Depression, Help-Seeking Behavior
Conditions
Keywords
Depression, Help-seeking behaviour, Demand side barriers, Stigma, Nepal
Brief summary
Depression is a serious public health concern worldwide due to its high prevalence rate and significant emotional and financial burden on individuals, their families, and society. There is a substantial gap between the number of people in need of treatment for depression and those who actually receive it. The recent World Health Organization (WHO) World Mental Health Survey revealed that 86.3% of people with anxiety, mood, or substance disorders in lower-middle-income countries did not receive any treatment in the past 12 months. This study aims to evaluate a community-based intervention to address demand-side barriers by improving mental health literacy, dispelling myths and misconceptions about depression, changing negative attitudes towards depression care, and promoting help-seeking behavior.
Detailed description
It is estimated that more than 300 million people worldwide are experiencing depression, which is about 4.4% of the world's population. Despite the availability of evidence-based treatment, it is reported that 86.3% of people with anxiety, mood, or substance disorders in lower-middle-income countries received no treatment in the past 12 months. Among people who receive treatment for depression, only one out of 27 persons receive minimally adequate treatment in low- and middle-income countries (LMICs). Despite being the major contributor to the overall global burden of disease, depression receives less or no health priority in many LMICs, where more than 80% of people with depression reside. This study will take place in two municipalities in Morang district, eastern Nepal. Female Community Health Volunteers will administer the intervention to individuals identified with depression using the locally developed and validated Community Informant Detection Tool (CIDT). Participants who receive the intervention will be followed up after one month to evaluate their help-seeking behavior (primary outcome) and after three months to assess treatment adherence, a secondary objective of the study. The study will assess the effects and interactions of four intervention components (information on depression, available treatments, stigma and myths, and life transformation experiences) on the primary outcome of help-seeking behavior and secondary outcomes such as treatment adherence. The severity of depression symptoms will be assessed using the validated PHQ-9, and knowledge and attitudes toward depression will be evaluated to assess mediation effects.
Interventions
BEHAVIORALGain-Life (Give informAtIoN to transform Life)
The Gain Life intervention comprises four components: (i) information about depression, (ii) awareness of available services, (iii) stigma reduction through dispelling myths and facts about depression, and (iv) a life transformation story. The first module aims to raise awareness about depression, with a particular focus on its causes, manifestations, and the potential negative consequences of untreated depression. The second component includes the types of services offered, costs, distance to service providers, and operating hours. The third component address stigma and misconceptions surrounding depression by addressing the root causes of stigma, dispelling myths, and providing accurate information about depression. The final module of the Gain Life intervention features recovery stories of individuals who have overcome depression. This module includes two 8-minute video stories of individuals who successfully recovered from depression.
Sponsors
Transcultural Psychosocial Organization Nepal
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Masking description
Data collectors will be blinded to the allocation of the participants to different groups.
Intervention model description
The unit of randomization will be study participants who are identified with depression by FCHVs. Each participant will be randomized into one of eight groups using a computer-generated random number.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* being an adult aged 18 or older residing in Kanepokhari Rural Municipality or Patharisanischare Municipality, * those detected through the CIDT * providing consent for participation * being proficient in speaking and understanding Nepali
Exclusion criteria
* people with already receiving mental health services * having severe mental illness\] * participants below the age of 18 years, * participants outside of Kanepokhari and Pathari-sanischare Municipality
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in help-seeking behaviour for depression care | In one month | The primary outcome of this study is change in help-seeking behavior for depression care, defined by the proportion of participants who receive treatment from a health provider. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Treatment adherence for depression | In three month | The secondary outcome of the study is treatment adherence for depression defined by the proportion of people who continue treatment for three months. |
| Change in symptom severity of depression | In three month | The secondary outcome of the study is change in symptom severity of depression assessed by patient health questionnaire (PHQ-9). The total score of PHQ9 can range from 0 to 27, with higher scores indicating greater severity of depression |
| Change in knowledge, attitude and perception | In three months | The secondary outcome of this study is to measure changes in knowledge, attitudes, and perceptions related to depression using a questionnaire developed based on the intervention content. The results will be presented based on the number of correct responses (yes and no) for each item of each scale separately. Number of greater "Yes" response indicates greater knowledge in depression, and positive attitude in help-seeking. |
Countries
Nepal
Outcome results
None listed