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Lay counselor intervention effective for depression in lower income countries

Lay counselors effectively provided a depression prevention intervention to older adults with depression living in low- and middle-income countries, according to a study published in JAMA Psychiatry.

“Depression in older adults is an increasing challenge in low- and middle-income countries (LMICs), reflecting demographic shifts, scarcity of depression treatment resources, and limited effect of treatment in reducing years lived with disability,” Amit Dias, MD, from the department of preventive and social medicine, Goa Medical College, India, and colleagues wrote. “Thus, developing effective strategies for prevention of depression in LMICs is important.”

In their parallel-group randomized clinical trial, researchers tested whether lay counselors could deliver a potentially scalable intervention — known as the depression in later life intervention — to prevent later-life episodes of major depression in adults aged older than 60 years with subsyndromal depressive symptoms at rural and urban primary care clinics in Goa, India.

The intervention incorporated problem-solving therapy for primary care and brief behavioral treatment for insomnia along with education in self-care for common medical disorders and in accessing medical and social programs. Researchers assessed incidence of major depressive episodes as well as anxiety and depression symptom change over 12 months, via the 12-item General Health Questionnaire. They also measured functional status, cognition, blood pressure and BMI.

Overall, 91 participants received the depression in later life intervention and 90 received care as usual. The results showed that participants in the intervention group experienced a reduced incidence of major depression episodes compared with those in the care as usual group (4.4% vs. 14.44%; P = .04). After 1 year, the estimates of percentage of depression-free participants was lower in the intervention group than in the care as usual group (95.1% [95% CI, 90.5-99.9] vs. 87.4% [95% CI, 80.4-95.1]).

Analysis also revealed that the intervention resulted in a lower incidence of depressive symptoms after 12 months (12-month mean difference: –1.18; 95% CI, –2.03 to –0.31); however, there were no changes in measures of disability or cognition. In addition, the intervention was linked to a greater lowering of systolic blood pressure (12-month mean difference: –6.98; 95% CI, –11.96 to –2.01) and change in BMI (12-month mean difference: 0.23; 95% CI, –0.97 to 1.43).

“If the success of the [depression in later life] intervention in depression prevention can be replicated in other LMICs, then its utility and scalability would be further supported,” Dias and colleagues concluded. “In addition, the cost-effectiveness of the model in LMICs should be studied.”

It is important to develop more cost-effective programs — for example, those that encompass advances in communication technology — to help people with mental health issues from lower income countries, Jagadisha Thirthalli, MD, from the department of psychiatry, National Institute of Mental Health and Neurosciences, India, and colleagues wrote in a related editorial.

“Until funding for additional mental health human resources to implement interventions is available, alternative approaches using volunteers (lay counselors) should be explored,” Thirthalli and colleagues wrote. “This article will hopefully provide impetus to much needed research addressing the difficult question of developing scalable and sustainable programs to provide mental health care in low-resource settings.” – by Savannah Demko

Disclosure: The authors and editorial authors report no relevant financial disclosures.