Background
Methods
Setting
Description of the collaborative mental health care package
Research design
Facility detection survey (FDS)
Study procedure, sample and measures
Statistical analyses
Depression cohort study
Study procedure, sample and measures
Analysis
Results
Facility detection survey
Pre-implementation (n = 1310) | Post-implementation (n = 1246) | p | |
---|---|---|---|
Age, years (SD) | 46.9 (13.3) | 46.2 (13.5) | 0.18 |
Female (%) | 983 (75.0) | 967 (77.6) | 0.14 |
Marital status (%) | 0.20 | ||
Single | 405 (30.9) | 358 (28.7) | |
Partnered | 619 (47.2) | 581 (46.6) | |
Divorced/Separated/Widowed | 286 (21.8) | 307 (24.6) | |
Education (%) | 0.07 | ||
Never attended school | 89 (6.8) | 76 (6.1) | |
Some primary | 320 (24.4) | 261 (20.9) | |
Completed primary | 720 (55.0) | 705 (56.6) | |
Completed secondary | 181 (13.8) | 204 (16.4) | |
Employment Status (%) | 0.01 | ||
Unemployed | 519 (39.6) | 513 (41.2) | |
Paid | 505 (38.5) | 521 (41.8) | |
Othera | 286 (21.8) | 212 (17.0) | |
Household food insecurity (%) | 272 (20.8) | 538 (43.2) | 0.01 |
Clinic (%) | 0.01 | ||
Grace Mokhomo | 583 (44.5) | 495 (39.7) | |
Kanana | 274 (20.9) | 342 (27.4) | |
Orkney | 453 (34.6) | 409 (32.8) | |
Chronic condition (%) | |||
HIV | 783 (59.8) | 781 (62.8) | 0.12 |
Hypertension | 671 (51.2) | 664 (53.4) | 0.28 |
Diabetes | 123 (9.4) | 113 (9.1) | 0.84 |
Arthritis | 53 (4.1) | 44 (3.5) | 0.54 |
Chronic respiratory disease | 56 (4.3) | 31 (2.5) | 0.02 |
Tuberculosis | 73 (5.6) | 13 (1.1) | 0.01 |
Epilepsy | 47 (3.6) | 29 (2.3) | 0.06 |
Screening (%) | |||
PHQ-9 Screen Positive | 107 (8.1) | 130 (10.3) | 0.056 |
AUDIT Screen Positive | 43 (3.2) | 63 (5.0) | 0.03 |
Disorder | Pre-implementation | Post-implementation | Detection difference (95% CI)a |
---|---|---|---|
a | |||
Depression | |||
Screened | 1310 | 1246 | |
Screen positive | 106/1310 | 124/1246 | |
Detection data available c | 102/106 | 116/124 | |
Detection-narrow* | 6/102 (5.2) | 19/116 (16.2) | + 11.0 (3.3, 18.6)a |
Detection-broad** | 14/102 (14.2) | 31/116 (26.7) | + 12.5 (1.9, 23.0)a |
Alcohol use disorder | |||
Screened | 1310 | 1246 | |
Screen positive | 42/1310 | 62/1246 | |
Detection data available c | 37/42 | 58/62 | |
Detection | 0/37 (0.0) | 8/58 (11.7) | 11.7 (0.6, 22.8)b |
b. Screen negative patients | |||
Screened | 1310 | 1246 | |
Probable non-case d | 1084/1310 | 996/1246 | |
Randomly Selected | 118/1084 | 113/996 | |
Detection data available | 110/118 | 109/113 | |
Depression | |||
Detection-narrow e | 1/110 (0.9) | 2/109 (1.9) | |
Detection-broad f | 8/110 (6.7) | 8/109 (7.5) | |
Antidepressant prescribed | 2/110 (1.6) | 0/109 (0.0) | |
Alcohol use disorder | |||
Detection | 2/110 (1.6) | 0/109 (0.0) |
Depression cohort study
Excluded from analysis a | Included in the analysis | |||
---|---|---|---|---|
Treatment (n = 80) | Treatment (n = 137) | Comparison (n = 236) |
p
| |
Age, years (mean, SD) | 44.8 (14.77) | 42.6 (13.22) | 44.0 (12.64) | 0.469 |
Female (N, %) | 61 (76.3%) | 114 (83.2%) | 190 (80.5%) | 0.581 |
Marital status (N, %) | 0.909 | |||
Single | 22 (27.5%) | 55 (40.2%) | 90 (38.1) | |
Partnered | 46 (57.5%) | 59 (43.1%) | 103 (43.6%) | |
Widowed/divorced | 12 (15.0%) | 23 (16.8%) | 43 (18.2%) | |
Education (N, %) | 0.405 | |||
No or some primary | 24 (30.0%) | 38 (27.7%) | 60 (25.4%) | |
Completed primary | 38 (47.5%) | 80 (58.4%) | 152 (64.4%) | |
Completed secondary | 18 (22.5%) | 19 (13.9%) | 24 (10.2%) | |
Employment Status (%) | 0.305 | |||
Unemployed | 56 (70.0%) | 102 (74.5%) | 187 (78.2%) | |
Paid | 24 (30.0%) | 35 (25.5%) | 49 (20.8%) | |
Food insecurity | ||||
