Clinical trial NCT06574074: Improving Help-seeking for Depression Care in Nepal
Official title: Optimizing a Community-based Intervention to Improve Help-seeking for Depression Care in Morang District of Nepal
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Help-Seeking Behavior
Depression
Keywords: Depression
Help-seeking behaviour
Demand side barriers
Stigma
Nepal
Lead sponsor: Transcultural Psychosocial Organization Nepal
Sponsor class: OTHER
First posted: 2024-08-27
Enrollment: 286
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Intervention model description: The unit of randomization will be study participants who are identified with depression by FCHVs. Each participant will be randomized into one of eight groups using a computer-generated random number.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Depression is a serious public health concern worldwide due to its high prevalence rate and significant emotional and financial burden on individuals, their families, and society. There is a substantial gap between the number of people in need of treatment for depression and those who actually receive it. The recent World Health Organization (WHO) World Mental Health Survey revealed that 86.3% of people with anxiety, mood, or substance disorders in lower-middle-income countries did not receive any treatment in the past 12 months. This study aims to evaluate a community-based intervention to address demand-side barriers by improving mental health literacy, dispelling myths and misconceptions about depression, changing negative attitudes towards depression care, and promoting help-seeking behavior.

Detailed description: It is estimated that more than 300 million people worldwide are experiencing depression, which is about 4.4% of the world's population. Despite the availability of evidence-based treatment, it is reported that 86.3% of people with anxiety, mood, or substance disorders in lower-middle-income countries received no treatment in the past 12 months. Among people who receive treatment for depression, only one out of 27 persons receive minimally adequate treatment in low- and middle-income countries (LMICs). Despite being the major contributor to the overall global burden of disease, depression receives less or no health priority in many LMICs, where more than 80% of people with depression reside.

This study will take place in two municipalities in Morang district, eastern Nepal. Female Community Health Volunteers will administer the intervention to individuals identified with depression using the locally developed and validated Community Informant Detection Tool (CIDT). Participants who receive the intervention will be followed up after one month to evaluate their help-seeking behavior (primary outcome) and after three months to assess treatment adherence, a secondary objective of the study. The study will assess the effects and interactions of four intervention components (information on depression, available treatments, stigma and myths, and life transformation experiences) on the primary outcome of help-seeking behavior and secondary outcomes such as treatment adherence. The severity of depression symptoms will be assessed using the validated PHQ-9, and knowledge and attitudes toward depression will be evaluated to assess mediation effects.

Eligibility criteria: Inclusion Criteria:

* being an adult aged 18 or older residing in Kanepokhari Rural Municipality or Patharisanischare Municipality,
* those detected through the CIDT
* providing consent for participation
* being proficient in speaking and understanding Nepali

Exclusion Criteria:

* people with already receiving mental health services
* having severe mental illness\]
* participants below the age of 18 years,
* participants outside of Kanepokhari and Pathari-sanischare Municipality

Primary outcomes:
measure: Change in help-seeking behaviour for depression care
timeFrame: In one month
Secondary outcomes:
measure: Treatment adherence for depression
timeFrame: In three month
measure: Change in symptom severity of depression
timeFrame: In three month
measure: Change in knowledge, attitude and perception
timeFrame: In three months
Other outcomes:
Locations:
city: Kathmandu
country: Nepal
facility: Transcultural Psychosocial Organization (TPO) Nepal
state: Bagmati
Study officials:
References: