Home-based digital counselling by frontline community workers for anxiety and depression symptoms in rural Sindh,...

There is limited evidence that interventions for improving mental well-being can be integrated sustainably into primary health care in Pakistan. We piloted 'mPareshan digital intervention' locally, adapted from WHO mhGAP and delivered by trained and supervised women lay workers to learn if it was feasible and possibly effective in reducing anxiety and depression prior to proposing implementation on a larger scale.

Using Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), a baseline household survey was conducted by independent data collectors to measure anxiety and depression. We trained 72 government Lady Health Workers (LHWs) and Lady Health Supervisors (LHSs) in District Badin, Sindh to screen and counsel adult men and women (> 18 years) with mild and moderate symptoms of anxiety and depression. Supervised by LHSs, these screen positive participants (SPs) received 6 counselling sessions by LHWs through the mPareshan app during their routine household visits. The app had interactive audio/video psychoeducation features. Severe anxiety and depression cases were referred to nearest available mental health service.

Of the 366 individuals surveyed at baseline, 75% had minimal anxiety, 23% had mild to moderate anxiety, and 2% had severe anxiety. 74% had minimal depression, 24% had mild to moderate depression, and 2% had moderately severe to severe depression. 98 participants (53 men and 45 women, mean age 43.2 years) screened positive for mild and moderate anxiety and/or depression and were eligible for the mPareshan intervention. Six SPs did not complete the intervention for various reasons. Of the 92 SPs who completed all 6 monthly counselling sessions, their mean PHQ-9 score declined from 7.5 (SD 3.1) to 2.6 (SD 2.2) after intervention. Mean GAD-7 score fell from 6.6 (SD 3.0) to 2.1 (SD 2.2) after 6 sessions. No significant association between sociodemographic variables (age, gender, education, and income levels) and anxiety and depression scores was noted.

Preliminary evidence suggests meaningful reduction in anxiety and depression using this locally adapted digital counselling intervention delivered by lay health workers in a rural setting of Sindh, Pakistan. An appropriately powered randomized control trial is needed to test effectiveness of this task-shifting model.

Registered as non-randomized, pretest-posttest, feasibility trial on 14/07/2022 with Registration number ACTRN12622000989741 at the Australian New Zealand Clinical Trial Registry ( https://www.anzctr.org.au/Default.aspx ).