Overview

Depression is the leading cause of disability worldwide and accounts for about 40% of disability-adjusted life years (DALYs) attributable to mental and substance use disorders. Present estimates suggest that the prevalence of depression in India is 2.7%, and the treatment gap stands at 85%. Access to mental healthcare in LMICs remains limited due to both demand and supply side barriers such as lack of mental health professionals, low recognition rates of depression, stigma associated with mental disorders and the lack of contextualized evidence based psychosocial interventions.

Our program aims to explore the implementation of two scalable models- delivery of an evidence-based psychosocial intervention in primary health centers and a community-based intervention in a low-and-middle-income country context.

IMPRESS is an effectiveness-implementation hybrid type 2-cluster randomized controlled trial, comparing two models of delivery of the psychological intervention, in an attempt to tackle one of the major unanswered questions in global mental health i.e. the coordination between community and primary care-based approaches to reduce the treatment gap for depression.

Rationale

IMPRESS aims to reduce the treatment gap for depression by addressing both, supply and demand side barriers by combining two strategies previously developed by Sangath. The supply side will be targeted by scaling up the Healthy Activity Program (HAP), a manualised psychological treatment based on behavioural activation, which was shown to reduce symptom severity and increase remission among people living with depression in Sangath’s PREMIUM study. The demand side will be targeted by developing a community-based intervention, building on Sangath’s VISHRAM program’s work to ensure an increase in awareness, uptake, and adherence to treatment.

Progress till date

We have completed the formative stage of the project which included conducting three systematic reviews, qualitative interviews with 35 community stakeholders, and 4 Theory of Change workshops with potential facility and community-intervention delivery agents. The data collected over the formative phase informed our intervention development process. We developed, revised, and piloted our community intervention materials while also working towards embedding systems in 30 healthcare facilities all over Goa.

Our randomized controlled trial began on 1st November 2023.

Partner/s

• London School of Hygiene and Tropical Medicine, London, UK

• Harvard Medical School, Boston, USA

• Directorate of Health Services, Goa, India

• Mount Sinai Hospital, Ontario, Canada

• University of Toronto, Ontario, Canada