Lay interventions for depression and drinking

Brief psychological interventions delivered by lay counsellors in primary care were effective and cost-effective for patients with depression and harmful drinking in India, according to two studies in PLOS Medicine by Vikram Patel of Harvard Medical School, USA, and colleagues from the London School of Hygiene & Tropical Medicine, London, UK and Sangath, India. The authors have previously reported the effectiveness of the two interventions, Healthy Activity Programme (HAP) and Counselling for Alcohol Problems (CAP), at 3 months; however, the longer-term benefits of the interventions were previously unknown.

In the first trial, 493 adult primary health care attendees with moderately severe or severe depression were randomly assigned to either the HAP treatment plus enhanced usual care (EUC), or enhanced usual care (EUC) alone. The researchers found that HAP participants maintained the benefits they showed at the end of treatment through the 12-month period, with significantly lower symptom severity scores (adjusted mean difference in BDI-II: ?4.45) and higher rates of remission (PHQ-9 score < 5: 63% versus 48%) than participants who received EUC alone.

In the second trial, 377 adult male primary health care attendees with harmful drinking were randomly assigned to either the CAP treatment plus EUC, or EUC alone. The researchers found that CAP participants maintained the gains they showed at the end of treatment through the 12-month period, with higher remission rates (AUDIT score < 8: 54.3% versus 31.9%) and a greater proportion reporting no alcohol consumption in the past 14 days (45.1% versus 26.4%), compared with individuals who received EUC alone.

Both HAP and CAP were likely to be cost-effective, and could even save money if productivity costs were taken into account.

The authors say "We have provided the first evidence that two brief psychological therapies targeting the two leading mental health related causes of the global burden of disease, delivered by the same lay counsellor in routine primary care, to patients who had never received such therapies before, can lead to sustained improvements in health over one year, and that the investments made in providing this intervention is excellent value for money. Given the enormous economic and social consequences of untreated depression and harmful drinking, the moral imperative is for governments to scale up these treatments globally."