ESSENCE

Enabling translation of Science to Service to ENhance Depression CarE

Completed project (2017-2022).

 

The Aim of the Study:

Led by Dr. Vikram Patel (PI, Harvard Medical School), Dr. Anant Bhan (Site PI, Sangath), and Dr. John A. Naslund (Project Lead, Harvard Medical School), ESSENCE aimed to enhance mental health care in South Asia by bridging the gap between scientific research and clinical services. The project sought to strengthen collaborations between South Asian institutions and scale up effective, evidence-based mental health interventions for depression in primary care settings.

ESSENCE focused on the following objectives:

  1. Evolve the existing administrative infrastructure of SHARE Hub (the South Asian Hub for Advocacy, Research and Education on mental health) for International Mental Health Research, into a South Asian Mental Health Implementation Science Hub comprising the ESSENCE partners, which include governmental, non-governmental, academic, and implementing agencies in the region.
  2. Carry out implementation research to assess the comparative effectiveness of technology-enabled interventions to train non-specialist health workers and provide them implementation support to address the key barriers to the coordinated delivery of evidence-based clinical treatments for depression (Healthy Activity Program and Antidepressant Therapy) at the primary health care level.
  3. Develop and offer a range of opportunities, including fellowships and online courses tailored for the region, to build the capacity of researchers to generate knowledge, of media professionals and service user representatives to disseminate that knowledge, and of policymakers and program managers to ensure uptake of that knowledge.

     

The Background:

In India, depression accounts for 37% of the mental health-related Disability Adjusted Life Years (DALYs) and significantly contributes to the burden attributed to suicide and ischemic heart disease, thus making it a critical public health priority. However, despite the knowledge of evidence-based clinical treatments (EBT), treatment gaps exceed 90% in rural areas. ESSENCE will address the critical knowledge gap regarding the training and implementation support strategies necessary to scale up the delivery of cost-effective evidence-based treatments for depression in a low-resource setting. 

 

The Project Plan:

This implementation research project aimed to identify the most effective and cost-effective strategies for scaling up evidence-based clinical treatments for depression (i.e., the Healthy Activity Program, a brief psychological treatment delivered by Non-Specialist Health Workers) in primary care facilities in Madhya Pradesh, India.

ESSENCE consisted of two complementary, sequential randomized controlled trials:
 

ESSENCE_project_plan

Through these efforts, ESSENCE sought to inform and transform mental health practices and policies within the region.


Supporters and Project Duration:

ESSENCE was supported by the National Institute of Mental Health (NIMH) in the USA and ran from 2017 to 2022. Partners included Sangath (India), Schizophrenia Research Foundation (Chennai), Schizophrenia Awareness Association (Pune), HealthNet TPO (Afghanistan), Independent University (Bangladesh), and Transcultural Psychosocial Organization (Nepal).


Findings:

Both trials were completed. The Training Trial demonstrated the feasibility and relative effectiveness of digital training modalities for ASHAs in rural primary care settings. The Implementation Trial successfully integrated evidence-based depression care into 14 rural Health and Wellness Centers. Results from both trials are currently under analysis.
 

Publications:

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