# ESSENCE ## **E**nabling translation of **S**cience to **S**ervice to **EN**hance Depression Car**E** 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](/sites/g/files/omnuum8326/files/mentalhealthlab/files/essence_project_plan.png) 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: - July 2025: [Characterizing modifications to the mental health gap action programme (mhGAP) intervention guide during implementation in low- and middle-income countries using the framework for reporting adaptations and modifications to evidence-based interventions: a systematic review of reviews. International Journal of Mental Health Systems.](https://drive.google.com/file/d/1AA3jahySeUlWTCCLCleaZzN34FhwzFzr/view?usp=sharing) - December 2024: [Adapting and deploying a digital program for training non-specialist providers on a brief psychological intervention for depression in rural Gujarat, India. PLOS Global Public Health.](https://drive.google.com/file/d/1LfVb-qbjn3ypoG4rOBVKvmPt04EwveZm/view?usp=sharing) - December 2024: [Development of a remote implementation support strategy to enhance integration of depression treatment into primary care settings in rural India. Frontiers in Public Health.](https://drive.google.com/file/d/1eqzzPLzvExX5Tqta3qn-jC_A37MJSvcE/view?usp=sharing) - September 2024: [Remote coaching for supporting the implementation of treatment for depression in primary care in Madhya Pradesh, India: protocol for a cluster randomized controlled trial. Frontiers in Health Services.](https://drive.google.com/file/d/1fC5L5vweAOZIJVu8iLun42rh0qbYRrJ6/view?usp=sharing) - 2024: [Burnout, motivation and job satisfaction among community health workers recruited for a depression training in Madhya Pradesh, India: a cross-sectional study. BMJ Public Health.](https://drive.google.com/file/d/1dOg9Fa9kAsTiYEZplEep0drDcDtlXHBL/view?usp=sharing) - 2023: [Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India. Global Health: Science and Practice.](https://drive.google.com/file/d/1jfoH-r57uCo4mjMo7ISJZJeL2vlI-Sbv/view?usp=sharing) - December 2022: [Adaptation and translation of a scalable measure for assessing health worker competence to deliver a brief psychological intervention: A case study from central India. Psychiatric Quarterly.](https://drive.google.com/file/d/15lupuJ4gRdgm09di5ivc0AM38g2C4wf8/view?usp=sharing) - 2022: [ESSENCE: An Implementation Research Program to Scale Up Depression Care in Rural Communities. Psychiatric Services.](https://drive.google.com/file/d/1C6KaZ9JRKk2VkouiJsUv2sDBtEjhqErk/view?usp=sharing) - November 2021: [Assessing costs of developing a digital program for training community health workers to deliver treatment for depression: A case study in rural India. Psychiatry Research.](https://drive.google.com/file/d/1neEO7ZJIl607SlUynh_-wG31oH0lCkwZ/view?usp=sharing) - July 2021: [Development and implementation of COVID-19 safety protocols for conducting a randomized trial in global mental health: Field report from Central India. Asian Journal of Psychiatry.](https://drive.google.com/file/d/1bEN0gZdo0HP596wXbbBnRtk2eHZHbse7/view?usp=sharing) - February 2021: [Economic Evaluations of Internet-Based Psychological Interventions for Anxiety Disorders and Depression: A Systematic Review. Journal of Affective Disorders.](https://drive.google.com/file/d/1qW4hwVYLCKkXx-Y3FpESjiUU4T89vVsV/view?usp=sharing) - January 2021: [Digital training for non-specialist health workers to deliver a brief psychological treatment for depression in India: Protocol for a three-arm randomized controlled trial. Contemporary Clinical Trials.](https://drive.google.com/file/d/1Ln5gBzzXaGMbIgvbXU0zbD3Fro2goJbB/view?usp=sharing) - 2020: [Economic evaluation and costs of telepsychiatry programmes: A systematic review. Journal of Telemedicine and Telecare.](https://drive.google.com/file/d/1U6cymyPulEbdNqW9JdNE1MiCiKAohgyQ/view?usp=sharing) - October 2020: [Assessing health worker competence to deliver a brief psychological treatment for depression: Development and validation of a scalable measure. Journal of Behavioral and Cognitive Therapy.](https://drive.google.com/file/d/1vIB0fyqc1b-POE0Q-pe8Usoq3dvjjv3-/view?usp=sharing) - September 2020: [Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study. International Journal of Environmental Research and Public Health.](https://drive.google.com/file/d/1Ondks1URMOhXx-InbVskyzsvsf1t3_mO/view?usp=sharing) - August 2020: [Design and Development of a Digital Program for Training Non-specialist Health Workers to Deliver an Evidence-Based Psychological Treatment for Depression in Primary Care in India. Journal of Technology in Behavioral Science.](https://drive.google.com/file/d/1Ondks1URMOhXx-InbVskyzsvsf1t3_mO/view?usp=sharing) - September 2019: [Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India. Asian Journal of Psychiatry.](https://drive.google.com/file/d/1OXB_UTH6724vDq1JtpMeDVo_ulNkYycr/view?usp=sharing) ## Latest Lab News [### Publication: Breaking the Cycle - How Maternal Adversity Shapes Parenting Among Adolescent Mothers in Brazil ](/news/2026/05/publication-breaking-cycle-how-maternal-adversity-shapes-parenting-among-adolescent) May 12, 2026 This publication explores how adverse childhood experiences (ACEs) and intimate partner violence (IPV) shape parenting behaviors among adolescent mothers in Brazil. Drawing on data from 237 mothers aged 14-19 in southern Brazil's public primary care... 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