Dias 2019.
| Study characteristics | |
| Methods |
Study design: RCT Duration of study: the study was conducted from 2015 (the first participant entered the trial) to 2017 (the last participant exited). The paper was published in 2019. Country: India Income classification: low‐middle‐income country from 2015 to 2019 Geographical scope: urban and rural, recruited from rural and urban primary health care clinics and the broader community in Goa, India Healthcare setting: the Depression in later life (DIL) intervention was provided at places convenient to participants (usually their home or in social or religious centres). |
| Participants | 1. Age: N. 181; mean 69.6 (SD 7.2) 2. Gender: both 3. Socioeconomic background: not specified 4. Educational background: 22.6% illiterate; 20.4% literate (no formal education); 31.5% primary school; 21.0% secondary school; 3.9% graduate; 0.6% professional/postgraduate Inclusion criteria: a. mildly symptomatic person without current mental illness; b. warranted other active treatment (e.g. antidepressant medication); c. 60 years or older (as determined from government identification cards and medical records); d. scores of 4 or higher on the rater‐administered, 12‐item General Health Questionnaire (GHQ‐12), with scores ranging from 0 to 12 (higher scores indicating greater symptoms of depression and anxiety), and not in a current episode of major depression; e. ability to speak Konkani, Hindi, or English; f. residence in the same locality for the subsequent 12 months. Exclusion criteria: a. persons with major depression or anxiety disorders within the past 12 months as determined by the Mini International Neuropsychiatric Interview (MINI) 6.0; b. moderate‐to‐high suicide risk (i.e. intent or plan to attempt suicide in the near future); c. history of psychiatric disorders other than nonpsychotic unipolar major depression or anxiety disorder; e. low cognitive scores (< 24 on the Hindi Mini‐Mental State Examination [HMMSE]; score range, 0‐30, with higher scores indicating better cognitive functioning); f. currently taking antidepressants; g. living with an unstable or acute medical illness that would interfere with trial participation. Note: at baseline, the intervention and control group scores for the GHQ‐12 were, respectively, 6.29 (1.87) and 6.23 (1.90). Stated purpose: to assess whether an intervention for depression prevention provided by lay counsellors is effective in older adults from low‐ and middle‐income countries |
| Interventions |
Name: the DIL intervention Title/name of PW and number: lay counsellors (4) 1. Selection: member of the local community, 30 years or older 2. Educational background: they were graduates from any non‐health‐related field (including counselling). 3. Training: the LCs were trained in workshops conducted by 2 members of the research team (M.S. and J.Q.M.) and were required to demonstrate proficiency in 2 practice cases. 4. Supervision: weekly supervision locally and biweekly via Skype from the United States was performed for therapy quality assurance. 5. Incentives/remuneration: not specified Prevention type: indicated – the intervention was defined as indicated: “consistent with indicated depression prevention, we enrolled mildly symptomatic persons without current mental illness that warranted other active treatment.” Intervention details: the DIL intervention (a mix of problem‐solving therapy [PSt] and Brief Behavioral Treatment for Insomnia [BBTI] using lay healthy counsellors) thus dealt with 2 potentially modifiable risk factors for major depression: avoidant or passive coping and insomnia. The DIL intervention sessions, 30 to 40 minutes in length, were provided at places convenient to participants (usually their home or in social or religious centres) for 6 sessions that spanned 6 to 10 weeks. We included 2 booster sessions, 1 each at months 7 and 10, to encourage practice and maintenance of skills for dealing adaptively with future problems. Control: usual care – the control group received care as usual (CAU) together with the same schedule of outcome assessments used in the DIL in the intervention. |
| Outcomes |
Participants’outcomes of interest for this review
Carers’ outcomes of interest for this review Nil Economic outcomes Nil Time points: baseline, post‐intervention (< 1 month; 1‐6 months; 7‐24 months) |
| Notes |
Source of funding: this study was supported by grants MH R34 96997 and MH P30 90333 from National Institute of Mental Health. Notes on validation of instruments (screening and outcomes): the selected measures are widely used and validated for use across contexts. Additional information: none Handling the data: not applicable Prospective trial registration number: NCT02145429 |