Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care

Area of Science:

• Global Health
• Mental Health Services Research
• Primary Care Integration

Background:

• Task shifting is recommended to address the mental health treatment gap in low- and middle-income countries.
• Integrating mental health treatment into primary care can improve access for depression.
• This study evaluated a novel depression care model in a low-resource setting.

Purpose of the Study:

• To examine a new model for depression care using community health workers.
• To compare this model against enhanced treatment at usual (E-TAU).
• To assess the effectiveness of Interpersonal Counseling (IPC) delivered by non-specialists.

Main Methods:

• A randomized controlled trial was conducted in São Paulo, Brazil.
• Non-specialist community health workers were trained to deliver IPC.
• 86 patients with depression were randomized to IPC or E-TAU and followed for 2 months.

Main Results:

• Both groups showed significant symptom improvement over 2 months.
• Per-protocol analysis indicated better Hamilton Rating Scale (HDRS-17) outcomes for the IPC group.
• No significant differences were found between groups in intention-to-treat analysis.

Conclusions:

• Training community health workers in IPC is a viable strategy for depression management.
• This approach can reduce the burden of depression in low- and middle-income countries.
• IPC offers a potentially low-cost, effective alternative to specialist mental health services.