Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care

Authors: Camila T. Matsuzaka, Milton Wainberg, Andrea Norcini Pala, Elis V. Hoffmann, Bruno M. Coimbra, Rosaly F. Braga, Annika C. Sweetland, Marcelo F. Mello

Published in: BMC Psychiatry | Issue 1/2017

Login to get access

Abstract

Background

Task shifting approaches (rational redistribution of tasks among health workforce teams) to train lay professionals to assist with integrating mental health treatment in primary care has been recommended to close the mental health treatment gap for depression in low- and middle-income countries. This study aims to examine the a new model for depression care in a low-resource environment compared to enhanced treatment at usual (E-TAU).

Methods

We trained non-specialist community health workers (local lay employees of the public health system) to provide Interpersonal Counseling (IPC) to treat depressive symptoms in the Brazilian, São Paulo city, family health strategy (FHS). We conducted a randomized controlled trial involving 86 patients with a current major depressive disorder or dysthymia (based on DSM-IV) recruited from an FHS clinic. Participants were randomized to IPC intervention (n = 43) or E-TAU (n = 43). Participants allocated to IPC received 3–4 sessions provided by community health workers; research psychologists followed the E-TAU participants to facilitate their referral to specialized mental health care within the public system. Reduction of depressive symptoms was assessed using the Hamilton Rating Scale (HDRS-17) and the Patient Health Questionnaire (PHQ-9); minor psychiatric symptomatology (including depression, anxiety and somatoform symptoms) were measured using the Self Reporting Questionnaire (SRQ); and functioning was measured by the Clinical Global Impression Scale over a 2-month period.

Results

Intention-to-treat analysis showed significant improvement on symptoms for both groups over 2 months, without significant differences between them. Per-protocol analysis showed significant better HDRS-17 outcomes for the IPC group.

Conclusions

Training non-specialist community health workers in low- and middle-income countries to provide IPC could be a successful strategy in reducing the burden of depression and also potentially a low-cost and effective alternative to specialist-led services that might not be possible in low income settings.

