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Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal

  • Mark J. D. Jordans (a1), Nagendra P. Luitel (a2), Emily Garman (a3), Brandon A. Kohrt (a4), Sujit D. Rathod (a5), Pragya Shrestha (a6), Ivan H. Komproe (a7), Crick Lund (a8) and Vikram Patel (a9)...

Abstract

Background

Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.

Aim

Evaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).

Method

Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire – 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.

Results

Participants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = −5.90, 95% CI −7.55 to −4.25, β = −3.68, 95% CI −5.68 to −1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = −12.21, 95% CI −19.58 to −4.84, β = −10.74, 95% CI −19.96 to −1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).

Conclusion

Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Mark J. D. Jordans, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London SE5 8AF, UK. Email: mark.jordans@kcl.ac.uk

References

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Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal

  • Mark J. D. Jordans (a1), Nagendra P. Luitel (a2), Emily Garman (a3), Brandon A. Kohrt (a4), Sujit D. Rathod (a5), Pragya Shrestha (a6), Ivan H. Komproe (a7), Crick Lund (a8) and Vikram Patel (a9)...

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Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal

  • Mark J. D. Jordans (a1), Nagendra P. Luitel (a2), Emily Garman (a3), Brandon A. Kohrt (a4), Sujit D. Rathod (a5), Pragya Shrestha (a6), Ivan H. Komproe (a7), Crick Lund (a8) and Vikram Patel (a9)...
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