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
Abstract 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 a...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | Trials |
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| Online Access: | https://doi.org/10.1186/s13063-021-05136-5 |
| _version_ | 1818337088437747712 |
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| author | Mercian Daniel Pallab K. Maulik Sudha Kallakuri Amanpreet Kaur Siddhardha Devarapalli Ankita Mukherjee Amritendu Bhattacharya Laurent Billot Graham Thornicroft Devarsetty Praveen Usha Raman Rajesh Sagar Shashi Kant Beverley Essue Susmita Chatterjee Shekhar Saxena Anushka Patel David Peiris |
| author_facet | Mercian Daniel Pallab K. Maulik Sudha Kallakuri Amanpreet Kaur Siddhardha Devarapalli Ankita Mukherjee Amritendu Bhattacharya Laurent Billot Graham Thornicroft Devarsetty Praveen Usha Raman Rajesh Sagar Shashi Kant Beverley Essue Susmita Chatterjee Shekhar Saxena Anushka Patel David Peiris |
| author_sort | Mercian Daniel |
| collection | DOAJ |
| description | Abstract 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. Trial registration Clinical Trial Registry India CTRI/2018/08/015355 . Registered on 16 August 2018. |
| first_indexed | 2024-12-13T14:49:39Z |
| format | Article |
| id | doaj.art-dcc65b67425b4f398defc88f14945403 |
| institution | Directory Open Access Journal |
| issn | 1745-6215 |
| language | English |
| last_indexed | 2024-12-13T14:49:39Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Trials |
| spelling | doaj.art-dcc65b67425b4f398defc88f149454032022-12-21T23:41:23ZengBMCTrials1745-62152021-03-0122111310.1186/s13063-021-05136-5An 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 programmeMercian Daniel0Pallab K. Maulik1Sudha Kallakuri2Amanpreet Kaur3Siddhardha Devarapalli4Ankita Mukherjee5Amritendu Bhattacharya6Laurent Billot7Graham Thornicroft8Devarsetty Praveen9Usha Raman10Rajesh Sagar11Shashi Kant12Beverley Essue13Susmita Chatterjee14Shekhar Saxena15Anushka Patel16David Peiris17The George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global Health, University of New South WalesCentre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonUniversity of New South WalesUniversity of HyderabadAll India Institute of Medical SciencesAll India Institute of Medical SciencesInstitute for Health Policy, Management and Evaluation, University of TorontoThe George Institute for Global HealthHarvard T H Chan School of Public HealthThe George Institute for Global Health, University of New South WalesThe George Institute for Global Health, University of New South WalesAbstract 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. Trial registration Clinical Trial Registry India CTRI/2018/08/015355 . Registered on 16 August 2018.https://doi.org/10.1186/s13063-021-05136-5Common mental disordersPrimary healthcare workerAnti-stigma campaignElectronic decision support systemsSMART Mental HealthIndia |
| spellingShingle | Mercian Daniel Pallab K. Maulik Sudha Kallakuri Amanpreet Kaur Siddhardha Devarapalli Ankita Mukherjee Amritendu Bhattacharya Laurent Billot Graham Thornicroft Devarsetty Praveen Usha Raman Rajesh Sagar Shashi Kant Beverley Essue Susmita Chatterjee Shekhar Saxena Anushka Patel David Peiris 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 Trials Common mental disorders Primary healthcare worker Anti-stigma campaign Electronic decision support systems SMART Mental Health India |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Common mental disorders Primary healthcare worker Anti-stigma campaign Electronic decision support systems SMART Mental Health India |
| url | https://doi.org/10.1186/s13063-021-05136-5 |
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