Mental Health Care Support in Rural India: A Cluster Randomized Clinical Trial.

IF 22.5 1区 医学 Q1 PSYCHIATRY
Pallab K Maulik, Mercian Daniel, Siddhardha Devarapalli, Sudha Kallakuri, Amanpreet Kaur, Arpita Ghosh, Laurent Billot, Ankita Mukherjee, Rajesh Sagar, Sashi Kant, Susmita Chatterjee, Beverley M Essue, Usha Raman, Devarsetty Praveen, Graham Thornicroft, Shekhar Saxena, Anushka Patel, David Peiris
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引用次数: 0

Abstract

Importance: More than 150 million people in India need mental health care but few have access to affordable care, especially in rural areas.

Objective: To determine whether a multifaceted intervention involving a digital health care model along with a community-based antistigma campaign leads to reduced depression risk and lower mental health-related stigma among adults residing in rural India.

Design, setting, and participants: This parallel, cluster randomized, usual care-controlled trial was conducted from September 2020 to December 2021 with blinded follow-up assessments at 3, 6, and 12 months at 44 rural primary health centers across 3 districts in Haryana and Andhra Pradesh states in India. Adults aged 18 years and older at high risk of depression or self-harm defined by either a Patient Health Questionnaire-9 item (PHQ-9) score of 10 or greater, a Generalized Anxiety Disorder-7 item (GAD-7) score of 10 or greater, or a score of 2 or greater on the self-harm/suicide risk question on the PHQ-9. A second cohort of adults not at high risk were selected randomly from the remaining screened population. Data were cleaned and analyzed from April 2022 to February 2023.

Interventions: The 12-month intervention included a community-based antistigma campaign involving all participants and a digital mental health intervention involving only participants at high risk. Primary health care workers were trained to identify and manage participants at high risk using the Mental Health Gap Action Programme guidelines from the World Health Organization.

Main outcomes and measures: The 2 coprimary outcomes assessed at 12 months were mean PHQ-9 scores in the high-risk cohort and mean behavior scores in the combined high-risk and non-high-risk cohorts using the Mental Health Knowledge, Attitude, and Behavior scale.

Results: Altogether, 9928 participants were recruited (3365 at high risk and 6563 not at high risk; 5638 [57%] female and 4290 [43%] male; mean [SD] age, 43 [16] years) with 9057 (91.2%) followed up at 12 months. Mean PHQ-9 scores at 12 months for the high-risk cohort were lower in the intervention vs control groups (2.77 vs 4.48; mean difference, -1.71; 95% CI, -2.53 to -0.89; P < .001). The remission rate in the high-risk cohort (PHQ-9 and GAD-7 scores <5 and no risk of self-harm) was higher in the intervention vs control group (74.7% vs 50.6%; odds ratio [OR], 2.88; 95% CI, 1.53 to 5.42; P = .001). Across both cohorts, there was no difference in 12-month behavior scores in the intervention vs control group (17.39 vs 17.74; mean difference, -0.35; 95% CI, -1.11 to 0.41; P = .36).

Conclusions and relevance: A multifaceted intervention was effective in reducing depression risk but did not improve intended help-seeking behaviors for mental illness.

Trial registration: Clinical Trial Registry India: CTRI/2018/08/015355.

印度农村地区的心理保健支持:集群随机临床试验。
重要性印度有 1.5 亿多人需要心理健康护理,但很少有人能获得负担得起的护理,尤其是在农村地区:目的:确定涉及数字医疗模式的多方面干预措施以及基于社区的反污名化运动是否能降低印度农村成年人的抑郁风险并减少与心理健康相关的污名化:这项平行、分组随机、常规护理对照试验于 2020 年 9 月至 2021 年 12 月在印度哈里亚纳邦和安得拉邦 3 个地区的 44 个农村初级保健中心进行,并在 3、6 和 12 个月时进行盲法随访评估。患者健康问卷-9(PHQ-9)项目得分达到或超过 10 分,广泛性焦虑症-7(GAD-7)项目得分达到或超过 10 分,或 PHQ-9 中自残/自杀风险问题得分达到或超过 2 分,即为抑郁症或自残高风险 18 岁及以上成年人。从剩余的筛查人群中随机抽取了第二批非高风险成人。从 2022 年 4 月至 2023 年 2 月对数据进行清理和分析:为期 12 个月的干预措施包括一项由所有参与者参与的社区反污名化运动和一项仅由高风险参与者参与的数字心理健康干预措施。对初级卫生保健工作者进行了培训,以使用世界卫生组织的心理健康差距行动方案指南来识别和管理高风险参与者:在 12 个月内评估的 2 项主要结果是高风险人群的 PHQ-9 平均得分,以及高风险和非高风险人群使用心理健康知识、态度和行为量表的平均行为得分:共招募了 9928 名参与者(高危 3365 人,非高危 6563 人;女性 5638 人 [57%],男性 4290 人 [43%];平均 [SD] 年龄 43 [16] 岁),其中 9057 人(91.2%)接受了 12 个月的随访。干预组与对照组相比,高危人群在 12 个月后的 PHQ-9 平均得分较低(2.77 vs 4.48;平均差异,-1.71;95% CI,-2.53 to -0.89;P 结论及意义:多方面干预能有效降低抑郁风险,但并不能改善精神疾病的预期求助行为:印度临床试验注册中心:CTRI/2018/08/015355.
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来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
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