Identification and treatment of depression and anxiety symptoms
depression, AMD, anxiety
SECONDARY, DISORDERS
The champions’ case detection rate (accurate identification of common mental disorders) as compared to actual GHQ-12 scores (cut-off score of 3 or more) was 58% for all the clusters and periods in the intervention condition.Data on counseling sessions attended was available for 89% (N = 543) of the intervention sample. Participants attended a mean of 5.2 (SD = 1.2) and a median of 6 (Q1, Q3: 5, 6) sessions. At the 3-month follow-up, 2% (n = 11) of participants were referred to public health services (either the PHC or the DMHP) by the champions. In the control group, 52% (n = 244) were similarly referred to public health services.PHQ-9 depression scores were significantly lower among intervention condition participants compared to those in the control condition, with an adjusted mean difference (AMD) of -1.8 (95%CI: -3.0 to -0.6; effect size 0.3) at 3 months and AMD of -4.4 (95% CI: -5.7 to -3.0; effect size 0.6) at 8 months (p<0.05). PHQ-9 scores among intervention condition participants changed from moderate depression scores of 10–12 at baseline to mild depression scores of 5–9 (range of adjusted means) at 8-month follow-up (p<0.05). On anxiety symptoms as measured by the GAD-7, the intervention group did not show improvement (AMD: -0.8 (-1.9 to 0.3; effect size 0.1) at 3 months whereas showed significant improvement -3.5 (-4.6 to -2.2; effect size 0.5) at 8 months follow-up (p<0.05). Among participants in the intervention condition, GAD scores changed from moderate anxiety symptoms at baseline to mild to none at 8-month follow-up. There was no significant improvement at the 3-month follow-up on functioning scores, as assessed by the WHO-DAS whereas showed improvement at 8 month (AMD of -3.6 (95%CI: -5.3 to -2.0; effect size 0.4). WHO-DAS scores increased significantly at 8 months follow-up in intervention participants with AMD of -3.2 (-5.9 to -0.4 effect size 0.2), -3.0 (-4.5 to -1.4; effect size 0.3) and -2.8 (-4.7 to -0.9; effect size 0.3) for W1, W2, W3 respectively. Compared to baseline, SRQ scores improved at 3 month (AMD -1.7 (95%CI: -2.7 to -0.6; effect size 0.2) and at 8-month follow-up (AMD: -3.6 (95%CI: -4.9 to -2.3; effect size 0.4). Health-related quality of life assessed by EQ-5D, showed significant improvement 0.06 (95%CI: 0.03 to 0.1; effect size 0.3) at 8 month follow-up (On the Client Satisfaction Questionnaire, the average score was 24.0 ±5.2 demonstrating a high satisfaction level with Considering the loss to follow-up rate was greater than 10% at the end of 3 months follow-up and 8 months follow-up, baseline measures between the participants who continued the intervention and those lost to follow-up in each condition were analyzed separately. For data at 3 months follow-up in the intervention condition, no significant differences were observed between the baseline values on the GHQ-12, PHQ-9, GAD-7, and SRQ-20) among participants who remained in the intervention compared to those lost to follow-up. In the control condition, the baseline values were significantly higher among participants who remained in the intervention (p<0.05).At 8-month follow-up, mean baseline values of measures were similar (p>0.05) in those who remained in the trial versus those lost to follow-up in both control and intervention conditions.Moreover, the power to detect observed differences between the intervention and control condition remained at 80% at the end of 3 months. For an 8-month follow-up, data were considered until period 4 so based on the observed difference with the sample size of 276 in intervention and 217 in control with 3 steps and 48 clusters the power remained 80%.The overall results across primary and secondary outcomes demonstrate that the intervention was effective, with effects sustained and improving over time, including at 8 months follow-up after counseling sessions ended.