An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme

被引：18

作者：

Daniel, Mercian ^{[1
]}

Maulik, Pallab K. ^{[1
,2
,3
,4
]}

Kallakuri, Sudha ^{[5
]}

Kaur, Amanpreet ^{[1
]}

Devarapalli, Siddhardha ^{[5
]}

Mukherjee, Ankita ^{[1
]}

Bhattacharya, Amritendu ^{[1
]}

Billot, Laurent ^{[6
]}

Thornicroft, Graham ^{[7
,8
]}

Praveen, Devarsetty ^{[2
,3
,5
]}

Raman, Usha ^{[9
]}

Sagar, Rajesh ^{[10
]}

Kant, Shashi ^{[10
]}

Essue, Beverley ^{[11
]}

Chatterjee, Susmita ^{[1
,2
,3
]}

Saxena, Shekhar ^{[12
]}

Patel, Anushka ^{[6
]}

Peiris, David ^{[6
]}

机构：

[1] George Inst Global Hlth, New Delhi, India

[2] Univ New South Wales, Sydney, NSW, Australia

[3] Prasanna Sch Publ Hlth, Manipal, India

[4] George Inst Global Hlth, Oxford, England

[5] George Inst Global Hlth, Hyderabad, India

[6] Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia

[7] Kings Coll London, Ctr Global Mental Hlth, London, England

[8] Kings Coll London, Inst Psychiat Psychol & Neurosci, Ctr Implementat Sci, Hlth Serv & Populat Res Dept, London, England

[9] Univ Hyderabad, Hyderabad, India

[10] All India Inst Med Sci, New Delhi, India

[11] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[12] Harvard TH Chan Sch Publ Hlth, Boston, MA USA

来源：

TRIALS | 2021年 / 22卷 / 01期

基金：

英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;

关键词：

Common mental disorders; Primary healthcare worker; Anti-stigma campaign; Electronic decision support systems; SMART Mental Health; India; Implementation; Cluster randomised controlled trial; MAJOR DEPRESSIVE DISORDER; DECISION-SUPPORT-SYSTEMS; PREVALENCE; IMPACT;

D O I：

10.1186/s13063-021-05136-5

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

Background: Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75-95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed. Methods: We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged >= 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived-a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation. Expected outcomes: The primary study outcome is the difference in mean behaviour scores at 12 months in the combined 'high-risk' and 'non-high-risk' cohort and the mean difference in PHQ-9 scores at 12 months in the 'high-risk' cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations. Significance: The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings.

引用

页数：13

共 45 条

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