CoChat
Sign Up
Cited by 177Mental Health Treatment and AccessHealth Systems, Economic Evaluations, Quality of LifeGlobal Health Workforce Issues

Economic evaluation of a task-shifting intervention for common mental disorders in India

Open access
Buttorff, Christine, Hock, Rebecca, Weiss, Helen, Naik, Smita, Araya, Ricardo, Kirkwood, Betty, Chisholm, Daniel, Patel, Vikram·2012·Bulletin of the World Health Organization
DOI 10.2471/blt.12.104133PMC PMC3506405
Open this paper in CoChat — free account

Abstract

OBJECTIVE: To carry out an economic evaluation of a task-shifting intervention for the treatment of depressive and anxiety disorders in primary-care settings in Goa, India. METHODS: Cost-utility and cost-effectiveness analyses based on generalized linear models were performed within a trial set in 24 public and private primary-care facilities. Subjects were randomly assigned to an intervention or a control arm. Eligible subjects in the intervention arm were given psycho-education, case management, interpersonal psychotherapy and/or antidepressants by lay health workers. Subjects in the control arm were treated by physicians. The use of health-care resources, the disability of each subject and degree of psychiatric morbidity, as measured by the Revised Clinical Interview Schedule, were determined at 2, 6 and 12 months. FINDINGS: Complete data, from all three follow-ups, were collected from 1243 (75.4%) and 938 (81.7%) of the subjects enrolled in the study facilities from the public and private sectors, respectively. Within the public facilities, subjects in the intervention arm showed greater improvement in all the health outcomes investigated than those in the control arm. Time costs were also significantly lower in the intervention arm than in the control arm, whereas health system costs in the two arms were similar. Within the private facilities, however, the effectiveness and costs recorded in the two arms were similar. CONCLUSION: Within public primary-care facilities in Goa, the use of lay health workers in the care of subjects with common mental disorders was not only cost-effective but also cost-saving.

AI snapshot

Written from the paper’s full text.

TL;DR

In the MANAS trial in Goa, India, a task-shifting intervention led by lay health workers for common mental disorders was cost-effective and cost-saving in public primary-care facilities, with similar health-system costs but lower time and total costs and better outcomes than enhanced usual care. In private facilities, health outcomes and costs did not differ significantly between arms.

Key findings

  • In public facilities, the intervention arm had significantly lower time costs (−US$45, 95% CI −65 to −27) and total costs (−US$46, 95% CI −79 to −12) than the control arm, while health-system costs were similar (difference US$0.5, 95% CI −19 to 22). Outcomes improved more in the intervention arm: psychiatric symptom score by 3.84 points (95% CI 3.29–4.38), QALYs by 0.02 (95% CI 0.01–0.03), and complete or partial days worked by 62.2 (95% CI 49.6–75.0).
  • The intervention was less costly and more effective in public facilities; it was cost-saving under about half of the conditions illustrated in Fig. 1, and the probability it was cost-effective at a very low threshold of < INR 400 (US$8.60) was nearly 1.00. When the outcome was days of work gained, the intervention always appeared cost-effective; when time costs were included, it appeared cost-saving.
  • The mean total human-resource cost associated with the intervention was INR 93 (US$2; SD 1.53) per participant, or 2% of the unadjusted total health-system cost in the intervention arm. Subjects in the intervention arm had contact with lay health workers on a mean of 6.9 occasions (SD 3.80) for a mean total of 70.8 min (SD 54.2).
  • In private facilities, no between-arm differences in health outcomes reached statistical significance. Mean health-system and total costs were INR 916 (US$20) and INR 1511 (US$32) lower in the intervention arm, respectively, but the 95% CIs crossed zero. Complete data were collected from 1243 (75.4%) public-facility subjects and 938 (81.7%) private-facility subjects.

Methods

  • Cost-utility and cost-effectiveness analyses were performed within the MANAS cluster-randomized controlled trial in 24 public and private primary-care facilities in Goa, India. Subjects were randomly assigned to an intervention arm (psycho-education, case management, interpersonal psychotherapy and/or antidepressants delivered by lay health workers) or a control arm (enhanced usual care by physicians).
  • Outcomes were assessed at 2, 6 and 12 months using the Revised Clinical Interview Schedule psychiatric symptom score, PROSQY diagnostic algorithm, WHO Disability Assessment Schedule disability scores converted to QALYs, and days of lost or reduced work. Costs were based on self-reported health-care utilization, medication use and out-of-pocket payments, divided into health-system costs and time costs.
  • Generalized linear models with gamma distributions and log transformations were used, adjusted for baseline depression scores. Costs were calculated in 2009 Indian rupees and reported in US dollars at INR 46.5 = US$1; no annual discounting was required. Cost-effectiveness acceptability curves and sensitivity analyses were also performed.

