Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months
Open accessAbstract
Background: Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare. Aims: To test the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders. Method: Twenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinicaltrials.gov (NCT00446407). Results: A total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53–0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59–0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR = 0.64, 95% CI 0.42–0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities. Conclusions: Trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
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By moving psychological treatment delivery from specialists to non-specialist community health workers, task-sharing can increase the supply of mental health providers.
“Task-sharing is a strategy that can expand the availability of mental health providers by shifting delivery of psychological treatments from specialist providers to non-specialist community health workers (Chibanda et al., 2016; Patel et al., 2011; Rahman et al., 2008; Raviola et al., 2019).”
From Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India (2019) · cites this paper as Patel et al., 2011
Previous studies where nurses and other lay community health workers delivered psychosocial interventions effectively support these results.
“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 [10]
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- Authors
- Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., Bhat, B., Araya, R., King, M., Simon, G., Verdeli, H., & Kirkwood, B. R.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Sangath (IN)
- University of Bristol (GB)
- The Royal Free Hospital (GB)
- Group Health Cooperative (US)
- Columbia University (US)
- Corresponding author
- Patel, Vikram
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2011-12
- Volume
- 199
- Issue
- 6
- Pages
- 459-466
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC3227809
- OpenAlex
- W2110879520
- Cited by
- 291
- References
- 24
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 24 · 2023: 12 · 2022: 17 · 2021: 60 · 2020: 20 · 2019: 20 · 2018: 12 · 2017: 18 · 2016: 22 · 2015: 20 · 2014: 24 · 2013: 16 · 2012: 6
- FWCI
- 20.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust (091834)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- common mental disorders, depression, anxiety, lay health workers, stepped care, collaborative care, primary care, suicide attempts, disability, psychological morbidity, Goa
- MeSH terms
- Suicide Prevention, Adult, Anxiety Disorders, Community Health Workers, Counseling, Depressive Disorder, Family Practice, Female, Health Facilities, Proprietary, Health Services Accessibility, Health Status, Humans, India, Male, Middle Aged, Primary Health Care, Severity of Illness Index, Suicide, Program Evaluation, Prevalence, Outcome Assessment, Health Care, Public Sector, International Classification of Diseases
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