Randomized Controlled Trial

. 2016 Apr;208(4):381-8.

doi: 10.1192/bjp.bp.114.161075. Epub 2015 Oct 22.

The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: systematic development and randomised evaluation

Neerja Chowdhary¹, Arpita Anand¹, Sona Dimidjian¹, Sachin Shinde¹, Benedict Weobong¹, Madhumitha Balaji¹, Steven D Hollon¹, Atif Rahman¹, G Terence Wilson¹, Helena Verdeli¹, Ricardo Araya¹, Michael King¹, Mark J D Jordans¹, Christopher Fairburn¹, Betty Kirkwood¹, Vikram Patel²

Affiliations

¹ Neerja Chowdhary, MD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Arpita Anand, MSc, MA, Sangath, Goa, India; Sona Dimidjian, PhD, University of Boulder, Boulder, Colorado, USA; Sachin Shinde, MPA, Sangath, Goa, India; Benedict Weobong, PhD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Madhumitha Balaji, MSc, Sangath, Goa, India; Steve D. Hollon, PhD, Vanderbilt University, Nashville, Tennessee, USA; Atif Rahman, PhD, University of Liverpool, Liverpool, UK; G. Terence Wilson, PhD, Rutgers University, New Brunswick, New Jersey, USA; Helena Verdeli, PhD, Teachers College, Columbia University, New York, USA; Ricardo Araya, PhD, London School of Hygiene & Tropical Medicine, London, UK; Michael King, PhD, University College, London, UK; Mark J. D. Jordans, PhD, King's College, London, UK; Christopher Fairburn, PhD, Oxford University, Oxford, UK; Betty Kirkwood, PhD, London School of Hygiene & Tropical Medicine, London, UK; Vikram Patel, FMedSi, Sangath, Goa, Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India and London School of Hygiene & Tropical Medicine, London, UK.
² Neerja Chowdhary, MD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Arpita Anand, MSc, MA, Sangath, Goa, India; Sona Dimidjian, PhD, University of Boulder, Boulder, Colorado, USA; Sachin Shinde, MPA, Sangath, Goa, India; Benedict Weobong, PhD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Madhumitha Balaji, MSc, Sangath, Goa, India; Steve D. Hollon, PhD, Vanderbilt University, Nashville, Tennessee, USA; Atif Rahman, PhD, University of Liverpool, Liverpool, UK; G. Terence Wilson, PhD, Rutgers University, New Brunswick, New Jersey, USA; Helena Verdeli, PhD, Teachers College, Columbia University, New York, USA; Ricardo Araya, PhD, London School of Hygiene & Tropical Medicine, London, UK; Michael King, PhD, University College, London, UK; Mark J. D. Jordans, PhD, King's College, London, UK; Christopher Fairburn, PhD, Oxford University, Oxford, UK; Betty Kirkwood, PhD, London School of Hygiene & Tropical Medicine, London, UK; Vikram Patel, FMedSi, Sangath, Goa, Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India and London School of Hygiene & Tropical Medicine, London, UK vikram.patel@lshtm.ac.uk.

PMID: 26494875
PMCID: PMC4816974
DOI: 10.1192/bjp.bp.114.161075

Randomized Controlled Trial

The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: systematic development and randomised evaluation

Neerja Chowdhary et al. Br J Psychiatry. 2016 Apr.

. 2016 Apr;208(4):381-8.

doi: 10.1192/bjp.bp.114.161075. Epub 2015 Oct 22.

