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. 2020 Feb 12:14:8.
doi: 10.1186/s13033-020-00342-1. eCollection 2020.

Is supported self-management for depression effective for adults in community-based settings in Vietnam?: a modified stepped-wedge cluster randomized controlled trial

Jill K Murphy  1 , Hui Xie  2 , Vu Cong Nguyen  3 , Leena W Chau  4 , Pham Thi Oanh  3 , Tran Kieu Nhu  3 , John O'Neil  4 , Charles H Goldsmith  2 , Nguyen Van Hoi  5 , Yue Ma  6 , Hayami Lou  4 , Wayne Jones  4 , Harry Minas  7
Affiliations

Is supported self-management for depression effective for adults in community-based settings in Vietnam?: a modified stepped-wedge cluster randomized controlled trial

Jill K Murphy et al. Int J Ment Health Syst. .

Abstract

Background: This study tested the effectiveness of a supported self-management (SSM) intervention to reduce symptoms of depression among adults compared with enhanced treatment as usual in community-based and primary care settings in Vietnam.

Methods: The cluster randomized trial included 376 adults in 32 communes in eight provinces. Eligible participants scored > 7 on the SRQ-20 depression scale. Patients with severe symptoms were excluded and referred to tertiary care. Randomization took place at the commune level. The immediate intervention group included 16 communes with 190 participants and the delayed group included 16 communes with 186 participants. Participants in communes randomized to the immediate intervention group received a two-month course of SSM, consisting of a workbook and supportive coaching. Those in communes randomized to the delayed group received enhanced treatment as usual and, for ethical purposes, received the SSM intervention after 4 months. The primary outcome is the effect of SSM on reduction in depression scores as indicated by a reduced proportion of participants with SRQ-20 scores > 7 at 2 months after commencement of SSM intervention. Blinding was not possible during intervention delivery but outcome assessors were blinded. Analysis was intention-to-treat.

Results: At 2 months, 26.4% of the intervention group and 42.3% of the delayed group had SRQ-20 scores > 7. The adjusted odds ratio of having depression between the intervention and control was 0.42 (p < 0.0001), 95% CI (0.28, 0.63). Receiving the intervention thus reduces the odds of having depression by 58%, compared with receiving the control after 2 months of treatment. No adverse events were reported.

Conclusions: Results suggest that SSM is effective for decreasing depression symptoms among adults in community-based settings in Vietnam.Trial Registration This trial is registered at ClinicalTrials.gov, number NCT03001063.

Keywords: Depression; Supported self-management; Task-sharing; Vietnam.

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Conflict of interest statement

Competing interestsNVH is a representative of MOLISA, which provided matched funding for the study. He did not influence the study design, data collection or interpretation of results. All other authors have no conflict to declare.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
CONSORT flow diagram
Fig. 3
Fig. 3
The overall effect sizes and 95% cis in Period 1
See this image and copyright information in PMC

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