Centre for Mental Health Law and Policy, Indian Law Society, Pune, India.
Hospital for Mental Health, Ahmedabad, India.
PLoS One. 2023 Jun 8;18(6):e0285385. doi: 10.1371/journal.pone.0285385. eCollection 2023.
While effective lay-health worker models for mental health care have been demonstrated through efficacy trials, there is limited evidence of the effectiveness of these models implemented in rural LMIC settings.
To evaluate the impact of a volunteer community-led intervention on reduction in depression and anxiety symptoms and improvement in functioning, and social participation among people living in rural Gujarat, India.
Stepped-wedge cluster randomized controlled trial was used to assess the effectiveness of delivery of psychosocial intervention across 645 villages in Mehsana district of Gujarat, India between April 2017 and August 2019. The primary outcome was an improvement in depression and/or anxiety symptoms assessed using GHQ-12 at 3-month follow-up. Secondary outcomes were improvement in (a) depression and anxiety (Patient Health Questionnaire, (PHQ-9), Generalized Anxiety Disorder (GAD-7) & Self-Reporting Questionnaire-20 (SRQ-20); b) quality of life (EQ- 5D); c) functioning (WHO-DAS-12), and social participation (Social Participation Scale SPS). Generalized linear mixed-effects models were used to assess the independent effect of the intervention.
Out of a total of 1191 trial participants (608- intervention & 583-control), 1014 (85%) completed 3-month follow-up. In an adjusted analysis, participants in the intervention condition showed significant recovery from symptoms of depression or anxiety (OR 2.2; 95% CI 1.2 to 4.6; p<0.05) at the end of 3-months, with effects sustained at 8-month follow-up (OR 3.0; 95% CI 1.6 to 5.9). Intervention participants had improved scores on the PHQ-9 (Adjusted mean difference (AMD) -1.8; 95%CI -3.0 to -0.6), and SRQ-20 (AMD -1.7; 95%CI -2.7 to -0.6), at 3-months and PHQ-9, GAD-7, SRQ-20, EQ-5D and WHO-DAS at 8 months follow-up.
Findings suggest that Atmiyata had a significant effect on recovery from symptoms of depression and anxiety with sustained effects at 8-month follow-up.
Trial registration details. The trial was registered prospectively with the "Clinical Trial Registry in India" (registry number: CTRI/2017/03/008139).
虽然已经通过疗效试验证明了针对心理健康护理的有效兼职卫生工作者模式，但在农村中低收入国家实施这些模式的有效性证据有限。
评估在印度古吉拉特邦农村地区，由志愿者主导的社区干预对减轻抑郁和焦虑症状、改善功能以及社会参与的影响。
采用阶梯式楔形集群随机对照试验，于 2017 年 4 月至 2019 年 8 月在古吉拉特邦梅赫萨纳区的 645 个村庄评估心理社会干预的有效性。主要结局是使用 GHQ-12 在 3 个月随访时评估抑郁和/或焦虑症状的改善。次要结局是改善（a）抑郁和焦虑（PHQ-9、广泛性焦虑症（GAD-7）和自我报告问卷-20（SRQ-20）；b）生活质量（EQ-5D）；c）功能（WHO-DAS-12）和社会参与（社会参与量表 SPS）。采用广义线性混合效应模型评估干预的独立效果。
在总共 1191 名试验参与者（608-干预和 583-对照）中，有 1014 名（85%）完成了 3 个月的随访。在调整分析中，干预组的参与者在 3 个月结束时表现出抑郁或焦虑症状的显著恢复（OR 2.2；95%CI 1.2 至 4.6；p<0.05），并且在 8 个月随访时仍保持这种效果（OR 3.0；95%CI 1.6 至 5.9）。干预组在 3 个月时的 PHQ-9（调整平均差异（AMD）-1.8；95%CI-3.0 至-0.6）和 SRQ-20（AMD-1.7；95%CI-2.7 至-0.6）评分以及在 8 个月时的 PHQ-9、GAD-7、SRQ-20、EQ-5D 和 WHO-DAS 评分上都有所改善。
结果表明，Atmiyata 对抑郁和焦虑症状的恢复有显著影响，并且在 8 个月的随访中仍有持续的效果。
试验注册详情。该试验在印度“临床试验注册处”（注册号：CTRI/2017/03/008139）进行了前瞻性注册。
