A stepped care intervention for non-specialist health workers' management of depression in the Mental Health in Primary Care (MeHPriC) project, Lagos, Nigeria: A cluster randomised controlled trial.
Gen Hosp Psychiatry
; 60: 76-82, 2019.
Article
de En
| MEDLINE
| ID: mdl-31351240
ABSTRACT
BACKGROUND:
The study aimed to evaluate the clinical effectiveness of a developed stepped care intervention for management of depression in primary care.METHODS:
A cluster randomised controlled trial with primary care centres (PHCs) as unit of randomization. Five PHCs were randomised to stepped care intervention (SCI) group and another 5 PHCs were randomised to enhanced usual care (eUCA) control group. Participants were adults (18-60â¯years) with clinically significant depression symptoms. The primary outcome was clinical recovery at 12th months follow up. The outcome assessors were blinded to the cluster allocation.RESULTS:
There were 456 participants in SCI group and 451 in eUCA group. At 12â¯months, clinical recovery was significantly higher in the SCI group compared with the eUCA group (60.3% vs 18.2%, ARR 3.10, 95% CI 2.15-3.87). The SCI group also had significantly better quality of life and lesser rates of disability, death or deliberate self-harm compared to the eUCA group. Subgroup analysis within the SCI group showed no difference in clinical outcomes between participants receiving problem solving therapy (PST) and those receiving antidepressants.CONCLUSIONS:
Our study showed that stepped care intervention significantly improved clinical outcomes at 12â¯months. This lends support to growing evidence of clinically effective intervention for depression at primary care level in less resourced countries. TRIAL REGISTRATION http//www.isrctn.com/ISRCTN66243738.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Évaluation des résultats et des processus en soins de santé
/
Soins de santé primaires
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Psychothérapie
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Trouble dépressif
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Services de santé mentale
Type d'étude:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
Aspects:
Patient_preference
Limites:
Adolescent
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Adult
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Female
/
Humans
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Male
/
Middle aged
Pays/Région comme sujet:
Africa
Langue:
En
Journal:
Gen Hosp Psychiatry
Année:
2019
Type de document:
Article