Mixed Methods Implementation Evaluation of an Integrated Depression and Microfinance Program for Women in Vietnam
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Observational [Patient Registry]

Summary: 
      This is an implementation project to develop a model to support implementation of LIFE-DM, an
      evidence-based practice (EBP) program that integrates depression management with microfinance
      services to address both poverty and depression among low-income women in Vietnam. This
      evaluation is a mixed methods study that will 1) describe the development of
      community-partnered implementation process, 2) study the effectiveness of the training and
      implementation support plan on provider and patient outcomes, and 3) identify factors that
      impact implementation success.
    

Detailed description: 
      Livelihood Integration for Effective Depression Management (LIFE-DM) aims to address the dual
      challenges of poverty and depression faced by women in Vietnam by integrating evidence-based
      treatment for depression management and microfinance services. With funding from NIMH, the
      investigators established initial evidence for the effectiveness of LIFE-DM in reducing
      depression and improving functioning, social support, self-efficacy, and income at six
      months. These treatment effects were maintained at twelve months, suggesting that the LIFE-DM
      program may be an effective strategy to break the cycle of depression and poverty in
      low-income women.

      For the Grand Challenges of Canada (GCC) Transition to Scale Grant, the investigators
      developed a model to scale up the program in the public health and social system across two
      provinces, Danang and Thua Thien Hue through 1) the training of local trainers from the
      psychiatric hospital to support local implementation, 2) development of a supervision model,
      and 3) use of a learning collaborative.

      To evaluate the success of the model, the investigators will conduct a mixed methods
      implementation study that will assess implementation and patient outcomes according to the
      RE-AIM framework, as well as identify barriers and facilitators to implementation.
    

Intervention name(s): LIFE-DM Group (Integrated Depression and Livelihood Group Intervention)
Intervention type(s): Other
Intervention description(s): Livelihood Integration for Effective Depression Management (LIFE-DM) program aims to address the dual challenges of poverty and depression by integrating evidence-based treatment for depression management and microfinance services. The LIFE-DM group is a 12-session based on Behavior Activation and Problem Solving therapy for depression applied to both mood problems and livelihood stressors. Livelihood supports includes training on personal finance, referrals to vocational training, and access to microfinance loans. The group is provided at the local commune health stations, and facilitated by primary care health provider and a lay community provider from the Women's Union. The intervention generally lasts about 3-4 months.
Other intervention name(s): Livelihood Integration for Effective Depression Management; behavior activation; problem solving; microfinance
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Study participants are recruited from community health clinics that are implementing
        LIFE-DM and depression care services in the GCC funded transition to scale grant. These
        participants are 18-60 years old, have elevated depressive symptoms (PHQ 9 > 9), have
        economic disadvantage, and are interested in participating in an integrated depression and
        livelihood program. Patients with severe mental illness, such as psychosis, mania,
        substance abuse, or high risk of suicide are also excluded and referred to psychiatric
        hospital for higher level of care. Those who have disabilities, significant cognitive
        impairments, and chronic illness that may interfere with their ability to participate in
        group therapy are also excluded and referred to other more individualized support.
      
Keywords: depression; poverty