IMPRESS

IMPlementation of evidence-based facility and community interventions to reduce the treatment gap for depRESSion

Funding agency: National Institute of Mental Health, USA
Duration: October 2018 – September 2023
Principal Investigator: Dr. Abhijit Nadkarni
Host institute: Sangath, Goa, India

Background

Depression is the leading cause of disability worldwide and accounts for about 40% of the disability-adjusted life years (DALYs) attributable to mental and substance use disorders. Present estimates suggest that the prevalence of depression in India is 2.7%, and the treatment gap stands at 85%.

IMPRESS aims to reduce this treatment gap by addressing both supply and demand side barriers by combing two strategies previously developed by Sangath. The supply-side will be targeted by scaling up the Healthy Activity Program (HAP), a manualised psychological treatment based on behavioural activation, which was shown to reduce symptom severity and increase remission among depressed participants in Sangath’s PREMIUM study. The VISHRAM program was a community-based mental health intervention with a goal of increasing mental health demand through the enhancement of mental health literacy.

Objective

Our program is comparing two scalable models for delivering the HAP in a low-and-middle-income country context. One model will be the implementation of the HAP in health centers alone, while the other will be the implementation of HAP in health centers in parallel with VISHRAM in the community.

Study Design

First, the formative and pilot research will be used to adapt the HAP and VISHRAM components to the study context for scaling up. A mixed-methods study including ‘theory of change’ workshops with various stakeholders, a contextual adaptation of training and supervision platforms, and piloting of the full intervention will be carried out across primary and community health centers.

The trial phase will consist of an effectiveness-implementation hybrid type 2-cluster RCT comparing the two models for the delivery of the HAP. A facility-only model arm with the HAP being delivered by counsellors identified during the formative phase will be compared with a community model arm in which the VISHRAM intervention is implemented in addition to the HAP.