Developing a Depression Care Model for the Hill Tribes: A Family- and Community-Based Participatory Research

A high prevalence of depression has been detected among individuals from the hill tribes in Thailand. However, there are no proper interventions to address this problem. Using a community-based participatory research (CBPR) design, the study team developed a model of depression care for this population. The study involved 45 people in the model development and 65 people in the model testing, who were patients, family members, village health volunteers (VHVs), community and religious leaders, healthcare personnel, NGOs, and local administrative staff. The model development was divided into three phases: understanding the current situation of depression and care, model development, and evaluation of its effectiveness using psychological and relevant outcomes. Questionnaires, observations, focus groups, and in-depth interviews were used for data collection, and content analysis was employed for qualitative data. The Wilcoxon signed-rank test was used to analyze changes in VHVs' knowledge and skills before and after training. The resulting model, “SMILE,” consists of stakeholders' readiness (S), external and internal motivations (M), interpersonal relationship (I), life and community assets (L), and empowerment (E). VHVs underwent training on the model, and after training, their knowledge increased significantly from 3.50 ± 1.14 to 8.28 ± 0.81 (p < 0.001). Moreover, their basic counselling and depression screening skills showed improvement from 3.39 ± 1.23 to 7.64 ± 3.76 (p < 0.001). The developed model can be applied to other hill tribe communities in Northern Thailand to improve depression care.