Authors

Affiliations

¹ Neerja Chowdhary, MD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Arpita Anand, MSc, MA, Sangath, Goa, India; Sona Dimidjian, PhD, University of Boulder, Boulder, Colorado, USA; Sachin Shinde, MPA, Sangath, Goa, India; Benedict Weobong, PhD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Madhumitha Balaji, MSc, Sangath, Goa, India; Steve D. Hollon, PhD, Vanderbilt University, Nashville, Tennessee, USA; Atif Rahman, PhD, University of Liverpool, Liverpool, UK; G. Terence Wilson, PhD, Rutgers University, New Brunswick, New Jersey, USA; Helena Verdeli, PhD, Teachers College, Columbia University, New York, USA; Ricardo Araya, PhD, London School of Hygiene & Tropical Medicine, London, UK; Michael King, PhD, University College, London, UK; Mark J. D. Jordans, PhD, King's College, London, UK; Christopher Fairburn, PhD, Oxford University, Oxford, UK; Betty Kirkwood, PhD, London School of Hygiene & Tropical Medicine, London, UK; Vikram Patel, FMedSi, Sangath, Goa, Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India and London School of Hygiene & Tropical Medicine, London, UK.
² Neerja Chowdhary, MD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Arpita Anand, MSc, MA, Sangath, Goa, India; Sona Dimidjian, PhD, University of Boulder, Boulder, Colorado, USA; Sachin Shinde, MPA, Sangath, Goa, India; Benedict Weobong, PhD, Sangath, Goa, India and London School of Hygiene & Tropical Medicine, London, UK; Madhumitha Balaji, MSc, Sangath, Goa, India; Steve D. Hollon, PhD, Vanderbilt University, Nashville, Tennessee, USA; Atif Rahman, PhD, University of Liverpool, Liverpool, UK; G. Terence Wilson, PhD, Rutgers University, New Brunswick, New Jersey, USA; Helena Verdeli, PhD, Teachers College, Columbia University, New York, USA; Ricardo Araya, PhD, London School of Hygiene & Tropical Medicine, London, UK; Michael King, PhD, University College, London, UK; Mark J. D. Jordans, PhD, King's College, London, UK; Christopher Fairburn, PhD, Oxford University, Oxford, UK; Betty Kirkwood, PhD, London School of Hygiene & Tropical Medicine, London, UK; Vikram Patel, FMedSi, Sangath, Goa, Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India and London School of Hygiene & Tropical Medicine, London, UK vikram.patel@lshtm.ac.uk.

PMID: 26494875
PMCID: PMC4816974
DOI: 10.1192/bjp.bp.114.161075

Abstract

Background: Reducing the global treatment gap for mental disorders requires treatments that are economical, effective and culturally appropriate.

Aims: To describe a systematic approach to the development of a brief psychological treatment for patients with severe depression delivered by lay counsellors in primary healthcare.

Method: The treatment was developed in three stages using a variety of methods: (a) identifying potential strategies; (b) developing a theoretical framework; and (c) evaluating the acceptability, feasibility and effectiveness of the psychological treatment.

Results: The Healthy Activity Program (HAP) is delivered over 6-8 sessions and consists of behavioral activation as the core psychological framework with added emphasis on strategies such as problem-solving and activation of social networks. Key elements to improve acceptability and feasibility are also included. In an intention-to-treat analysis of a pilot randomised controlled trial (55 participants), the prevalence of depression (Beck Depression Inventory II ⩾19) after 2 months was lower in the HAP than the control arm (adjusted risk ratio = 0.55, 95% CI 0.32-0.94,P= 0.01).

Conclusions: Our systematic approach to the development of psychological treatments could be extended to other mental disorders. HAP is an acceptable and effective brief psychological treatment for severe depression delivered by lay counsellors in primary care.

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Conflict of interest statement

Declaration of interest

None.

Figures

**Fig. 1**
An overview of the psychological treatment development process.

**Fig. 2**
Modelling of intervention components and pathways to outcomes. HAP, Healthy Activity Program.

See this image and copyright information in PMC

Comment in

Challenges in developing feasible and cost-effective therapies for use in LMICs.
Naeem F, Rathod S, Khan NS, Ayub M. Naeem F, et al. Br J Psychiatry. 2016 Sep;209(3):263-4. doi: 10.1192/bjp.209.3.263a. Br J Psychiatry. 2016. PMID: 27587767 No abstract available.
Author's reply.
Patel V. Patel V. Br J Psychiatry. 2016 Sep;209(3):264. doi: 10.1192/bjp.209.3.264. Br J Psychiatry. 2016. PMID: 27587768 No abstract available.

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The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: systematic development and randomised evaluation

Affiliations

The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: systematic development and randomised evaluation

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Miscellaneous