Trial registration

Brazilian Clinical Trials, number RBR-5qhmb5 (trial url: http://​www.​ensaiosclinicos.​gov.​br/​rg/​RBR-5qhmb5/​), retrospectively registered after May 1, 2013.
Literature
1.
Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJ, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10(11):e1001547.CrossRefPubMedPubMedCentral
2.
3.
4.
Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58(1):55–61.CrossRefPubMed
5.
Craven MA, Bland R. Depression in primary care: current and future challenges. Can J Psychiatr. 2013;58(8):442–8.CrossRef
6.
Mark TL, Levit KR, Buck JA. Datapoints: psychotropic drug prescriptions by medical specialty. Psychiatric Serv. 2009;60(9):1167.CrossRef
7.
8.
Raue PJ, Schulberg HC, Heo M, Klimstra S, Bruce ML. Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study. Psychiatric Serv. 2009;60(3):337–43.CrossRef
9.
10.
van Schaik DJ, Klijn AF, van Hout HP, van Marwijk HW, Beekman AT, de Haan M, et al. Patients' preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry. 2004;26(3):184–9.CrossRefPubMed
11.
Gelenberg AJ, Freeman MP, Markowitz JC, Rosenbaum JF, Thase ME, Trivedi MH, Van Rhoads RS, Reus VI, J Raymond DePaulo Jr M, Fawcett JA. Practice guideline for the treatment of patients with major depressive disorder third edition. Am J Psychiatry. 2010;167(10):1.
12.
Depression: the NICE guideline on the treatment and management of depression in adults. National Institute for Health and Clinical Excellence 2009.
13.
Mental Health Gap Intervention Guide. World Health Organization 2010.
14.
Macinko J, Harris MJ. Brazil's family health strategy--delivering community-based primary care in a universal health system. N Engl J Med. 2015;372(23):2177–81.CrossRefPubMed
15.
Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778–97.CrossRefPubMed
16.
Pereira MA, Barbieri L, de Paula VP, Franco Mdos S. Mental health in the family health program: the conceptions of community agents about mental illness. Rev Escola Enfermagem U S P. 2007;41(4):567–72.CrossRef
17.
de Barros MM, Chagas MI, Dias MS. Knowledge and practices of the community health agent in the universe of mental disorder. Ciencia Saude Coletiva. 2009;14(1):227–32.CrossRefPubMed
18.
Waidman MA, da Costa B, Paiano M. Community health Agents' perceptions and practice in mental health. Rev Escola Enfermagem U S P. 2012;46(5):1170–7.CrossRef
19.
Organization WH. Treat train retain. Task shifting: global recommendations and guidelines. Geneva: WHO; 2008.
20.
Mutamba BB, van Ginneken N, Smith Paintain L, Wandiembe S, Schellenberg D. Roles and effectiveness of lay community health workers in the prevention of mental, neurological and substance use disorders in low and middle income countries: a systematic review. BMC Health Serv Res. 2013;13:412.CrossRefPubMedPubMedCentral
21.
Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T, Ferrari AJ, Hyman S, Laxminarayan R, Levin C et al: Addressing the burden of mental, neurological, and substance use disorders: key messages from disease control priorities, 3rd edition. Lancet 2015.
22.
Cuijpers P, Geraedts AS, van Oppen P, Andersson G, Markowitz JC, van Straten A. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011;168(6):581–92.CrossRefPubMedPubMedCentral
23.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376(9758):2086–95.CrossRefPubMedPubMedCentral
24.
Weissman MM, Hankerson SH, Scorza P, Olfson M, Verdeli H, Shea S, et al. Interpersonal counseling (IPC) for depression in primary care. Am J Psychother. 2014;69(4):359–83.
25.
Judd FK, Piterman L, Cockram AM, McCall L, Weissman MM. A comparative study of venlafaxine with a focused education and psychotherapy program versus venlafaxine alone in the treatment of depression in general practice. Hum Psychopharmacol. 2001;16(5):423–8.CrossRefPubMed
26.
Menchetti M, Bortolotti B, Rucci P, Scocco P, Bombi A, Berardi D. Depression in primary care: interpersonal counseling vs selective serotonin reuptake inhibitors. The DEPICS study. A multicenter randomized controlled trial. Rationale and design. BMC Psychiatry. 2010;10:97.CrossRefPubMedPubMedCentral
27.
Menchetti M, Rucci P, Bortolotti B, Bombi A, Scocco P, Kraemer HC, et al. Moderators of remission with interpersonal counselling or drug treatment in primary care patients with depression: randomised controlled trial. Br J Psychiatry. 2014;204(2):144–50.CrossRefPubMed
28.
Klerman GL, Budman S, Berwick D, Weissman MM, Damico-White J, Demby A, et al. Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care. Med Care. 1987;25(11):1078–88.CrossRefPubMed
29.
Mossey JM, Knott KA, Higgins M, Talerico K. Effectiveness of a psychosocial intervention, interpersonal counseling, for subdysthymic depression in medically ill elderly. J Gerontol A Biol Sci Med Sci. 1996;51(4):M172–8.CrossRefPubMed
30.
Holmes A, Hodgins G, Adey S, Menzel S, Danne P, Kossmann T, et al. Trial of interpersonal counselling after major physical trauma. Aust N Z J Psychiatry. 2007;41(11):926–33.CrossRefPubMed
31.
Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007;56(1):44–53.CrossRefPubMed
32.
Badger T, Segrin C, Meek P, Lopez AM, Bonham E. A case study of telephone interpersonal counseling for women with breast cancer and their partners. Oncol Nurs Forum. 2004;31(5):997–1003.CrossRefPubMed
33.
Badger T, Segrin C, Meek P, Lopez AM, Bonham E. Profiles of women with breast cancer: who responds to a telephone interpersonal counseling intervention. J Psychosoc Oncol. 2005;23(2–3):79–99.PubMed
34.
Badger T, Segrin C, Meek P, Lopez AM, Bonham E, Sieger A. Telephone interpersonal counseling with women with breast cancer: symptom management and quality of life. Oncol Nurs Forum. 2005;32(2):273–9.CrossRefPubMed
35.
Badger TA, Segrin C, Figueredo AJ, Harrington J, Sheppard K, Passalacqua S, et al. Psychosocial interventions to improve quality of life in prostate cancer survivors and their intimate or family partners. Qual Life Res. 2011;20(6):833–44.CrossRefPubMed
