The Healthy Activity Program, lay counsellor-delivered treatment for severe depression in India: Systematic development and randomised evaluation

Neerja Chowdhary; Arpita Anand; Sona Dimidjian; Sachin Shinde; Benedict Weobong; Madhumitha Balaji; Steven D. Hollon; Atif Rahman; G. Terence Wilson; Helena Verdeli; Ricardo Araya; Michael King; Mark J D Jordans; Christopher Fairburn; Betty Kirkwood; Vikram Patel

doi:10.1192/bjp.bp.114.161075

The Healthy Activity Program, lay counsellor-delivered treatment for severe depression in India: Systematic development and randomised evaluation

Neerja Chowdhary, Arpita Anand, Sona Dimidjian, Sachin Shinde, Benedict Weobong, Madhumitha Balaji, Steven D. Hollon, Atif Rahman, G. Terence Wilson, Helena Verdeli, Ricardo Araya, Michael King, Mark J D Jordans, Christopher Fairburn, Betty Kirkwood, Vikram Patel^*

^*Corresponding author for this work

Health Service & Population Research

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: Reducing the global treatment gap for mental disorders requires treatments that are economical, effective and culturally appropriate.

AIMS: To describe a systematic approach to the development of a brief psychological treatment for patients with severe depression delivered by lay counsellors in primary healthcare.

METHOD: The treatment was developed in three stages using a variety of methods: (a) identifying potential strategies; (b) developing a theoretical framework; and (c) evaluating the acceptability, feasibility and effectiveness of the psychological treatment.

RESULTS: The Healthy Activity Program (HAP) is delivered over 6-8 sessions and consists of behavioral activation as the core psychological framework with added emphasis on strategies such as problem-solving and activation of social networks. Key elements to improve acceptability and feasibility are also included. In an intention-to-treat analysis of a pilot randomised controlled trial (55 participants), the prevalence of depression (Beck Depression Inventory II ⩾19) after 2 months was lower in the HAP than the control arm (adjusted risk ratio = 0.55, 95% CI 0.32-0.94,P= 0.01).

CONCLUSIONS: Our systematic approach to the development of psychological treatments could be extended to other mental disorders. HAP is an acceptable and effective brief psychological treatment for severe depression delivered by lay counsellors in primary care.

Original language	English
Pages (from-to)	381-388
Number of pages	8
Journal	British Journal of Psychiatry
Volume	208
Issue number	4
Early online date	2 Jan 2018
DOIs	https://doi.org/10.1192/bjp.bp.114.161075
Publication status	Published - 2 Jan 2018

Keywords

Adult
Counselors
Depressive Disorder, Major
Female
Humans
India
Male
Middle Aged
Pilot Projects
Primary Health Care
Program Development
Psychotherapy, Brief
Treatment Outcome
Young Adult

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Chowdhary, N., Anand, A., Dimidjian, S., Shinde, S., Weobong, B., Balaji, M., Hollon, S. D., Rahman, A., Wilson, G. T., Verdeli, H., Araya, R., King, M., Jordans, M. J. D., Fairburn, C., Kirkwood, B., & Patel, V. (2018). The Healthy Activity Program, lay counsellor-delivered treatment for severe depression in India: Systematic development and randomised evaluation. British Journal of Psychiatry, 208(4), 381-388. https://doi.org/10.1192/bjp.bp.114.161075

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title = "The Healthy Activity Program, lay counsellor-delivered treatment for severe depression in India: Systematic development and randomised evaluation",

abstract = "BACKGROUND: Reducing the global treatment gap for mental disorders requires treatments that are economical, effective and culturally appropriate.AIMS: To describe a systematic approach to the development of a brief psychological treatment for patients with severe depression delivered by lay counsellors in primary healthcare.METHOD: The treatment was developed in three stages using a variety of methods: (a) identifying potential strategies; (b) developing a theoretical framework; and (c) evaluating the acceptability, feasibility and effectiveness of the psychological treatment.RESULTS: The Healthy Activity Program (HAP) is delivered over 6-8 sessions and consists of behavioral activation as the core psychological framework with added emphasis on strategies such as problem-solving and activation of social networks. Key elements to improve acceptability and feasibility are also included. In an intention-to-treat analysis of a pilot randomised controlled trial (55 participants), the prevalence of depression (Beck Depression Inventory II ⩾19) after 2 months was lower in the HAP than the control arm (adjusted risk ratio = 0.55, 95% CI 0.32-0.94,P= 0.01).CONCLUSIONS: Our systematic approach to the development of psychological treatments could be extended to other mental disorders. HAP is an acceptable and effective brief psychological treatment for severe depression delivered by lay counsellors in primary care.",

