Management of depression by lay primary health workers in Nigeria

22 May, 2019

Dear HIFA colleagues,

Extracts below. Full text here: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30197-4/fulltext

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

Bolanle Adeyemi Ola, Olayinka Atilola

Open Access Published: May 13, 2019 The Lancet Global Health

DOI: https://doi.org/10.1016/S2214-109X(19)30197-4

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30197-4/fulltext

In the 2005 World Mental Health survey, only about 17% of people with a 12-month history of diagnosable depression in Nigeria had received any treatment. This dire situation is sustained by various factors, including an extreme shortage of specialist mental health professionals, especially in rural areas where the majority of Nigerians live; insufficient mental health knowledge and skill among non-specialist physicians superintending over the few community health facilities attended by most people with mental health morbidities; and mental health policy that is absent, poorly conceived, or not driven by evidence-based interventions. In the absence of training resources to provide enough specialist manpower to bridge the huge gap in depression treatment, enhancement of the skill of primary care physicians in Nigeria has been the intervention model of choice, showing some promise...

In The Lancet Global Health, Oye Gureje and colleagues report [http://dx.doi.org/10.1016/S2214-109X(19)30148-2] the results of a cluster-randomised trial designed to establish whether two different models of task-shifted intervention delivered by lay health workers in Nigeria could yield similar outcomes in patients with moderate to severe depression. Patients in the intervention group received a 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. Those in the control group received unstructured usual care, enhanced with mhGAP-IG-based training of providers in recognition of depression and basic psychological and pharmacological interventions for depression. In both groups, similar proportions of patients showed remission of depression... These findings provide further evidence that task-shifted interventions for depression delivered by lay health workers are effective...

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...

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

http://www.hifa.org/projects/community-health-workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org