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Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal

BACKGROUND. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress...

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Autores principales: Markkula, N., Lehti, V., Adhikari, P., Peña, S., Heliste, J., Mikkonen, E., Rautanen, M., Salama, E., Guragain, B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669965/
https://www.ncbi.nlm.nih.gov/pubmed/31391947
http://dx.doi.org/10.1017/gmh.2019.15
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author Markkula, N.
Lehti, V.
Adhikari, P.
Peña, S.
Heliste, J.
Mikkonen, E.
Rautanen, M.
Salama, E.
Guragain, B.
author_facet Markkula, N.
Lehti, V.
Adhikari, P.
Peña, S.
Heliste, J.
Mikkonen, E.
Rautanen, M.
Salama, E.
Guragain, B.
author_sort Markkula, N.
collection PubMed
description BACKGROUND. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. METHODS. A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35–60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. RESULTS. A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4–50.4)]. The difference in BDI scores at T2 between PSY and EUC was −7.43 (95% CI −9.71 to −5.14). CONCLUSIONS. Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.
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spelling pubmed-66699652019-08-07 Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal Markkula, N. Lehti, V. Adhikari, P. Peña, S. Heliste, J. Mikkonen, E. Rautanen, M. Salama, E. Guragain, B. Glob Ment Health (Camb) Original Research Paper BACKGROUND. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. METHODS. A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35–60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. RESULTS. A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4–50.4)]. The difference in BDI scores at T2 between PSY and EUC was −7.43 (95% CI −9.71 to −5.14). CONCLUSIONS. Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings. Cambridge University Press 2019-07-16 /pmc/articles/PMC6669965/ /pubmed/31391947 http://dx.doi.org/10.1017/gmh.2019.15 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by/4.0/ This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited
spellingShingle Original Research Paper
Markkula, N.
Lehti, V.
Adhikari, P.
Peña, S.
Heliste, J.
Mikkonen, E.
Rautanen, M.
Salama, E.
Guragain, B.
Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal
title Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal
title_full Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal
title_fullStr Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal
title_full_unstemmed Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal
title_short Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal
title_sort effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural nepal
topic Original Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669965/
https://www.ncbi.nlm.nih.gov/pubmed/31391947
http://dx.doi.org/10.1017/gmh.2019.15
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