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author = "Neerja Chowdhary and Arpita Anand and Sona Dimidjian and Sachin Shinde and Benedict Weobong and Madhumitha Balaji and Hollon, {Steven D.} and Atif Rahman and Wilson, {G. Terence} and Helena Verdeli and Ricardo Araya and Michael King and Jordans, {Mark J D} and Christopher Fairburn and Betty Kirkwood and Vikram Patel",

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doi = "10.1192/bjp.bp.114.161075",

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Chowdhary, N, Anand, A, Dimidjian, S, Shinde, S, Weobong, B, Balaji, M, Hollon, SD, Rahman, A, Wilson, GT, Verdeli, H, Araya, R, King, M, Jordans, MJD, Fairburn, C, Kirkwood, B & Patel, V 2018, 'The Healthy Activity Program, lay counsellor-delivered treatment for severe depression in India: Systematic development and randomised evaluation', British Journal of Psychiatry, vol. 208, no. 4, pp. 381-388. https://doi.org/10.1192/bjp.bp.114.161075

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T1 - The Healthy Activity Program, lay counsellor-delivered treatment for severe depression in India

T2 - Systematic development and randomised evaluation

AU - Chowdhary, Neerja

AU - Anand, Arpita

AU - Dimidjian, Sona

AU - Shinde, Sachin

AU - Weobong, Benedict

AU - Balaji, Madhumitha

AU - Hollon, Steven D.

AU - Rahman, Atif

AU - Wilson, G. Terence

AU - Verdeli, Helena

AU - Araya, Ricardo

AU - King, Michael

AU - Jordans, Mark J D

AU - Fairburn, Christopher

AU - Kirkwood, Betty

AU - Patel, Vikram

N1 - © The Royal College of Psychiatrists 2015.

PY - 2018/1/2

Y1 - 2018/1/2

N2 - BACKGROUND: Reducing the global treatment gap for mental disorders requires treatments that are economical, effective and culturally appropriate.AIMS: To describe a systematic approach to the development of a brief psychological treatment for patients with severe depression delivered by lay counsellors in primary healthcare.METHOD: The treatment was developed in three stages using a variety of methods: (a) identifying potential strategies; (b) developing a theoretical framework; and (c) evaluating the acceptability, feasibility and effectiveness of the psychological treatment.RESULTS: The Healthy Activity Program (HAP) is delivered over 6-8 sessions and consists of behavioral activation as the core psychological framework with added emphasis on strategies such as problem-solving and activation of social networks. Key elements to improve acceptability and feasibility are also included. In an intention-to-treat analysis of a pilot randomised controlled trial (55 participants), the prevalence of depression (Beck Depression Inventory II ⩾19) after 2 months was lower in the HAP than the control arm (adjusted risk ratio = 0.55, 95% CI 0.32-0.94,P= 0.01).CONCLUSIONS: Our systematic approach to the development of psychological treatments could be extended to other mental disorders. HAP is an acceptable and effective brief psychological treatment for severe depression delivered by lay counsellors in primary care.

AB - BACKGROUND: Reducing the global treatment gap for mental disorders requires treatments that are economical, effective and culturally appropriate.AIMS: To describe a systematic approach to the development of a brief psychological treatment for patients with severe depression delivered by lay counsellors in primary healthcare.METHOD: The treatment was developed in three stages using a variety of methods: (a) identifying potential strategies; (b) developing a theoretical framework; and (c) evaluating the acceptability, feasibility and effectiveness of the psychological treatment.RESULTS: The Healthy Activity Program (HAP) is delivered over 6-8 sessions and consists of behavioral activation as the core psychological framework with added emphasis on strategies such as problem-solving and activation of social networks. Key elements to improve acceptability and feasibility are also included. In an intention-to-treat analysis of a pilot randomised controlled trial (55 participants), the prevalence of depression (Beck Depression Inventory II ⩾19) after 2 months was lower in the HAP than the control arm (adjusted risk ratio = 0.55, 95% CI 0.32-0.94,P= 0.01).CONCLUSIONS: Our systematic approach to the development of psychological treatments could be extended to other mental disorders. HAP is an acceptable and effective brief psychological treatment for severe depression delivered by lay counsellors in primary care.

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KW - Counselors

KW - Depressive Disorder, Major

KW - Female

KW - Humans

KW - India

KW - Male

KW - Middle Aged

KW - Pilot Projects

KW - Primary Health Care

KW - Program Development

KW - Psychotherapy, Brief

KW - Treatment Outcome

KW - Young Adult

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SN - 0007-1250

VL - 208

SP - 381

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JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

IS - 4

ER -

The Healthy Activity Program, lay counsellor-delivered treatment for severe depression in India: Systematic development and randomised evaluation

Abstract

Keywords

UN SDGs

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