The onset and duration of benefit from counselling by minimally trained counsellors on anxiety and depression in women

Abstract

Objective: To assess the onset and duration of benefit of counselling by minimally trained community counsellors on level of anxiety and/or depression in women of their own community.

Method: A randomized controlled trial for assessing the effectiveness of 4 and 8 weeks of counselling by minimally trained community women in reducing the levels of anxiety and depression was carried out in a lower middle class, semi-urban community in Karachi, Pakistan. In the baseline survey, 366 anxious and/or depressed women were identified and randomized to intervention and control arms. The intervention arm was re-screened for anxiety and depression after 4 and 8 weeks of counselling and again 8 weeks after the last counselling session. As the results showed a significant benefit in the intervention arm, for ethical reasons the controls were also counselled; and were screened in the same way. This study is a sub-analysis from the RCT specifically looking at the onset and the duration of benefit.

Results: A significant reduction in the mean scores of both the groups was found after 4 weeks of counselling which further improved at 8 weeks. The gradient of improvement was steeper at 4 weeks. At 8 weeks post counselling some loss of effect was detected but the levels still remained below the initial mean score.

Conclusion: This study indicates that literate women from semi urban communities can be trained as counsellors and their counselling can lead to a significant benefit in just 4 counselling sessions of 1 hour each, and could last at least till 8 weeks after the last session. Keeping in view the current high prevalence, the available facilities for treatment and the stigma attached to psychiatric treatment in our communities; this modality of intervention at the PHC level could be an alternative strategy for the management of depression.