The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index; none of the 5 sources its claims cite is checked for support yet.
Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial
Open accessAbstract
Background Depression and anxiety disorders are common mental disorders worldwide. The MANAS trial aimed to test the effectiveness of an intervention led by lay health counsellors in primary care settings to improve outcomes of people with these disorders.Methods In this cluster randomised trial, primary care facilities in Goa, India, were assigned (1:1) by computer-generated randomised sequence to intervention or control (enhanced usual care) groups. All adults who screened positive for common mental disorders were eligible. The collaborative stepped-care intervention offered case management and psychosocial interventions, provided by a trained lay health counsellor, supplemented by antidepressant drugs by the primary care physician and supervision by a mental health specialist. The research assessor was masked. The primary outcome was recovery from common mental disorders as defined by the International Statistical Classification of Diseases and Related Health Problems-10th revision (ICD-10) at 6 months. This study is registered with ClinicalTrials.gov, number NCT00446407.Findings 24 study clusters, with an equal proportion of public and private facilities, were randomised equally between groups. 1160 of 1360 (85%) patients in the intervention group and 1269 of 1436 (88%) in the control group completed the outcome assessment. Patients with ICD-10-confirmed common mental disorders in the intervention group were more likely to have recovered at 6 months than were those in the control group (n=620 [65·0%] vs 553 [52·9%]; risk ratio 1·22, 95% CI 1·00-1·47; risk difference=12·1%, 95% CI 1·6%-22·5%). The intervention had strong evidence of an effect in public facility attenders (369 [65·9%] vs 267 [42·5%], risk ratio 1·55, 95% CI 1·02-2·35) but no evidence for an effect in private facility attenders (251 [64·1%] vs 286 [65·9%], risk ratio 0·95, 0·74-1·22). There were three deaths and four suicide attempts in the collaborative stepped-care group and six deaths and six suicide attempts in the enhanced usual care group. None of the deaths were from suicide.Interpretation A trained lay counsellor-led collaborative care intervention can lead to an improvement in recovery from CMD among patients attending public primary care facilities.Funding The Wellcome Trust.
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10 Own method · 10 Own result · 3 Not checked yet · 1 Sources not found · 1 No basis given
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“The trial population was predominantly female (82%), with mean age 46.3 years (SD 13.3 years).”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Results > Study population
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“The MANAS trial is the largest effectiveness trial of a primary-care based intervention to integrate CMD treatments into routine primary care in a developing country.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Implications
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“Secondary analyses showed that the intervention had a generally strong and consistent effect in PHC facility attenders but not GP facility attenders for all diagnostic groups apart from depression where no effect was found.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Results
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“These process indicators show that, apart from the IPT, the intervention was delivered with high fidelity to the original protocol.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Results > Process indicators (Table 6)
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In the paper
“There was modest evidence of an effect of the intervention on recovery from ICD-10 cases at six months (proportion recovered: 65.0% vs. 52.9% in CSC and EUC arms respectively; RR=1.22, 95%CI 1.00,1.47). The effect was larger among PHC participants (65.9% vs. 42.5%, RR=1.55, 95%CI 1.02,2.35) but not GP participants (64.1% vs. 65.9%, RR=0.95, 95%CI 0.74, 1.22, p-value for effect-modification=0.001).”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Results > Impact of the intervention
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“There was modest evidence of an effect on prevalence of ICD-10 at six months among screen positive cases, with a halving of prevalence in PHCs (RR=0.54, 95%CI 0.34, 0.81) but no effect in GP facilities (p-value for effect-modification=0.003).”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Results > Impact of the intervention
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“For each diagnostic group, the mean CIS-R score was lower in the CSC than the EUC arm.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Results > Impact of the intervention
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In the paper
“Altogether 20,352 patients were screened, of whom 3,816 (18.8%) screened positive for CMD and 3,434 were eligible to participate. Of these, 2,796 (81%) consented to participate and were enrolled”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Results > Participant flow
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In the paper
“Patients with ICD-10 definite CMD in the intervention arm were more likely to have recovered at 6 months (65% vs 53%; risk ratio=1.22, 95%CI 1.00–1.47; risk difference=12%, 95%CI 2%-23%).”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Results
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The trial demonstrates that an intervention led by a trained lay counsellor improves recovery from CMD, in particular among those attending primary health care facilities.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Implications
