A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria
Open accessAbstract
BACKGROUND: Depression is common in primary care and is often unrecognized and untreated. Studies are needed to demonstrate the feasibility of implementing evidence-based depression care provided by primary health care workers (PHCWs) in sub-Saharan Africa. We carried out a pilot two-parallel arm cluster randomized controlled trial of a package of care for depression in primary care. METHODS: Six primary health care centers (PHCC) in two Local Government Areas of Oyo State, South West Nigeria were randomized into 3 intervention and 3 control clinics. Three PHCWs were selected for training from each of the participating clinics. The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation, activity scheduling, problem solving treatment and medication for severe depression. Providers from the control clinics delivered care as usual, enhanced by a refresher training on depression diagnosis and management. Outcome measures Patient's Health Questionnaire (PHQ-9), WHO quality of Life instrument (WHOQOL-Bref) and the WHO disability assessment schedule (WHODAS) were administered in the participants' home at baseline, 3 and 6 months. RESULTS: About 98% of the consecutive attendees to the clinics agreed to have the screening interview. Of those screened, 284 (22.7%) were positive (PHQ-9 score ≥ 8) and 234 gave consent for inclusion in the study: 165 from intervention and 69 from control clinics. The rates of eligible and consenting participants were similar in the control and intervention arms. In all 85.9% (92.8% in intervention and 83% in control) of the participants were successfully administered outcome assessments at 6 months. The PHCWs had little difficulty in delivering the intervention package. At 6 months follow up, depression symptoms had improved in 73.0% from the intervention arm compared to 51.6% control. Compared to the mean scores at baseline, there was improvement in the mean scores on all outcome measures in both arms at six months. CONCLUSION: The results provide support for the feasibility of conducting a fully-powered randomized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms. TRIAL REGISTRATION NUMBER: ISRCTN46754188 (ISRTCN registry at isrtcn.com); registered 23 September 2013, details of the pilot study added 12/02/2015.
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The task-shifting approach is applicable in alcohol cessation programs.
“However, we found that this task-shifting approach (31), is applicable in alcohol cessation programs similar to the way it has been found effective in stepped care approach to manage depression in primary care setting in Nigeria (24), and outside the field of mental health (32).”
CHEWs have been involved in task-shifting models to address gaps in depression in primary health care settings in Nigeria.
“They have been involved in task-shifting models to address gaps in reproductive health care in primary care settings in Nigeria (23) as well as for depression in primary health care settings (24).”
EXPONATE was adapted from a Nigerian primary care depression stepped care program and included mhGAP recommendations.
“The EXPONATE intervention was adapted from a stepped care program for depression in primary care previously developed and tested in Nigeria38, and incorporated key treatment recommendations outlined in the mhGAP program.30”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [38]
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Background
- Authors
- Oladeji, B. D., Kola, L., Abiona, T., Montgomery, A. A., Araya, R., & Gureje, O.
- Affiliations
- University of Ibadan (NG)
- University of Nottingham (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Oladeji, Bibilola D
- Venue
- BMC Psychiatry
- Published
- 2015-05-01
- Volume
- 15
- Issue
- 1
- Pages
- 96-96
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4424568
- OpenAlex
- W1973368176
- Cited by
- 36
- References
- 33
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 7 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 2
- FWCI
- 4.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (publishedVersion, cc-by)
- Research Portal (King's College London) (acceptedVersion, cc-by)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
- Greater South Information System
- Funders
- Wellcome Trust
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, stepped care, primary care, primary health care workers, depression screening, PHQ-9, psychoeducation, activity scheduling, problem-solving therapy, antidepressants, feasibility, quality of life, disability, sub-Saharan Africa, Nigeria
- MeSH terms
- Adult, Combined Modality Therapy, Depression, Female, Health Personnel, Humans, Male, Middle Aged, Nigeria, Pilot Projects, Primary Health Care, Quality of Life, Treatment Outcome
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