Abstract
BackgroundAlthough around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap.ObjectiveThis study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders.MethodsA before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system.ResultsIn total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively.ConclusionsThe intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial.
Highlights
BackgroundThe Global Burden of Disease study estimates that about 7.1% of total disability-adjusted life years lost are because of mental and substance use disorders [1]
Recent surveys from India estimate that around 10% of the population (150 million) experience depression, anxiety, alcohol, and substance use disorders requiring mental health care [2]; only 15% to 25% receive any treatment in low- and middle-income countries (LMICs), such as India [3]
Unlike the study [24] that used primary health care center PHQ (PHC) as clusters to assess the behavioral intervention, this study evaluated behavioral intervention using Accredited Social Health Activist common mental disorders (CMDs) (ASHA) as clusters
Summary
The Global Burden of Disease study estimates that about 7.1% of total disability-adjusted life years lost are because of mental and substance use disorders [1]. Recent surveys from India estimate that around 10% of the population (150 million) experience depression, anxiety, alcohol, and substance use disorders requiring mental health care [2]; only 15% to 25% receive any treatment in low- and middle-income countries (LMICs), such as India [3]. Contributors to this gap are poor mental health awareness, stigma associated with mental disorders, few trained mental health professionals, and limited relevant health care services [4,5]. The intervention used the principles of task sharing supported by a technology-enabled mental health services delivery model for screening, diagnosing, and managing common mental disorders (CMDs)—defined here as stress, depression, and increased suicide risk
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