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Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti

BACKGROUND: There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such int...

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Autores principales: Rose, Alexandra L., McBain, Ryan, Wilson, Jesse, Coleman, Sarah F., Mathieu, Emmanuel, Fils-Aimé, J. Reginald, Affricot, Emmeline, Thérosmé, Tatiana, Dubuisson, Wilder, Eustache, Eddy, Smith, Stephanie L., Raviola, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192595/
https://www.ncbi.nlm.nih.gov/pubmed/34168884
http://dx.doi.org/10.1017/gmh.2021.17
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author Rose, Alexandra L.
McBain, Ryan
Wilson, Jesse
Coleman, Sarah F.
Mathieu, Emmanuel
Fils-Aimé, J. Reginald
Affricot, Emmeline
Thérosmé, Tatiana
Dubuisson, Wilder
Eustache, Eddy
Smith, Stephanie L.
Raviola, Giuseppe
author_facet Rose, Alexandra L.
McBain, Ryan
Wilson, Jesse
Coleman, Sarah F.
Mathieu, Emmanuel
Fils-Aimé, J. Reginald
Affricot, Emmeline
Thérosmé, Tatiana
Dubuisson, Wilder
Eustache, Eddy
Smith, Stephanie L.
Raviola, Giuseppe
author_sort Rose, Alexandra L.
collection PubMed
description BACKGROUND: There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake. METHODS: For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose. RESULTS: 306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0–39), controlling for sex, age, and days in treatment (95% CI −1.478 to −0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms. CONCLUSIONS: Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.
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spelling pubmed-81925952021-06-23 Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti Rose, Alexandra L. McBain, Ryan Wilson, Jesse Coleman, Sarah F. Mathieu, Emmanuel Fils-Aimé, J. Reginald Affricot, Emmeline Thérosmé, Tatiana Dubuisson, Wilder Eustache, Eddy Smith, Stephanie L. Raviola, Giuseppe Glob Ment Health (Camb) Original Research Paper BACKGROUND: There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake. METHODS: For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose. RESULTS: 306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0–39), controlling for sex, age, and days in treatment (95% CI −1.478 to −0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms. CONCLUSIONS: Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings. Cambridge University Press 2021-05-31 /pmc/articles/PMC8192595/ /pubmed/34168884 http://dx.doi.org/10.1017/gmh.2021.17 Text en © The Author(s) 2021 https://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, provided the original article is properly cited.
spellingShingle Original Research Paper
Rose, Alexandra L.
McBain, Ryan
Wilson, Jesse
Coleman, Sarah F.
Mathieu, Emmanuel
Fils-Aimé, J. Reginald
Affricot, Emmeline
Thérosmé, Tatiana
Dubuisson, Wilder
Eustache, Eddy
Smith, Stephanie L.
Raviola, Giuseppe
Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti
title Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti
title_full Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti
title_fullStr Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti
title_full_unstemmed Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti
title_short Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti
title_sort evaluating clinical outcomes of routinely delivered task-shared care for depression in rural haiti
topic Original Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192595/
https://www.ncbi.nlm.nih.gov/pubmed/34168884
http://dx.doi.org/10.1017/gmh.2021.17
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