Incorporation of depression treatment in the care of chronic health conditions improving well -being for both patients and their families
• Outstanding research
In many low and medium -sized countries, significant public health resources are dedicated to addressing health conditions such as HIV and malaria, but most people with depression and other mental disorders do not receive mental health treatment.
The integration of mental health care in routine medical care offers a promising approach to close this treatment gap, according to a study led by Rand researchers Ryan K. McBain, SC.D., SC.M. and Glenn Wagner, Ph.D. . This integrated approach can also improve the other health conditions of patients and the well -being of family members, benefits that are often underestimated in profitability evaluations.
What did the researchers do in the study?
The research team conducted a random cluster test in 14 chronic medical care facilities in the Neno district, a remote region in Malawi. These health facilities are HIV clinics that also offer detection, diagnosis and treatment for chronic conditions such as high blood pressure, diabetes and asthma. The clinic staff received initial training on study procedures, update training and continuous supervision.
Clinical patients were eligible to participate if they were newly diagnosed with depression (determined by a standard depression exam and a brief diagnostic interview) and actively receiving attention from one of the 14 clinics. A total of 487 participants in the study analysis were included.
The study began with a reference period of 3 months during which the 14 clinics provided attention as usual. Participants with symptoms of depression who attended clinics while receiving attention as usual received psychoeducation and, if necessary, referred to a mental health care provider in the District of Neno or in a regional hospital.
Then, every 3 months, two or three clinics went on to provide integrated depression treatment, while the other clinics continued as usual. At the end of the study, all clinics provided integrated depression treatment. The clinical counselors provided treatment recommendations based on the symptoms of depression of the participants, but each participant could select the option they preferred: only group therapy, group therapy and antidepressant medications, or antidepressant medications only. Group therapy consisted of a standardized approach called Plus problem management, which covers issues such as stress management, strengthening social connections and support, and the development of daily routines that support well -being.
The researchers compared the treatment integrated with the care as usual, measuring the changes in the symptoms of depression of the participants, the daily functioning and the chronic health conditions every 3 months during the 27 -month proof period. They also measured the changes in the symptoms of depression, the operation and perceived burden of attention between a subset of household members, from just before the beginning of the treatment to 6 months later.
The researchers calculated intervention costs by estimating the costs associated with all intervention activities, including training, detection, diagnosis and service provision.
What did the study find?
Most participants selected independent group therapy as their favorite treatment.
In general, receiving any type of depression treatment as part of the current medical care led to a decrease in the depressive symptoms of the participants and an increase in their operation over time. Participants also showed a slight decrease in systolic blood pressure while receiving depression treatment.
The effects of integrated depression treatment also extended to their homes. Household members were less likely to experience a depressive episode and showed an improvement in symptoms of depression, daily functioning and perceived charge of care to support their relative.
After accounting for improved well -being between participants and members of their homes, the researchers determined that integrated depression treatment led to a 32% increase in profitability in relation to attention as usual.
What do the results mean?
The results of the study suggest that the integration of treatment for depression in the care of chronic health conditions improves well -being both at the individual and home level and could be a profitable approach to care in low -income environments.
The authors point out that the study took place during the apogee of the COVID-19 pandemic, which may have influenced the disposition of people to participate. They also point out that the sample was 82% of women: the highest research could help clarify why men may or may not choose to participate and if men show similar improvements with integrated depression treatment.
The findings highlight the importance of considering how the effects of mental health treatment can be extended to family, friends and a broader social network. McBain and his colleagues point out that researchers, doctors, public health workers and political leaders can underestimate the benefits of mental health care, especially on low -income environments, when they focus only on the benefits for the person that receives attention.
Reference
McBain, RK, Mwale, O., Mpinga, K., Kamwiyo, M., Kayira, W., Ruderman, T., Connolly, E., Watson, yes, Wroe, Eb, Munyaneza, F., Dullie, L ., Raviola, G., Smith, SL, Kulisewa, K., Udedi, M., Patel, V. and Wagner, GJ (2024). Effectiveness, profitability and positive externalities of integrated chronic care for adults with major depressive disorder in Malawi (IC3D): a slope test, randomized cluster and controlled. The lancet, 404(10465), 1823-1834. https://doi.org/10.1016/S0140-6736(24)01809-9
