Vikram Patel|Benedict Weobong|Helen A. Weiss|Arpita Anand|Bhargav Bhat|Basavraj Katti|Sona Dimidjian|Ricardo Araya|Steve D. Hollon|Michael King|Lakshmi Vijayakumar|A?La Park|David McDaid|Terry Wilson|Richard Velleman|Betty Kirkwood|Christopher G. Fairburn
The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial
Sangath|London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine|Medical Research Council|London School of Hygiene & Tropical Medicine|Sangath|Sangath|Sangath|University of Colorado Boulder|London School of Hygiene & Tropical Medicine|Vanderbilt University|University College London|University of Melbourne|London School of Economics and Political Science|London School of Economics and Political Science|Rutgers, The State University of New Jersey|University of Bath|Sangath|London School of Hygiene & Tropical Medicine|University of Oxford
although structured psychological treatments recommended firstline interventions depression small fraction people globally receive treatments poor access routine primary care assessed effectiveness costeffectiveness brief psychological treatment healthy activity program hap delivery lay counsellors patients moderately severe severe depression primary healthcare settingsin randomised controlled trial recruited participants aged 1865 years scoring 14 patient health questionnaire 9 phq9 indicating moderately severe severe depression ten primary health centres goa india pregnant women patients needed urgent medical attention unable communicate clearly eligible participants randomly allocated 11 enhanced usual care euc alone euc combined hap randomly sized blocks block size four six two four men stratified primary health centre sex allocation concealed use sequential numbered opaque envelopes physicians providing euc masked primary outcomes depression symptom severity beck depression inventory version ii remission depression phq9 score 10 3 months intentiontotreat population assessed masked field researchers secondary outcomes disability days unable work behavioural activation suicidal thoughts attempts intimate partner violence resource use costs illness assessed serious adverse events perprotocol population trial registered isrctn registry number isrctn95149997between oct 28 2013 july 29 2015 enrolled randomly allocated 495 participants 247 50 euc plus hap group two subsequently excluded protocol violations 248 50 euc alone group 466 95 completed 3 month primary outcome assessment 230 49 euc plus hap group 236 51 euc alone group participants euc plus hap group significantly lower symptom severity beck depression inventory version ii euc plus hap group 1999 sd 1570 vs 2752 1326 euc alone group adjusted mean difference 757 95 ci 1027 486 p00001 higher remission 147 64 230 phq9 score 10 hap plus euc group vs 91 39 236 euc alone group adjusted prevalence ratio 161 134193 euc alone group euc plus hap showed better results euc alone secondary outcomes disability adjusted mean difference 273 439 106 p0001 days work 229 384 073 p0004 intimate partner physical violence women 053 029096 p004 behavioural activation 217 134300 p00001 suicidal thoughts attempts 061 045083 p0001 incremental cost per qualityadjusted lifeyear gained 9333 95 ci 386228 169 2015 international dollars 87 chance costeffective study setting serious adverse events infrequent similar groups nine 4 euc plus hap group vs ten 4 euc alone group p100hap delivered lay counsellors plus euc better euc alone patients moderately severe severe depression routine primary care goa india hap readily accepted previously untreated population costeffective setting hap could key strategy reduce treatment gap depressive disorders leading mental health disorder worldwidewellcome trust