Treating people in low-income countries for depressive disorders can also help improve their physical health and the well-being of household members, showing that mental health treatments can be cost-effective, a new RAND study shows. study.
Researchers examined a program in the sub-Saharan country of Malawi that builds on the infrastructure of the country’s HIV care system and trains local people in rural communities to help treat those suffering from depression.
The study found that participants had significant improvements in their depression symptoms, and those who had hypertension also showed improvements in their blood pressure. In addition, household members of the treated individuals experienced improvements in their own depression symptoms and their overall functioning.
The findings are published in the journal The Lancet.
“More than 75% of people with mental health problems in low-income countries do not receive any treatment, partly because governments tend to think that mental health care is not a cost-effective investment,” said Ryan McBain, lead author of the study. a senior policy researcher at RAND, a nonprofit research organization.
“We showed that a strategy focused on integrated care and task shifting can save money, and that healthcare has benefits that are usually underestimated because positive externalities are not measured.”
In low- and middle-income countries, common mental disorders, including depressive disorders, are responsible for more years of disability than HIV and malaria combined. Nevertheless, the vast majority of affected individuals do not receive treatment.
The financing landscape contributes to this disparity. For example, development assistance for HIV in 2021 totaled $9.9 billion, compared to $217 million for common mental disorders – a difference of 45 times.
Underlying this is the perception that treatments for common mental disorders, compared to treatments for infectious diseases such as HIV, are time-consuming and less cost-effective. This perception has been partially challenged by mounting evidence that shifting roles from mental health professionals to lay health professionals can maintain efficacy while reducing costs.
Researchers from RAND and partner organizations conducted a randomized trial in a network of 14 health facilities in a remote region of Malawi. The health facilities operated integrated chronic care clinics, a model in which HIV clinics have been reconfigured to offer screening, diagnosis and treatment for a wide range of chronic health conditions such as hypertension, diabetes and asthma.
Adults were eligible for the study if they had recently been diagnosed with major depressive disorder and were actively enrolled in an integrated chronic care clinic for the treatment of one or more health conditions. Researchers enrolled 487 people in the study.
Treatment for depression included group therapy sessions – led by clinic staff and trained local community members – that focused on managing stress, managing problems, behavioral activation, strengthening social support and maintenance routines. Some patients also received medication. All participants were followed for one year from the time the facility they attended began offering treatment.
The intervention resulted in a 38% lower prevalence of depression, as well as significant improvements in depression and general functioning among those who attended facilities that had begun offering treatment, compared to those who had not yet begun offering treatment.
Furthermore, six months after treatment initiation, household members reported fewer depressive symptoms, improved functioning, and significant reductions in their perceived caregiving burden, compared to baseline.
“Interventions can be relatively inexpensive if they build on existing infrastructure, involve task shifting to local community members, and provide group therapy,” McBain said. “We also show that the benefits extend to the physical health of participants and the well-being of household members.”
More information:
Effectiveness, cost-effectiveness and positive externalities of integrated chronic care for adults with major depressive disorder in Malawi (IC3D): a stepped wedge, cluster randomized controlled trial, The Lancet (2024).
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