Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal.
Abstract
BACKGROUND:Evidence shows benefits of psychological treatments in low-resource countries,
yet few government health systems include psychological services.AimEvaluating the
clinical value of adding psychological treatments, delivered by community-based counsellors,
to primary care-based mental health services for depression and alcohol use disorder
(AUD), as recommended by the Mental Health Gap Action Programme (mhGAP). METHOD:Two
randomised controlled trials, separately for depression and AUD, were carried out.
Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained
primary care workers (psychoeducation and psychotropic medicines when indicated),
or the same services plus individual psychological treatments (Healthy Activity Program
for depression and Counselling for Alcohol Problems). Primary outcomes were symptom
severity, measured using the Patient Health Questionnaire - 9 item (PHQ-9) for depression
and the Alcohol Use Disorder Identification Test for AUD, and functional impairment,
measured using the World Health Organization Disability Assessment Schedule (WHODAS),
at 12 months post-enrolment. RESULTS:Participants with depression in the intervention
arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants
in the control (n = 60) (PHQ-9: M = -5.90, 95% CI -7.55 to -4.25, β = -3.68, 95% CI
-5.68 to -1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = -12.21, 95% CI -19.58
to -4.84, β = -10.74, 95% CI -19.96 to -1.53, P= 0.022, Cohen's d = 0.42). For the
AUD trial, no significant effect was found when comparing control (n = 80) and intervention
participants (n = 82). CONCLUSION:Adding a psychological treatment delivered by community-based
counsellors increases treatment effects for depression compared with only mhGAP-based
services by primary health workers 12 months post-treatment.Declaration of interestNone.
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https://hdl.handle.net/10161/17936Published Version (Please cite this version)
10.1192/bjp.2018.300Publication Info
Jordans, Mark JD; Luitel, Nagendra P; Garman, Emily; Kohrt, Brandon A; Rathod, Sujit
D; Shrestha, Pragya; ... Patel, Vikram (2019). Effectiveness of psychological treatments for depression and alcohol use disorder
delivered by community-based counsellors: two pragmatic randomised controlled trials
within primary healthcare in Nepal. The British journal of psychiatry : the journal of mental science. pp. 1-9. 10.1192/bjp.2018.300. Retrieved from https://hdl.handle.net/10161/17936.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Brandon A. Kohrt
Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences
Brandon Kohrt is a medical anthropologist and psychiatrist who completed his MD-PhD
at Emory University in 2009. He is currently Assistant Professor of Psychiatry, Global
Health, and Cultural Anthropology at Duke University. Dr. Kohrt has worked in Nepal
since 1996 researching and aiding victims of war including child soldiers. Since 2006
has worked with Transcultural Psychosocial Organization (TPO) Nepal. Dr. Kohrt has
been a consultant to The Carter Center Mental Health Program Liberia Init

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