Limitations

  • The paper states that all service-utilization data were participant-reported and subject to recall bias; no baseline resource-use data were collected; detailed results are presented only for public facilities because private-facility results did not show greater effectiveness; and using the minimum wage to value lost time is conservative but uncertain, with a more detailed microeconomic analysis of household impacts needed.
  • The text also makes evident that cluster-level summaries were not used because there were too few clusters, and resource-use analysis was restricted to subjects available at each scheduled follow-up. Sensitivity analyses indicated the cost data were sensitive to missing observations, although the main conclusions were unchanged.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2471/blt.12.104133

Cites

49 of 49 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 25 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the private facilities studied, none of the between-arm differences seen in health outcomes reached statistical significance.

    “In the private facilities that were studied, none of the between-arm differences seen in health outcomes reached statistical significance (Appendix A).”
    Quote in the paperSubstantial claim
  • Findingown data

    In public facilities, the intervention would be cost-saving under about half of the conditions illustrated in Fig. 1.

    “In the public facilities, incremental cost-effectiveness ratios indicate that the intervention would be cost-saving under about half of the conditions illustrated in Fig. 1.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    When the only outcome considered is the number of days of work gained, the intervention always appears to be cost-effective.

    “When the only outcome considered is the number of days of work gained, the intervention always appears to be cost-effective.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Over the 12 months of follow-up, mean psychiatric symptom scores improved by 3.84 points (95% CI 3.29 to 4.38) more in the intervention arm than in the control arm.

    “Over the 12 months of follow-up, mean psychiatric symptom scores improved by 3.84 points (95% CI: 3.29 to 4.38) more in the intervention arm than in the control arm (Table 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    Subjects in the intervention arm had contact with lay health workers, in person or by telephone, on a mean of 6.9 occasions (SD 3.80) and for a mean total of 70.8 min (SD 54.2).

    “Subjects in the intervention arm had contact with the lay health workers, either in person or over the telephone, on a mean of 6.9 occasions (SD: 3.80) and for a mean total of 70.8 min (SD: 54.2).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Findingown data

    In public facilities, total health system costs were marginally higher in the intervention arm than in the control arm, but the difference was not statistically significant.

    “Total health system costs were marginally higher in the intervention arm than in the control arm but this difference was not statistically significant.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Baseline resource use did not differ between the intervention and control arms.

  • May combine two claims.

    Findingown data

    In public facilities, overall time costs for subjects and their families and total costs were significantly lower in the intervention arm than in the control arm (P < 0.001 and < 0.01, respectively).

    “However, overall time costs for subjects and their families and total costs were significantly lower in the intervention arm than in the control arm (P < 0.001 and < 0.01, respectively).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Baseline resource use did not differ between the intervention and control arms.

  • May combine two claims.

    Findingown data

    The mean total cost of human resources associated with the intervention was INR 93 (US$ 2; SD 1.53) per participant, or 2% of the unadjusted total health system cost incurred in the intervention arm.

    “The mean total cost of the human resources associated with the intervention was INR 93 (US$ 2; SD: 1.53) per participant, or 2% of the unadjusted total health system cost incurred in the intervention arm.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In private facilities, mean health system costs and total costs in the intervention arm were INR 916 (US$ 20) and INR 1511 (US$ 32) lower, respectively, than in the control arm over the year of follow-up, but the associated 95% CIs crossed zero.

    “Although, per subject, mean health system costs and total costs in the intervention arm were INR 916 (US$ 20) and INR 1511 (US$ 32) lower, respectively, than the corresponding values in the control arm over the year of follow-up, the associated 95% CIs (in INR, -3426 to 1110 and -4221 to 1008; in US$, -74 to 24 and -91 to 22, respectively) both crossed zero.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    When time costs are included, the intervention appears to be cost-saving, since it improves health outcomes while lowering costs.

    “When time costs are included, the intervention appears to be cost-saving, since it improves health outcomes while lowering costs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the public but not the private facilities investigated, time costs were lower and health outcomes were significantly better in the intervention arm than in the control arm.

    “In the public (but not the private) facilities investigated, time costs were lower and health outcomes were significantly better in the intervention arm than in the control arm.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Compared with their counterparts in the control arm, subjects in the intervention arm gained significantly more QALYs and achieved significantly more days of work.

