The effect of VISHRAM, a grass-roots community-based mental health programme, on the treatment gap for depression in rural communities in India: a population-based study
The effect of VISHRAM, a grass-roots community-based mental health programme, on the treatment gap for depression in rural communities in India: a population-based study
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DOI：
10.1016/s2215-0366(16)30424-2
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发表时间：
2017-02-01
影响因子：
64.3
通讯作者：
Patel, Vikram
中科院分区：
文献类型：
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作者：
Shidhaye, Rahul;Murhar, Vaibhav;Patel, Vikram
VISHRAM是一个以社区为基础的精神卫生项目，目标是解决印度中部维达尔巴阿姆拉瓦蒂地区30个村庄的自杀心理健康风险因素。我们的目的是评估是否实施VISHRAM与抑郁症患者寻求治疗的比例增加（接触面）。方法VISHRAM的核心战略是通过提高心理健康素养，增加对护理的需求，并改善抑郁症和酒精使用障碍的循证干预措施的供应。抑郁症的干预由社区工作者和非专业顾问领导，并与设施内的普通医生和精神科医生合作进行。从2013年12月25日到2014年3月10日，在引入VISHRAM之前，我们对从选民名册中随机选择的成年人进行了基线横断面调查（基线调查人群）。结构化访谈由独立于VISHRAM干预的现场研究人员进行，包括有关社会人口特征、医疗服务使用、抑郁（使用患者健康问卷[PHQ]-9测量）和心理健康素养的问题。在VISHRAM颁布后18个月，我们重复了抽样方法，选择了一个单独的成人人群（18个月的调查人群），并进行了相同的调查。主要结局是VISHRAM接触覆盖率的变化，定义为基线和18个月调查人群之间寻求抑郁症状治疗的抑郁症患者（PHQ-9评分>9）比例的差异。次要结果是是否覆盖的分布是公平的，寻求服务的类型，和心理健康literacy.Findings 1887参与者完成了18个月的调查访谈之间的9月18日，和2015年10月8日。18个月调查人群中当前抑郁症的接触覆盖率（27.2%，95% CI 21.4-33.7）是基线调查人群（4.3%，1.5-7.1）的6倍。接触覆盖率在性别、教育、收入、宗教和种姓之间分布均匀。大多数咨询护理的提供者都是普通医生。我们观察到显着改善的一系列心理健康素养指标，例如，抑郁症的概念化作为一个心理健康问题，并打算寻求照顾depression.Interpretation基层社区为基础的计划，在印度农村与大幅增加公平的接触覆盖面抑郁症和改善心理健康素养。现在至关重要的是，通过印度的国家心理健康方案扩大这一方案，将这一知识转化为现实世界的实践。
Background VISHRAM was a community-based mental health programme with the goal of addressing the mental health risk factors for suicide in people from 30 villages in the Amravati district in Vidarbha, central India. We aimed to assess whether implementation of VISHRAM was associated with an increase in the proportion of people with depression who sought treatment (contact coverage).Methods A core strategy of VISHRAM was to increase the demand for care by enhancing mental health literacy and to improve the supply of evidence-based interventions for depression and alcohol-use disorders. Intervention for depression was led by community-based workers and non-specialist counsellors and done in collaboration with facility-based general physicians and psychiatrists. From Dec 25, 2013, to March 10, 2014, before VISHRAM was introduced, we did a baseline cross-sectional survey of adults randomly selected from the electoral roll (baseline survey population). The structured interview was administered by field researchers independent of the VISHRAM intervention and included questions about sociodemographic characteristics, health-care service use, depression (measured using the Patient Health Questionnaire [PHQ]-9), and mental health literacy. 18 months after VISHRAM was enacted, we repeated sampling methods to select a separate population of adults (18 month survey population) and administered the same survey. The primary outcome was change in contact coverage with VISHRAM, defined as the difference in the proportion of individuals with depression (PHQ-9 score >9) who sought treatment for symptoms of depression between the baseline and the 18 month survey population. Secondary outcomes were whether the distribution of coverage was equitable, the type of services sought, and mental health literacy.Findings 1887 participants completed the 18 month survey interview between Sept 18, and Oct 8, 2015. The contact coverage for current depression was six-times higher in the 18 month survey population (27.2%, 95% CI 21.4-33.7) than in the baseline survey population (4.3%, 1.5-7.1). Contact coverage was equitably distributed across sex, education, income, religion, and caste. Most providers consulted for care were general physicians. We observed significant improvements in a range of mental health literacy indicators, for example, conceptualisation of depression as a mental health problem and the intention to seek care for depression.Interpretation A grass-roots community-based programme in rural India was associated with substantial increase in equitable contact coverage for depression and improved mental health literacy. It is now crucially important to translate this knowledge into real-world practice by scaling-up this programme through the National Mental Health Programme in India.