Task-shifted interventions for depression delivered by lay primary health-care workers in low-income and middle-income countries

May 17, 2019
Authors: Bolanle Adeyemi Ola, Olayinka Atilola
Organization: Lancet

As we think more and more about how to integrate mental health support in OVC programs, the results of a cluster-randomised trial in Nigeria showed that task-shifted interventions delivered by lay health workers were associated with remission in more than three-quarters of patients with moderate to severe depression. The two interventions they tried were:

  1. Fully structured and manualised intervention package that incorporated components of the WHO Mental Health Gap Action Programme intervention guide (mhGAP-IG) for depression as well as problem-solving therapy
  2. Unstructured usual care, enhanced with mhGAP-IG-based training of providers in recognition of depression and basic psychological and pharmacological interventions for depression

Despite the first being more resource-intensive than the second, the outcomes were almost identical – except that in the second group, more anti-depressants were prescribed. The researchers theorize that in the second group, providers had less time and went for a “quick fix.” They write, “incorporation of and availability of skills in an evidence-based, culturally appropriate, and intensive psychological treatment could potentially reduce the need for and prescription of antidepressants in primary-care settings without compromising effectiveness. This will be an important consideration for Nigeria and other LMICs when scaling-up task-shifted models of care for depression among subpopulations such as adolescents and pregnant women, where antidepressant use might be unsafe.”