    “Furthermore, compared with their counterparts in the control arm, subjects in the intervention arm gained significantly more QALYs and achieved significantly more days of work (Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The between-arm difference in QALYs gained was 0.02, representing a mean of 7.3 additional days free of depression and/or anxiety for each subject in the intervention arm.

    “The between-arm difference in QALYs gained appeared small (0.02), partly because it only relates to a single year, but this difference represents a mean of 7.3 additional days free of depression and/or anxiety for each subject in the intervention arm.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In public facilities, in terms of health system costs, the intervention was more costly and more effective than the control.

    “| In terms of health system costs | - | More costly, more effective | - |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In public facilities, the mean health system cost per subject was 88 US$ in both the control and intervention arms, with a between-arm difference of 0.5 US$ (95% CI -19 to 22).

    “| Health system | 88 (78 to 100) | 88 (73 to 109) | 0.5 (-19 to 22) |”
    • Also stated in: § Discussion · plain
      “alors que les coûts du système de santé dans les deux groupes étaient similaires.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In private facilities, the efficacy and costs recorded were similar for the intervention and control arms.

    “En los centros privados, sin embargo, la eficacia y los costes registrados fueron similares para los dos brazos.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In public facilities, the mean complete or partial days worked was 197 in the control arm and 259.54 in the intervention arm, a difference of 62.2 (95% CI 49.6 to 75.0).

    “| Complete or partial days worked | 197 (187.7 to 206.8) | 259.54 (251.75 to 267.28) | 62.2 (49.6 to 75.0) |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In public facilities, the mean time cost per subject was 136 US$ in the control arm and 91 US$ in the intervention arm, a difference of -45 US$ (95% CI -65 to -27).

    “| Time | 136 (122 to 151) | 91 (79 to 104) | -45 (-65 to -27) |”
    • Also stated in: § Discussion · plain
      “Les coûts en termes de temps étaient également significativement plus faibles dans le groupe d'intervention que dans le groupe témoin”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In public facilities, in terms of total costs, the intervention was less costly and more effective than the control.

    “| In terms of total costs | - | Less costly, more effective | - |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    In private facilities, the care of subjects with depression and/or anxiety was cheaper in the intervention arm than in the control arm, and therefore the intervention still appeared advantageous from a cost-minimization perspective.

    “In these facilities, however, the care of the subjects with depression and/or anxiety was cheaper in the intervention arm than in the control arm and therefore the intervention still appeared advantageous from a cost-minimization perspective.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The WHO CHOICE programme deems an intervention highly cost-effective if it generates an extra year of healthy life for an amount no greater than the country's per capita gross domestic product.

    “In any particular country, the CHOICE programme of the World Health Organization (WHO) deems an intervention to be highly cost-effective if it generates an extra year of healthy life for an amount no greater than the country's per capita gross domestic product.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Estimates were adjusted for baseline depression scores.

    “Estimates were adjusted for baseline depression scores and are presented with confidence intervals (CIs).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In private facilities, 1054, 1013 and 981 subjects were available at the first, second and last follow-ups, respectively.

    “In private facilities, the corresponding numbers were 1054, 1013 and 981, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A task-shifting pharmaceutical intervention for HIV/AIDS patients in South Africa was found to be cost-effective.

    “A task-shifting pharmaceutical intervention for HIV/AIDS patients in South Africa was found to be cost-effective.47”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Collaborative-care and stepped-care components used together can maximize the efficient use of scarce resources, especially in public health facilities where case management has previously been relatively poor.

    “Used together, the collaborative-care and stepped-care components of this strategy can maximize the efficient use of scarce resources, especially in those public health facilities where case management has previously been relatively poor.20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Generalized linear models with gamma distributions and log transformations were used to assess differences between treatment and control groups and to allow for skewed cost and outcome data.

    “To assess the differences between the treatment and control groups and to allow for the skewed nature of the data on costs and outcomes, generalized linear models were used, with gamma distributions and log transformations.[34][35][36]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34][35][36]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Within public primary-care facilities in Goa, the use of lay health workers in the care of subjects with common mental disorders was not only cost-effective but also cost-saving.

    “Within public primary-care facilities in Goa, the use of lay health workers in the care of subjects with common mental disorders was not only cost-effective but also cost-saving.”
    • Also stated in: § Discussion · hedged
      “In the public primary-care facilities, therefore, the intervention appeared to be not only cost-effective but also cost-saving; the subjects in the intervention arm used and/or lost less cash and showed greater improvement in their mental state than the control subjects.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Baseline resource use did not differ between the intervention and control arms.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Chile, an intervention based on stepped care of depression in women was found to increase health-system costs but provided an extra depression-free day for a small incremental cost of about US$ 1 per woman.