No | 60 (75.0%) | 62 (45.3%) | 102 (43.2%) | 0.746 |
Yes | 20 (25.0%) | 75 (54.7%) | 134 (56.8%) | |
Clinic (%) | 0.005* | |||
OR | 10 (12.5%) | 11 (8.0%) | 21 (8.9%) | |
KA | 16 (20.0%) | 32 (23.4%) | 93 (39.4%) | |
GM | 38 (47.5%) | 67 (48.9%) | 77 (32.6%) | |
MJ | 16 (20.0%) | 27 (19.7%) | 45 (19.1%) | |
Chronic condition (%) | ||||
HIV | 26 (32.9%) | 57 (41.6%) | 173 (73.3%) | < 0.001** |
Hypertension | 31 (39.2%) | 53 (38.7%) | 107 (45.3%) | 0.233 |
Diabetes | 3 (3.80%) | 6 (4.4%) | 15 (6.4%) | 0.492 |
Other | 9 (11.4%) | 17 (12.4%) | 24 (10.2%) | 0.498 |
Main outcomes | ||||
PHQ-9 (mean, SD) | 6.3 (2.15) | 14.5 (3.47) | 12.8 (3.01) | < 0.001** |
WHODAS (mean, SD) | 24.1 (17.97) | 37.6 (17.19) | 40.0 (19.48) | 0.251 |
Control group | Treatment group | adjusted β or RR d (95%CI) |
p
| |||||
---|---|---|---|---|---|---|---|---|
N | Mean score (SD) or N (%) | Adjusted mean change (95%CI) from baseline | N | Mean score (SD) or N (%) | Adjusted mean change (95%CI) from baseline | |||
Midline (3 months)a | ||||||||
Response on PHQ-9 b | 209 | 49 (23.4%) | – | 125 | 69 (55.2%) | – | 2.10 (1.53 to 2.88) | < 0.001 |
Remission on PHQ-9 c | 209 | 25 (12.0%) | – | 125 | 40 (32.0%) | – | 2.78 (1.70 to 4.54) | < 0.001 |
PHQ-9 score | 209 | 9.6 (4.66) | -2.63 (− 3.34 to − 1.92) | 125 | 8.0 (6.16) | −5.05 (− 6.02 to − 4.08) | − 2.42 (− 3.49 to − 1.34) | < 0.001 |
WHODAS score | 209 | 34.7 (21.14) | − 4.65 (−8.02 to − 1.28) | 125 | 23.6 (20.99) | − 11.11 (− 15.18 to − 7.05) | − 6.46 (− 11.37 to − 1.55) | 0.010 |
Endline (12 months)a | ||||||||
Response on PHQ-9 b | 195 | 60 (30.8%) | – | 119 | 57 (47.9%) | – | 1.52 (1.13 to 2.05) | 0.006 |
Remission on PHQ-9 c | 195 | 33 (16.9%) | – | 119 | 32 (26.9%) | – | 1.72 (1.11 to 2.68) | 0.016 |
PHQ-9 score | 195 | 9.0 (4.89) | −3.10 (− 3.83 to − 2.37) | 119 | 7.9 (5.17) | −5.07 (− 6.05 to − 4.09) | −1.97 (− 3.04 to − 0.90) | < 0.001 |
WHODAS score | 195 | 31.3 (22.39) | −7.20 (− 10.68 to − 3.73) | 119 | 28.4 (21.64) | −8.00 (− 12.02 to − 3.99) | −0.80 (− 5.68 to 4.07) | 0.746 |
Control group | Treatment group | Difference of difference | adjusted β (95%CI) | |||||
---|---|---|---|---|---|---|---|---|
N | Mean PHQ-9 score (SD) | Adjusted mean change in PHQ-9 (95%CI) from baseline | N | Mean PHQ-9 score (SD) or N (%) | Adjusted mean change in PHQ-9 (95%CI) from baseline | |||
Midline (3 months) | ||||||||
Sex | ||||||||
Male | 43 | 8.3 (4.19) | −3.56 (− 5.04 to − 2.08) | 21 | 6.8 (4.98) | −5.39 (− 7.45 to − 3.33) | − 1.83 (− 4.28 to 0.62) | 0.76 (− 1.94 to 3.45) |
Female | 166 | 9.9 (4.73) | −2.41 (− 3.18 to − 1.64) | 104 | 8.2 (6.36) | −5.00 (− 6.03 to − 3.97) | −2.59 (− 3.77 to − 1.41) | |
Household food insecurity | ||||||||
Food secure | 89 | 8.7 (4.20) | −2.89 (− 3.92 to − 1.86) | 58 | 6.2 (4.84) | − 6.62 (− 7.95 to − 5.28) | −3.73 (− 5.30 to − 2.15) | − 2.50 a (− 4.60 to − 0.41) |
Food insecure | 120 | 10.3 (4.88) | −2.56 (− 3.47 to − 1.65) | 67 | 9.5 (6.79) | −3.79 (− 4.98 to − 2.59) | −1.23 (− 2.65 to 0.20) | |
Endline (12 months) | ||||||||
Sex | ||||||||
Male | 38 | 7.3 (4.29) | −4.44 (− 5.94 to − 2.94) | 21 | 7.7 (4.34) | − 4.64 (− 6.72 to − 2.56) | −0.20 (− 2.67 to 2.28) | 2.18 (− 0.55 to 4.91) |
Female | 157 | 9.4 (4.95) | −2.80 (− 3.59 to − 2.01) | 98 | 8.0 (5.35) | −5.17 (− 6.22 to − 4.13) | −2.38 (− 3.55 to − 1.20) | |
Household food insecurity | ||||||||
Food secure | 86 | 8.3 (4.81) | −3.27 (− 4.31 to − 2.24) | 55 | 6.5 (4.97) | −6.42 (− 7.76 to − 5.08) | −3.15 (− 4.72 to − 1.58) | − 2.24 a (− 4.34 to − 0.14) |
Food insecure | 109 | 9.6 (4.91) | − 3.10 (− 4.04 to − 2.17) | 64 | 9.2 (5.06) | −4.01 (− 5.22 to − 2.81) | −0.91 (− 2.33 to 0.52) |