Scientists looked at the program in the Sub-Saharan country of Malawi which is based on utilizing the HIV care facilities and employing and training those people in rural areas who need help for those who have depression.
As for the qualitative analysis, the study established marked changes in depression status among the participants and the hypertensive participants recorded a change in their blood pressure. Secondly, household members of those who received active treatment observed improvements in depressive symptoms and overall functioning.
“Of people with mental illness who reside in low-income countries, 75.4% do not access any treatment, a situation that the authors attribute to government beliefs that mental health care is not cost-effective,” said Ryan McBain of the RAND Corporation. We proved that money could be saved by implementing a care strategy based on integrated care and task-shifting and that the care has positive effects that are typically not considered to a sufficient degree because positive externalities are not accounted for.
Depressive disorders severely impact low and middle-income countries; major depressive disorder alone leads to more years lived in disability than low and middle-income countries HIV and malaria combined. This is explained by funding which paints the picture of increased disparity. For instance, development assistance for HIV was $9.9 billion in 2021 while for common mental disorders was $217 million 45 times less.
At its foundation, there is a view that as compared to the treatments of bacterial infections like HIV, treatments of CMs are time-consuming and costlier. The perception has been challenged partly by increasing discovery that the process of task-shifting to lay health workers instead of mental health professionals is as effective but cheaper.
The authors of the study from RAND and partner organizations conducted a randomly controlled trial in a network of 14 facilities in a relatively isolated area of Malawi. The health facilities have developed various aspects of the chronic care clinics model, which incorporates HIV clinic restructuring for screening, diagnosing, and managing various chronic diseases including hypertension, diabetes, and asthma.
The depression treatment plan entailed 198 group therapy sessions facilitated by the clinics and the members of the local community; the topics for the group were stress management, problem-solving, behavioral activation, building social support, and maintenance. Some of the patients also received medication. All participants were observed for one year beginning from the time that the facility in which the participant was enrolled offered treatment.
Moreover, household members also demonstrated a decrease in depressive symptoms severity, an increase in functioning, and a sizable reduction in perceived caregiving burden compared with a baseline, six months after the participants’ treatment started.
“Interventions can be relatively cheap if they are developed from previous structures, involve task delegation to local people, and are in group therapy,” said McBain. We also explain how many of these advantages translate into improvements in participant’s physical health, as well as the health of other household members.
This study analyzed 17,061 abstracts from sources including 4,007 from PubMed, 347 from PsycINFO, 5,912 from Embase, and 3,995 from the Cochrane Central Register of Controlled Trials. The examination involved all the randomized trials involving psychological treatment with control conditions. Out of all the databases researchers examined selected 440 studies that were related to economic outcome data.
Reference: Chisholm D, Sweeny K, Sheehan P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry. 2016;3(5):415-424. doi:https://doi.org/10.1016/s2215-0366(16)30024-4
