Abstract
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. 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. 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). 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.
Highlights
There is a vast treatment gap in mental disorders globally: approximately one in four persons with common mental disorders has received treatment (Alonso et al, 2018; Araya et al, 2018)
In psychosocial counselling (PSY), 101 participants (81.4%) had a response compared with 57 participants (42.5%) in enhanced usual care (EUC) [percentage difference 39.4%]
Non-medical psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings
Summary
There is a vast treatment gap in mental disorders globally: approximately one in four persons with common mental disorders has received treatment (Alonso et al, 2018; Araya et al, 2018). The gap is wider in developing countries, where human resources for mental health are extremely scarce (Chisholm et al, 2016b; De Silva et al, 2014; Kakuma, 2011). Psychosocial interventions, in their culturally adapted forms, have been shown to be effective in the treatment of common mental disorders (Chowdhary et al, 2014; De Silva et al, 2013). The focus on disease-specific treatment packages and stigma contribute to the low coverage of psychological therapies (Singla et al, 2017). Providing psychosocial counselling for common mental disorders, without disease-specific focus, at a primary care setting might help overcome some of these challenges.
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