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

Shashi Kant¹  Rajesh Sagar¹  Graham Thornicroft²  Shekhar Saxena³  Beverley Essue⁴  Siddhardha Devarapalli⁵  Sudha Kallakuri⁵  Amritendu Bhattacharya⁶  Mercian Daniel⁶  Amanpreet Kaur⁶  Ankita Mukherjee⁶  Susmita Chatterjee⁷  Pallab K. Maulik⁸  Laurent Billot⁹  David Peiris⁹  Anushka Patel⁹  Usha Raman^1,10  Devarsetty Praveen^1,11 

[1] All India Institute of Medical Sciences, New Delhi, India;Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;Harvard T H Chan School of Public Health, Boston, USA;Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada;The George Institute for Global Health, Hyderabad, India;The George Institute for Global Health, New Delhi, India;The George Institute for Global Health, New Delhi, India;University of New South Wales, Sydney, Australia;Prasanna School of Public Health, Manipal, India;The George Institute for Global Health, New Delhi, India;University of New South Wales, Sydney, Australia;Prasanna School of Public Health, Manipal, India;The George Institute for Global Health, Oxford, UK;The George Institute for Global Health, University of New South Wales, Sydney, Australia;University of Hyderabad, Hyderabad, India;University of New South Wales, Sydney, Australia;Prasanna School of Public Health, Manipal, India;The George Institute for Global Health, Hyderabad, India;

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;   

DOI  :  10.1186/s13063-021-05136-5

来源: Springer

【 摘 要 】

BackgroundAround 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.MethodsWe 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 outcomesThe 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.SignificanceThe 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 registrationClinical Trial Registry India CTRI/2018/08/015355. Registered on 16 August 2018.

【 授权许可】

CC BY