36.
Oranta O, Luutonen S, Salokangas RK, Vahlberg T, Leino-Kilpi H. The outcomes of interpersonal counselling on depressive symptoms and distress after myocardial infarction. Nordic journal of psychiatry. 2010;64(2):78–86.CrossRefPubMed
37.
Oranta O, Luutonen S, Salokangas RK, Vahlberg T, Leino-Kilpi H. The effects of interpersonal counselling on health-related quality of life after myocardial infarction. J Clin Nurs. 2011;20(23–24):3373–82.CrossRefPubMed
38.
Neugebauer R, Kline J, Bleiberg K, Baxi L, Markowitz JC, Rosing M, et al. Preliminary open trial of interpersonal counseling for subsyndromal depression following miscarriage. Depress Anxiety. 2007;24(3):219–22.CrossRefPubMed
39.
Neugebauer R, Kline J, Markowitz JC, Bleiberg KL, Baxi L, Rosing MA, et al. Pilot randomized controlled trial of interpersonal counseling for subsyndromal depression following miscarriage. J Clin Psychiatry. 2006;67(8):1299–304.CrossRefPubMed
40.
Menchetti M, Sighinolfi C, Di Michele V, Peloso P, Nespeca C, Bandieri PV, et al. Effectiveness of collaborative care for depression in Italy. A randomized controlled trial. Gen Hosp Psychiatry. 2013;35(6):579–86.CrossRefPubMed
41.
42.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33. quiz 34-57PubMed
43.
Weissman M, Verdeli H: Manual of interpersonal counseling (IPC). Revised; 2013.
44.
Chagas MH, Tumas V, Rodrigues GR, Machado-de-Sousa JP, Filho AS, Hallak JE, et al. Validation and internal consistency of patient health questionnaire-9 for major depression in Parkinson's disease. Age Ageing. 2013;42(5):645–9.CrossRefPubMed
45.
de Azevedo Marques JM, Zuardi AW. Validity and applicability of the Mini international neuropsychiatric interview administered by family medicine residents in primary health care in Brazil. Gen Hosp Psychiatry. 2008;30(4):303–10.CrossRefPubMed
46.
Lecrubier Y, Weiller E, Hergueta T, Amorim P, Bonora LI, Lépine JP, Sheehan D, Janavs J, Baker R, Sheehan KH et al: Mini international neuropsychiatric interview. Brazilian version 5.0.0 DSM-IV. 2002.
47.
Rizzo R, Piccinelli M, Mazzi MA, Bellantuono C, Tansella M. The personal health questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care. Psychol Med. 2000;30(4):831–40.CrossRefPubMed
48.
de Lima OF, Vilela Mendes A, Crippa JA, Loureiro SR. Study of the discriminative validity of the PHQ-9 and PHQ-2 in a sample of Brazilian women in the context of primary health care. Perspect Psychiatr Care. 2009;45(3):216–27.CrossRef
49.
50.
Rush AJ, First MB, Blacker D. Handbook of psychiatric measures. Washington: American Psychiatric Publishing, Inc.; 2008.
51.
Ramos de Carvalho TF, Garcia Lima M, Soares Azevedo RC, Caetano D. Tradução do inglês para o português do Questionário de Auto-avaliação da Escala de Hamilton para a depressão. Jornal Brasileiro de Psiquiatria. 1993;42(5):255–60.
52.
Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry. 1991;48(9):851–5.CrossRefPubMed
53.
Hollon SD, DeRubeis RJ, Fawcett J, Amsterdam JD, Shelton RC, Zajecka J, et al. Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA psychiatry. 2014;71(10):1157–64.CrossRefPubMedPubMedCentral
54.
Harding TW, de Arango MV, Baltazar J, Climent CE, Ibrahim HH, Ladrido-Ignacio L, et al. Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychol Med. 1980;10(2):231–41.CrossRefPubMed
55.
Iacoponi E, Mari JJ. Reliability and factor structure of the Portuguese version of self-Reporting questionnaire. Int J Soc Psychiatry. 1989;35(3):213–22.CrossRefPubMed
56.
Guy W. Clinical global impressions-ECDEU Asessment manual psychopharmacology (DHEW Publ no ADM 76–338). In.: Revised. Rockville MD: US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH; 1976.
57.
Fossaluza V, Diniz JB, de Bragança PB, Miguel EC, de Bragança Pereira CA. Sequential allocation to balance prognostic factors in a psychiatric clinical trial. Clinics. 2009;64(6):511–8.CrossRefPubMedPubMedCentral
58.
Corp I: IBM SPSS statistics for windows. In., version 22.0 edn; 2015.
59.
Muthen B, Asparouhov T. Bayesian structural equation modeling: a more flexible representation of substantive theory. Psychol Methods. 2012;17(3):313–35.CrossRefPubMed
60.
Feingold A. A regression framework for effect size assessments in longitudinal modeling of group differences. Rev Gen Psychol. 2013;17(1):111–21.CrossRefPubMed
61.
Stewart JW, McGrath PJ, Blondeau C, Deliyannides DA, Hellerstein D, Norris S, et al. Combination antidepressant therapy for major depressive disorder: speed and probability of remission. J Psychiatr Res. 2014;52:7–14.CrossRefPubMed
62.
Lambert MJ, Hatch DR, Kingston MD, Edwards BC. Zung, Beck, and Hamilton rating scales as measures of treatment outcome: a meta-analytic comparison. J Consult Clin Psychol. 1986;54(1):54–9.CrossRefPubMed
63.
64.
Petersen I, Ssebunnya J, Bhana A, Baillie K. Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda. Int J Ment Heal Syst. 2011;5:8.CrossRef
Metadata
Title
Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care
Authors
Camila T. Matsuzaka
Milton Wainberg
Andrea Norcini Pala
Elis V. Hoffmann
Bruno M. Coimbra
Rosaly F. Braga
Annika C. Sweetland
Marcelo F. Mello
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1379-y

Other articles of this Issue 1/2017

BMC Psychiatry 1/2017 Go to the issue

Research article

A systematic review of screening instruments for depression for use in antenatal services in low resource settings

Research article

Examining differences in cognitive and affective theory of mind between persons with high and low extent of somatic symptoms: an experimental study

Research article

Secondary distress in violence researchers: a randomised trial of the effectiveness of group debriefings

Research article

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Research article

Mental health literacy among pediatric hospital staff in the United Arab Emirates

Case report

A case of GABAR antibodies in schizophrenia