TY  - JOUR
PY  - 2021//
TI  - An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme
JO  - Trials
A1  - Daniel, Mercian
A1  - Maulik, Pallab K.
A1  - Kallakuri, Sudha
A1  - Kaur, Amanpreet
A1  - Devarapalli, Siddhardha
A1  - Mukherjee, Ankita
A1  - Bhattacharya, Amritendu
A1  - Billot, Laurent
A1  - Thornicroft, Graham
A1  - Praveen, Devarsetty
A1  - Raman, Usha
A1  - Sagar, Rajesh
A1  - Kant, Shashi
A1  - Essue, Beverley
A1  - Chatterjee, Susmita
A1  - Saxena, Shekhar
A1  - Patel, Anushka
A1  - Peiris, David
SP  - e179
EP  - e179
VL  - 22
IS  - 1
N2  - BACKGROUND: Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75-95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed. <br><br>METHODS: We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived-a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation. EXPECTED OUTCOMES: The primary study outcome is the difference in mean behaviour scores at 12 months in the combined 'high-risk' and 'non-high-risk' cohort and the mean difference in PHQ-9 scores at 12 months in the 'high-risk' cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations. SIGNIFICANCE: The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings. TRIAL REGISTRATION: Clinical Trial Registry India CTRI/2018/08/015355. Registered on 16 August 2018.<p />  <p>Language: en</p>
LA  - en
SN  - 1745-6215
UR  - http://dx.doi.org/10.1186/s13063-021-05136-5
ID  - ref1
ER  -