Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America.

Amy O’donnell ,Carolin Kilian ,Graciela Yazmín Sánchez Hernández ,Ines Bustamante Chavez ,Adriana Solovei ,Jakob Manthey ,Eileen Kaner ,Marina Piazza ,Juliana Mejía-Trujillo ,Augusto Pérez-Gómez ,Daša Kokole ,Antoni Gual ,Peter Anderson ,Christiane Sybille Schmidt ,Guillermina Natera ,Natalia Bautista Aguilar ,Bernd Schulte ,Jürgen Rehm ,Hein De Vries ,Eva Jané‐Llopis

doi:10.1371/journal.pone.0255594

Abstract

Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.

Highlights

Implementation of evidence-based care for heavy drinking and depression remains low in global health systems
There is a strong reciprocal relationship between alcohol use disorders (AUD) and major depression; heavy drinking increases the risk for developing a depressive disorder [8, 9] and there is a high prevalence of alcohol use disorders amongst those diagnosed with depression [10, 11]
Whilst available data suggest higher rates of depressive disorders are experienced in populations living in wealthier regions [4], depression poses a substantial public health challenge for low-and-middle income countries (LMIC), in part due to less developed health systems and limited resources to support those with mental ill-health [12, 13]