    “in Chile, an intervention based on the stepped care of depression in women was found to increase health-system costs but provided an extra depression-free day for a small incremental cost of about US$ 1 per woman.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The MANAS trial was registered with Clinicaltrials.gov (NCT00446407).

    “The present study formed part of the MANAS trial, which has been registered with Clinicaltrials.gov(NCT00446407) and previously described in detail.18,19,21”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    There is growing evidence of the effectiveness of task-shifting in the management of some chronic conditions, including HIV/AIDS, diabetes and some mental disorders.

    “There is growing evidence of the effectiveness of such task-shifting in the management of some chronic conditions, including infection with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), 2,3 diabetes 4 and some mental disorders.[5][6][7][8][9]”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [2]

      Not checked in the free run.

    • cites [3]

      Not checked in the free run.

    • cites [4]

      Not checked in the free run.

    • cites [5][6][7][8][9]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Psychiatric symptom score was evaluated using the Revised Clinical Interview Schedule, which measures 14 symptom groups of common mental disorder, including depression and anxiety.

    “For each subject, at enrolment and at each follow-up, a psychiatric symptom score between 0 and 49 was evaluated using the Revised Clinical Interview Schedule, which measures 14 symptom groups of common mental disorder, including depression and anxiety.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [24]

      Not checked in the free run.

    • cites [25][26][27]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In public facilities, 1437, 1416 and 1386 subjects were available at the first, second and last follow-ups, respectively.

    “In public facilities, 1437, 1416 and 1386 subjects were available at the first, second and last follow-ups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Complete data from all three follow-ups were collected from 1243 (75.4%) subjects in public facilities and 938 (81.7%) subjects in private facilities.

    “Complete data, from all three follow-ups, were collected from 1243 (75.4%) and 938 (81.7%) of the subjects enrolled in the study facilities from the public and private sectors, respectively.”
    • Also stated in: § Results · plain
      “Complete data were recorded for 1243 (75.4%) of the subjects recruited in public facilities and for 938 (81.7%) of those recruited in private facilities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    There were no statistically significant between-arm differences in any of the health outcomes investigated in private facilities, probably because the standard of routine care in such facilities was relatively high.

    “There were no statistically significant between-arm differences in any of the health outcomes investigated in private facilities, probably because the standard of routine care in such facilities (i.e. the basic level of care experienced in the control arm) was relatively high.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The analysis of resource use was based only on data from subjects who were available for each scheduled follow-up.

    “The analysis of resource use was based only on the data from subjects who were available for each of the scheduled follow-ups.39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    There is considerable institutional resistance to widespread implementation of task-shifting and concern that the quality of care will deteriorate.

    “Although the strategy appears particularly attractive in the many low-income countries with inadequate numbers of physicians and trained nurses, there is considerable institutional resistance to the widespread implementation of the strategy and also concern that the quality of care will deteriorate.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    In public facilities, the intervention was both less costly and more effective than enhanced usual care in terms of all the health outcomes investigated.

    “Although negative incremental cost-effectiveness ratios can be difficult to interpret, 36,42 the ratios calculated in the present study indicate that the intervention was both less costly and more effective than enhanced usual care in terms of all the health outcomes investigated.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36]

      Not checked in the free run.

    • cites [42]

      Not checked in the free run.

    • Rests on an assumption: Baseline resource use did not differ between the intervention and control arms.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Health-care utilization, medication use and out-of-pocket payments were self-reported on the same type of cost-of-illness inventory used in several earlier studies in India.

    “At each of the three follow-ups, subjects self-reported their health-care utilization, medication use and out-of-pocket payments on the same type of cost-ofillness inventory used in several earlier studies in India.25,31,32”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [25]

      Not checked in the free run.

    • cites [31]

      Not checked in the free run.

    • cites [32]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    No baseline data on resource use were collected, although there were no significant between-arm differences in any baseline outcome measures.

    “A second limitation of the present study is that no baseline data on resource use were collected, although there were no significant between-arm differences in any baseline outcome measures.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    In each phase, health-care facilities were randomized to the intervention arm or the control arm.

    “In each phase, health-care facilities were randomized to the intervention arm (i.e.collaborative and stepped care) or the control arm (i.e.enhanced usual care, described later).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Depressive and anxiety disorders are often grouped together as common mental disorders because they show a high degree of comorbidity, have similar epidemiological profiles and respond to similar treatments.

