeting criteria for depression in high-income countries endorsed need for treatment of a disorder compared with 35% in lower-middle income countries (57). In India, the VISHRAM project, an 18-month community-based program to enhance mental health literacy as pathway to reduce suicide risk, resulted in increased conceptualization of depression as a mental health problem and greater intention to seek care for depression, with a 6-fold increase in contact coverage (treatment seeking) (58). …”

Section: Discussionmentioning

confidence: 99%

Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015

Hagaman

Khadka²,

Lohani

et al. 2017

Soc Psychiatry Psychiatr Epidemiol

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Purpose Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world’s burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. Methods Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. Results In the total police sample (n=302), 57% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 51% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000 respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. Conclusions Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.

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Section: Discussionmentioning

confidence: 99%

Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015

Hagaman

Khadka²,

Lohani

et al. 2017

Soc Psychiatry Psychiatr Epidemiol

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“…Thus, the primary aim of this study was to test group PM+ as a novel depression intervention rather than testing an implementation strategy to enhance implementation outcomes for a depression intervention being delivered in routine implementation settings, as would occur in a Hybrid Type-3 or T3 study (see Table 3 for detailed study descriptions). By contrast, in a Hybrid Type-3 study, Shidhaye et al (2017) reported the costs associated with an implementation strategy focused on increasing populationlevel demand for the existing routine depression care. The primary aim of their study was increase contact coverage of existing routinely-implemented depression interventions.…”

Section: Depression Intervention Characteristicsmentioning

confidence: 99%

Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

et al. 2020

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Background. We systematically reviewed implementation research targeting depression interventions in low-and middle-income countries (LMICs) to assess gaps in methodological coverage. Methods. PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019. Results. A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectivenessimplementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3). Conclusions. Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability.

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“…The intervention was associated with a six-fold increase in the proportion of people with depression who sought treatment. 18 Nepal has achieved remarkable results from communitybased interventions promoting sexual and reproductive health in adolescents and young people, as well as improving maternal and neonatal health outcomes. This track record, as well as existing evidence on community mental health interventions and programmes in Nepal and other countries, suggests that there are promising opportunities for cost-effective and sustainable community-based mental health interventions for adolescents, including left-behind adolescents.…”

Section: Mental Health Governance In Nepal and The Role Of Communitymentioning

confidence: 99%

Adolescents left behind by migrant workers: a call for community-based mental health interventions in Nepal

Aryal

Regmi

Teijlingen

et al. 2019

WHO South-East Asia J Public Health

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Over the past two decades, the unique health needs associated with the second decade of life have been recognized, not least the mental health of adolescents. In parallel, the negative health impacts of parental migration on the children and adolescents who are "left behind" in low-and middle-income countries (LMICs) is beginning to be acknowledged. Nepal is a growing supplier of labour migrantsan estimated 3.5 million Nepali individuals are working abroad -resulting in families being separated and thousands of adolescents being left behind. This can increase psychological and emotional stress and feelings of loneliness and abandonment, and reduce self-esteem among left-behind adolescents, which in turn may have a negative impact on their psychosocial health. Globally, mental health and neurodevelopmental disorders are one of the top three causes of disability-adjusted life-years lost among adolescents. The devastating earthquake in Nepal in 2015 brought into sharp focus the lack of prioritization of mental health services and spurred development of the Community mental health care package Nepal, 2074 in 2017. This package, together with the upcoming revised National Mental Health Policy, emphasizes the need to (i) ensure the availability and accessibility of basic mental health and psychosocial support services for all; and (ii) facilitate integration of mental health services into the primary health-care system. Recognizing that mental health and psychosocial support services have been predominantly focused on the adult population only, the package includes a component on childhood and adolescent mental and behavioural disorders. It will be essential for policy-makers to ensure that strategies are in place to ensure that left-behind adolescents, especially those who are not in school, have access to these community-based services. Given the paucity of research on mental health interventions among adolescents in LMICs in general, monitoring and assessment of what works for this special group of young people in Nepal may have broader implications for implementation in other countries where migration has resulted in significant populations of left-behind adolescents.

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The effect of VISHRAM, a grass-roots community-based mental health programme, on the treatment gap for depression in rural communities in India: a population-based study

Cited by 68 publications

References 21 publications

Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015

Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015

Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

Adolescents left behind by migrant workers: a call for community-based mental health interventions in Nepal

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