Shidhaye Rahul, Murhar Vaibhav, Gangale Siddharth, Aldridge Luke, Shastri Rahul, Parikh Rachana, Shrivastava Ritu, Damle Suvarna, Raja Tasneem, Nadkarni Abhijit, Patel Vikram
Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
Sangath, Goa, India.
Lancet Psychiatry. 2017 Feb;4(2):128-135. doi: 10.1016/S2215-0366(16)30424-2. Epub 2017 Jan 5.
VISHRAM was a community-based mental health programme with the goal of addressing the mental health risk factors for suicide in people from 30 villages in the Amravati district in Vidarbha, central India. We aimed to assess whether implementation of VISHRAM was associated with an increase in the proportion of people with depression who sought treatment (contact coverage).
A core strategy of VISHRAM was to increase the demand for care by enhancing mental health literacy and to improve the supply of evidence-based interventions for depression and alcohol-use disorders. Intervention for depression was led by community-based workers and non-specialist counsellors and done in collaboration with facility-based general physicians and psychiatrists. From Dec 25, 2013, to March 10, 2014, before VISHRAM was introduced, we did a baseline cross-sectional survey of adults randomly selected from the electoral roll (baseline survey population). The structured interview was administered by field researchers independent of the VISHRAM intervention and included questions about sociodemographic characteristics, health-care service use, depression (measured using the Patient Health Questionnaire [PHQ]-9), and mental health literacy. 18 months after VISHRAM was enacted, we repeated sampling methods to select a separate population of adults (18 month survey population) and administered the same survey. The primary outcome was change in contact coverage with VISHRAM, defined as the difference in the proportion of individuals with depression (PHQ-9 score >9) who sought treatment for symptoms of depression between the baseline and the 18 month survey population. Secondary outcomes were whether the distribution of coverage was equitable, the type of services sought, and mental health literacy.
1887 participants completed the 18 month survey interview between Sept 18, and Oct 8, 2015. The contact coverage for current depression was six-times higher in the 18 month survey population (27·2%, 95% CI 21·4-33·7) than in the baseline survey population (4·3%, 1·5-7·1). Contact coverage was equitably distributed across sex, education, income, religion, and caste. Most providers consulted for care were general physicians. We observed significant improvements in a range of mental health literacy indicators, for example, conceptualisation of depression as a mental health problem and the intention to seek care for depression.
A grass-roots community-based programme in rural India was associated with substantial increase in equitable contact coverage for depression and improved mental health literacy. It is now crucially important to translate this knowledge into real-world practice by scaling-up this programme through the National Mental Health Programme in India.
Tata Trusts.
VISHRAM是一项基于社区的心理健康项目，目标是解决印度中部维达巴地区阿姆拉瓦蒂区30个村庄居民自杀的心理健康风险因素。我们旨在评估VISHRAM的实施是否与寻求治疗的抑郁症患者比例（接触覆盖率）的增加相关。
VISHRAM的一项核心策略是通过提高心理健康素养来增加对护理的需求，并改善针对抑郁症和酒精使用障碍的循证干预措施的供应。抑郁症干预由社区工作者和非专科咨询师主导，并与机构内的普通医生和精神科医生合作进行。在2013年12月25日至2014年3月10日，即VISHRAM引入之前，我们对从选民名单中随机抽取的成年人进行了基线横断面调查（基线调查人群）。结构化访谈由独立于VISHRAM干预的现场研究人员进行，包括有关社会人口学特征、医疗服务使用、抑郁症（使用患者健康问卷[PHQ]-9进行测量）和心理健康素养的问题。在VISHRAM实施18个月后，我们采用相同的抽样方法选择了另一组成年人群体（18个月调查人群），并进行了相同的调查。主要结局是VISHRAM接触覆盖率的变化，定义为基线调查人群和18个月调查人群中因抑郁症症状寻求治疗的抑郁症患者（PHQ-9评分>9）比例的差异。次要结局包括覆盖率的分布是否公平、寻求的服务类型以及心理健康素养。
2015年9月18日至10月8日期间，1887名参与者完成了18个月的调查访谈。18个月调查人群中当前抑郁症的接触覆盖率（27.2%，95%CI 21.4-33.7）比基线调查人群（4.3%，1.5-7.1）高六倍。接触覆盖率在性别、教育程度、收入、宗教和种姓之间公平分布。大多数寻求护理的提供者是普通医生。我们观察到一系列心理健康素养指标有显著改善，例如，将抑郁症概念化为心理健康问题以及寻求抑郁症护理的意愿。
印度农村地区的一项基层社区项目与抑郁症公平接触覆盖率的大幅提高以及心理健康素养的改善相关。现在至关重要的是，通过印度国家心理健康项目扩大该项目，将这一知识转化为实际行动。
塔塔信托基金。