    “In publichealth interventions, however, they are often grouped together as “common mental disorders” because they show a high degree of comorbidity, have similar epidemiological profiles and respond to similar treatments.11,[14][15][16]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11]

      Not checked in the free run.

    • cites [14][15][16]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    In public primary care facilities in Goa, the use of lay health workers for the care of subjects with common mental disorders was not only cost-effective but also cost-saving.

    “El uso de empleados sanitarios no profesionales en los centros de atención primaria públicos en Goa para el cuidado de sujetos con trastornos metales comunes no sólo fue efectivo en relación con los costes sino que también supuso un ahorro.”
    • Also stated in: § Discussion · plain
      “Dans les établissements publics de soins primaires à Goa, le recours à des agents de santé non professionnels pour la prise en charge des sujets atteints de troubles mentaux communs était non seulement efficace en termes de coût, mais aussi plus économique.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Subjects were randomly assigned to an intervention arm or a control arm.

    “De manera aleatoria, se asignó a los sujetos un brazo de intervención o otro de control.”
    • Also stated in: § Discussion · plain
      “Les sujets ont été répartis de manière aléatoire entre groupe d'intervention ou groupe témoin.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The use of the minimum wage as a measure of the economic value of lost time was designed to be conservative but is subject to uncertainty.

    “Finally, our use of the minimum wage as a measure of the economic value of lost time was designed to be conservative but is subject to uncertainty.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    There may be a compelling economic case for investing in lay health workers for the care of other chronic and non-communicable diseases in India.

    “There may be a compelling economic case for investing in lay health workers for the care of other chronic and non-communicable diseases in India.”
    Quote in the paperNot a substantial claim
40 of 40

  • The paper relies on this without support.

    Baseline resource use did not differ between the intervention and control arms.

    “A second limitation of the present study is that no baseline data on resource use were collected, although there were no significant between-arm differences in any baseline outcome measures.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Most trials recruit participants attending mental health facilities; these participants do not represent people experiencing depression in the population: they are more likely to have had prior treatments and to have complicated or persistent episodes of depression and high levels of personality disorder comorbidity that may dampen the effects of the active treatment.

    “Furthermore, most trials recruit participants attending mental health facilities. These participants do not represent people experiencing depression in the population 586 : they are more likely to have had prior treatments and to have complicated or persistent episodes of depression and high levels of personality disorder comorbidity 587 that may dampen the effects of the active treatment.”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [586]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The cited HIV/AIDS intervention is placed in two countries

    Minor

    The discussion places the cited intervention in South Africa, while the title of reference 47 places it in Uganda.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Goldberg D, Huxley P. Common mental disorders: a biosocial model. London: Routledge; 1992.
  2. Hayes R, Moulton L. Cluster randomized trials: a practical approach. Boca Raton: CRC Press; 2009.

Cited by

Sorted by citations

Related

Authors
Buttorff, C., Hock, R., Weiss, H., Naik, S., Araya, R., Kirkwood, B., Chisholm, D., & Patel, V.
Affiliations
  • Johns Hopkins University (US)
  • London School of Hygiene & Tropical Medicine (GB)
  • Sangath (IN)
  • University of Bristol (GB)
  • World Health Organization (CH)
ORCID
Venue
Bulletin of the World Health Organization
Publisher
WHO Press
Published
2012-11-01
Volume
90
Issue
11
Pages
813-821
ISSN
0042-9686 (ISSN-L)
DOI
10.2471/blt.12.104133
PMC
PMC3506405
OpenAlex
W2111438706
Semantic Scholar
30f365204c34cc4649872779517ba4d296569ffc
Cited by
175
References
48
Citations by year
2026: 1 · 2025: 13 · 2024: 12 · 2023: 5 · 2022: 26 · 2021: 21 · 2020: 15 · 2019: 7 · 2018: 14 · 2017: 15 · 2016: 15 · 2015: 15 · 2014: 11 · 2013: 5
FWCI
14.91
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Bulletin of the World Health Organization (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Wellcome Trust (091834)
  • National Institute of Mental Health (T32MH014592)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
Keywords
task shifting, lay health workers, common mental disorders, depression, anxiety disorders, primary care, cost-effectiveness, cost-utility analysis, psychoeducation, case management, interpersonal psychotherapy, antidepressants, public and private health facilities, Goa
MeSH terms
Workforce, Anxiety Disorders, Community Health Workers, Community Mental Health Services, Cost-Benefit Analysis, Depressive Disorder, Humans, India, Primary Health Care, Program Evaluation, Linear Models, Cost Savings, Outcome Assessment, Health Care, Sick Leave, Quality-Adjusted Life Years, Physicians, Primary Care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review