Lay counsellors may help tackle depression in resource-poor settings

Trained lay counsellors can be effective at helping treat people who have depression and anxiety in public primary care facilities, according to a study published today in the Lancet.

Approximately one in five people attending primary health centres in low-income countries is believed to have a common mood disorder, such as anxiety and depression, but there are several obstacles to providing effective interventions in these settings. These obstacles include the lack of skilled health workers, the low recognition rate of the disorders by primary care doctors, the inadequate use of antidepressant drugs or psychosocial treatments, and a low adherence to treatments.

In a study funded by the Wellcome Trust, Professor Vikram Patel and colleagues at the Sangath Centre, Goa, India, and the London School of Hygiene and Tropical Medicine tested the effectiveness of an intervention led by lay health counsellors in primary care.

Adult patients in 24 groups took part in a cluster randomised trial at public and private primary care facilities in Goa. Some of the groups were assigned interventions provided by a trained lay health counsellor, supplemented by antidepressant drugs by the primary care physician for patients with moderate or severe disorders and monthly supervision by a mental health specialist.

The researchers found that in public facilities, 66 per cent of patients with depression or anxiety in the intervention group recovered within six months, compared to 43 per cent in the control group. In the private facilities, however, recovery rates were similar in the two groups, suggesting that the standard of care in the private clinics that took part in the study was already as high as that provided by the intervention.

In the paper, Professor Patel and colleagues write: "This evidence should be used to improve services for common mental disorders in settings for which mental health professionals are scarce."