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Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study.

Pragya Rimal1,2, Nandini Choudhury3,4, Pawan Agrawal5

  • 1Nyaya Health Nepal, Kathmandu, Nepal pragya@possiblehealth.org.

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Summary

Collaborative Care Model (CoCM) implementation in rural Nepal improved provider capacity and motivation, leading to significant depression symptom reduction in 49% of patients. This demonstrates CoCM

Keywords:
depression & mood disordersmental healthprimary carepublic healthquality in health care

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Area of Science:

  • Global Mental Health
  • Implementation Science
  • Primary Care Research

Background:

  • Low-income countries bear a high burden of depression with limited access to effective care.
  • The Collaborative Care Model (CoCM) shows promise for improving mental health outcomes.
  • Real-world implementation data is crucial for expanding CoCM in resource-limited settings.

Purpose of the Study:

  • To assess the implementation and clinical impact of CoCM in rural Nepal.
  • To adapt and study the CoCM intervention using the COM-B framework.
  • To evaluate provider behavior changes and patient depression outcomes.

Main Methods:

  • A 2-year mixed-methods study in a rural Nepalese primary care clinic.
  • Utilized the WHO Mental Health Gap Action Programme protocols and COM-B framework.
  • Qualitative assessment of provider behavior and quantitative follow-up of 201 depressed patients.

Main Results:

  • Providers reported enhanced capability, opportunity, and motivation to deliver mental healthcare.
  • A substantial clinical response (≥50% PHQ-9 decrease) was observed in 49% of patients.
  • Median PHQ-9 score decreased by 7 points (p<0.0001).

Conclusions:

  • CoCM was successfully adapted and implemented in rural Nepal, enhancing provider engagement.
  • Clinical depression improvement was comparable to high-resource settings.
  • Recommends implementation research for adapting and evaluating CoCM in other resource-constrained areas.