Mark J. D. Jordans|Nagendra P. Luitel|Emily Garman|Brandon A. Kohrt|Sujit D Rathod|Pragya Shrestha|Ivan H. Komproe|Crick Lund|Vikram Patel
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
King's College London|University of Cape Town|George Washington University|London School of Hygiene & Tropical Medicine|Utrecht University|HealthNet TPO|University of Cape Town|King's College London|Harvard Global Health Institute|Harvard University
background evidence shows benefits psychological treatments lowresource countries yet government health systems include psychological services aim evaluating clinical value adding psychological treatments delivered communitybased counsellors primary carebased mental health services depression alcohol use disorder aud recommended mental health gap action programme mhgap method two randomised controlled trials separately depression aud carried participants randomly allocated 11 mental healthcare delivered mhgaptrained primary care workers psychoeducation psychotropic medicines indicated services plus individual psychological treatments healthy activity program depression counselling alcohol problems primary outcomes symptom severity measured using patient health questionnaire 9 item phq9 depression alcohol use disorder identification test aud functional impairment measured using world health organization disability assessment schedule whodas 12 months postenrolment results participants depression intervention arm n 60 greater reduction phq9 whodas scores compared participants control n 60 phq9 590 95 ci 755 425 368 95 ci 568 167 p lt 0001 cohens 066 whodas 1221 95 ci 1958 484 1074 95 ci 1996 153 p 0022 cohens 042 aud trial significant effect found comparing control n 80 intervention participants n 82 conclusion adding psychological treatment delivered communitybased counsellors increases treatment effects depression compared mhgapbased services primary health workers 12 months posttreatment declaration interest none