In the paper
“the primary analysis was the difference across arms in the proportion of ICD-10 cases at baseline who recover at six months.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Design And Methods > Statistical methods
What the sources say
- Not matchedcites [37]
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In the paper
“The LHC acted as a case-manager for all who screened positive for CMD and took overall responsibility for delivering the intervention for all non-drug treatments, in close collaboration with the primary care physician and the clinical specialist.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Design And Methods > The Interventions
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In the paper
“To evaluate the effectiveness of a LHC led collaborative stepped care (CSC) intervention on recovery from CMD in public (government) Primary Health Centre (PHC) and private General Practitioner (GP) health care settings”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Design And Methods > Objective
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In the paper
“Twenty-four primary care facilities, with an equal proportion of public Primary Health Centres (PHC) and private General Practitioners (GP) practices, were randomly allocated within pre-defined strata, to intervention (collaborative stepped care, CSC) or control (enhanced usual care, EUC) groups.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Method
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In the paper
“The CSC arm provided case management and psychosocial interventions, delivered by a trained Lay Health Counsellor, antidepressant medication by the primary care physician and supervision by a visiting mental health specialist.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Method
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Cluster randomised trial with primary care facility as unit of randomisation.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Method
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The locally-recruited LHC had non-health backgrounds and underwent a structured two month training course”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Design And Methods > The Interventions
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Manas was implemented by Sangath, a Goan community mental health non-governmental organization, in collaboration with the London School of Hygiene & Tropical Medicine (LSHTM), the Government of Goa’s Directorate of Health Services, the Voluntary Health Association of Goa and private general practitioners.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Design And Methods > Setting
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The MANAS trial was implemented to test the effectiveness of a lay health worker led intervention in primary health care settings to improve outcomes of people with CMD in Goa, India.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Background
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The trial was conducted in two consecutive phases from April 2007 to September 2009. Phase 1 involved 12 PHCs, while Phase 2 was conducted in 12 GP facilities.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Design And Methods > Design
None of the sources cited for this claim have been checked yet.
In the paper
“The majority of persons with CMD seek healthcare in primary care settings[1] where recognition is poor, with fewer than one third of clinically significant cases detected[11].”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Background
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All adults presenting at a facility were screened for CMD with the General Health Questionnaire and those scoring above a cut-off point of five were regarded as eligible for participation in the trial.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Method
In the paper
“Depressive and anxiety disorders are the leading neuropsychiatric cause of the global burden of disease[1],”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Background
What the sources say
- Not checked yetcites [1] Patel, 2003, Poverty and common mental disorders in developing countries, Bull World Health Organ source
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The primary outcome was recovery from ICD-10 defined CMD six months after recruitment.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Abstract > Method
In the paper
“the intervention is based on the stepped-care approach used in a Chilean trial [17] which emphasizes that while simple interventions such as psycho-education may be provided to all patients, more resource-intensive interventions may be reserved for participants who are severely ill or not responding to the simpler interventions.”
§ The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India > Design And Methods > The Interventions
What the sources say
- Not checked yetcites [17] Lewin, 2005, Lay health workers in primary and community health care, Cochrane Database Syst Rev source
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The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The exceptions are a collaborative care program involving lay health workers in both primary and private care settings(116), and depression screening studies in which psychiatrists oversaw the antidepressant treatment resulting in reduced suicide rates in both men and women (Table 2).”
From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [116]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“an effective approach to mitigating the shortage is training nonmental health professionals to deliver packages of mental health care in a collaborative, stepped-care, task-sharing approach (Patel et al., 2010; Padmanathan and De Silva, 2013; Raviola et al., 2019).”
From Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of the HAPPINESS intervention (2024) · cites this paper as Patel et al., 2010
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“There have been stepped care initiatives in LMICs; however, these have been limited to providing different levels of non-specialist counselling, psychotherapy and antidepressant medication, depending on the person’s mental health needs.22”
From Evaluating a stepped care model of psychological support for adults affected by adversity: study protocol for a randomised controlled trial in Jordan (2024) · cites this paper as [22]
Experimental — accuracy not yet measuredIn the citing paper
“These results are also supported by previous studies where nurses and other lay community health workers delivered psychosocial interventions effectively.10,43”
From Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study (2020) · cites this paper as [43]
In the citing paper
“The sample size was calculated on the prediction of a small to moderate effect size (d = 0.4) on the GHQ-12 at the 3-month follow-up assessment (based on prior interventions in primary care [40]).”
In the citing paper
“it was subsequently successfully adapted and replicated in other LMICs (9, 10).”
From Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review (2019) · cites this paper as [9]
Citations
Cites
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Self-citationPoverty and common mental disorders in developing countries.
Patel, V., & Kleinman, A. M. (2003) · Europe PMC (PubMed Central) · Cited by 1,118
Self-citationTreatment and prevention of mental disorders in low-income and middle-income countries
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Self-citationGroup Interpersonal Psychotherapy for Depression in Rural Uganda: A Randomized Controlled Trial
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Self-citationMental illness in general health care : an international study
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Lay health workers in primary and community health care
Lewin, S., Dick, J., Pond, P., Zwarenstein, M., Aja, G. N., van Wyk, B. E., Bosch-Capblanch, X., & Patrick, M. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004015.pub2 · Cited by 544
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Mental Illness in General Health Care: An International Study
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Self-citationBower, P., Gilbody, S., Richards, D., Fletcher, J., & Sutton, A. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.023655 · Cited by 429
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Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104
Self-citationCollaborative care for depression and anxiety problems
Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006525.pub2 · Cited by 1,126
Social determinants of mental health
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2014.928270 · Cited by 1,411
Human resources for mental health care: current situation and strategies for action
Kakuma, R., Minas, H., van Ginneken, N., Dal Poz, M. R., Desiraju, K., Morris, J. E., Saxena, S., & Scheffler, R. M. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61093-3 · Cited by 979
Challenges and opportunities in global mental health: a research-to-practice perspective
Wainberg, M. L., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., Neria, Y., Bradford, J.-M. E., Oquendo, M. A., & Arbuckle, M. R. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0780-z · Cited by 875
Metadata
- Authors
- Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., De Silva, M. J., Bhat, B., Araya, R., King, M., Simon, G., Verdeli, H., & Kirkwood, B. R.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Sangath (IN)
- Voluntary Health Association of Goa (IN)
- University of Bristol (GB)
- The Royal Free Hospital (GB)
- Group Health Cooperative (US)
- Columbia University (US)
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2010-12
- Volume
- 376
- Issue
- 9758
- Pages
- 2086-2095
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC4964905
- OpenAlex
- W2100008637
- Cited by
- 752
- References
- 44
- Citations by year
- 2026: 39 · 2025: 39 · 2024: 41 · 2023: 54 · 2022: 56 · 2021: 80 · 2020: 44 · 2019: 60 · 2018: 34 · 2017: 63 · 2016: 45 · 2015: 51 · 2014: 52 · 2013: 37 · 2012: 44
- FWCI
- 40.91
- Type
- journal article
- Language
- en
- Open access
- green
- orcid.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Wellcome Trust (091834, 076783)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- common mental disorders, depression, anxiety disorders, stepped-care intervention, primary care, case management, psychosocial interventions, antidepressants, public vs private health facilities, suicide attempts, community mental health services, Goa
- MeSH terms
- Workforce, Adolescent, Adult, Aged, Allied Health Personnel, Antidepressive Agents, Anxiety Disorders, Cooperative Behavior, Counseling, Depressive Disorder, Female, Fluoxetine, Humans, India, Male, Middle Aged, Patient Education as Topic, Primary Health Care, Psychotherapy, Severity of Illness Index, Suicide, Attempted, Odds Ratio, Treatment Outcome, Outcome Assessment, Health Care, Public Sector, Directive Counseling, Young Adult, General Practice
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