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Lay interventions for depression and drinking

September 12, 2017

Brief psychological interventions delivered by lay counsellors in primary care were effective and cost-effective for patients with depression and harmful drinking in India, according to two studies in PLOS Medicine by Vikram Patel of Harvard Medical School, USA, and colleagues from the London School of Hygiene & Tropical Medicine, London, UK and Sangath, India. The authors have previously reported the effectiveness of the two interventions, Healthy Activity Programme (HAP) and Counselling for Alcohol Problems (CAP), at 3 months; however, the longer-term benefits of the interventions were previously unknown.

In the first trial, 493 adult primary health care attendees with moderately severe or severe depression were randomly assigned to either the HAP treatment plus enhanced usual care (EUC), or enhanced usual care (EUC) alone. The researchers found that HAP participants maintained the benefits they showed at the end of treatment through the 12-month period, with significantly lower symptom severity scores (adjusted mean difference in BDI-II: ?4.45) and higher rates of remission (PHQ-9 score < 5: 63% versus 48%) than participants who received EUC alone.

In the second trial, 377 adult male primary health care attendees with harmful drinking were randomly assigned to either the CAP treatment plus EUC, or EUC alone. The researchers found that CAP participants maintained the gains they showed at the end of treatment through the 12-month period, with higher remission rates (AUDIT score < 8: 54.3% versus 31.9%) and a greater proportion reporting no alcohol consumption in the past 14 days (45.1% versus 26.4%), compared with individuals who received EUC alone.

Both HAP and CAP were likely to be cost-effective, and could even save money if productivity costs were taken into account.

The authors say "We have provided the first evidence that two brief psychological therapies targeting the two leading mental health related causes of the global burden of disease, delivered by the same lay counsellor in routine primary care, to patients who had never received such therapies before, can lead to sustained improvements in health over one year, and that the investments made in providing this intervention is excellent value for money. Given the enormous economic and social consequences of untreated depression and harmful drinking, the moral imperative is for governments to scale up these treatments globally."
-end-
Research Article

Funding:

This research was funded by a Wellcome Trust Senior Research Fellowship grant to Vikram Patel (091834), https://wellcome.ac.uk. Christopher G Fairburn is supported through a Principal Research Fellowship from the Wellcome Trust (046386). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

DM has received honoraria for lectures not related to this work from Otsuka Pharmaceuticals, Janssen-Cilag, and H Lundbeck in the past 2 years. CGF holds a Principal Research Fellowship from the Wellcome Trust (046386). VP is a member of the Editorial Board of PLOS Medicine. All other authors declare no competing interests.

Citation:

Weobong B, Weiss HA, McDaid D, Singla DR, Hollon SD, Nadkarni A, et al. (2017) Sustained effectiveness and cost-effectiveness of the Healthy Activity Programme, a brief psychological treatment for depression delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial. PLoS Med 14(9): e1002385. https://doi.org/10.1371/journal.pmed.1002385

Author Affiliations:

Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom
Department of Psychiatry, Sinai Health Network, University of Toronto, Toronto, Ontario, Canada
Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
Sangath, Socorro, Goa, India
Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, United States of America
Institute of Psychiatry, Psychology, and Neurosciences, King's College Hospital, London, United Kingdom
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
SNEHA, Voluntary Health Services, University of Melbourne, Melbourne, Victoria, Australia
Department of Psychology, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey, United States of America
Department of Psychology, University of Bath, Bath, United Kingdom
Department of Psychiatry, University of Oxford, Oxford, United Kingdom
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002385

Research Article

Funding:

This research was funded by a Wellcome Trust Senior Research Fellowship grant to VP (091834), https://wellcome.ac.uk. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

DMD has received honoraria for lectures not related to this work from Otsuka Pharmaceuticals, Janssen-Cilag, and H Lundbeck in the past 2 years. CGF holds a Principal Research Fellowship from the Wellcome Trust (046386).

Citation:

Nadkarni A, Weiss HA, Weobong B, McDaid D, Singla DR, Park A-L, et al. (2017) Sustained effectiveness and cost-effectiveness of Counselling for Alcohol Problems, a brief psychological treatment for harmful drinking in men, delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial. PLoS Med 14(9): e1002386. https://doi.org/10.1371/journal.pmed.1002386

Author Affiliations:

Sangath, Socorro, Goa, India
London School of Hygiene & Tropical Medicine, London, United Kingdom
Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom
Department of Psychiatry, Sinai Health Network, University of Toronto, Toronto, Ontario, Canada
Department of Health Sciences, University of York, York, United Kingdom
National Institute of Mental Health and Neurosciences, Bengaluru, India
Division of Psychiatry, University College London, London, United Kingdom
Department of Psychology, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey, United States of America
Department of Psychiatry, University of Oxford, Oxford, United Kingdom
Department of Psychology, University of Bath, Bath, United Kingdom
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002386

PLOS

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