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

Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services...

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Bibliographic Details
Published in:British journal of psychiatry 2019-08, Vol.215 (2), p.485-493
Main Authors: Jordans, Mark J. D., Luitel, Nagendra P., Garman, Emily, Kohrt, Brandon A., Rathod, Sujit D., Shrestha, Pragya, Komproe, Ivan H., Lund, Crick, Patel, Vikram
Format: Article
Language:English
Subjects:
Alcohol abuse
Alcohol related disorders
Alcohol use
Alcoholism
Clinical outcomes
Clinical trials
Community mental health services
Counseling
Counselors
Disability
Drugs
Epilepsy
Functional impairment
Health facilities
Health services
Intervention
Intoxication
Medical personnel
Mental depression
Mental disorders
Mental health care
Mental health services
Organizational effectiveness
Primary care
Psychiatry
Psychoeducational treatment
Psychological intervention
Psychological services
Psychosis
Psychotropic drugs
Questionnaires
Severity
Systematic review
Treatment methods
Workers
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Summary:Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating 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). 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. 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). 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 interestNone.
ISSN:0007-1250
1472-1465
DOI:10.1192/bjp.2018.300