Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-17T18:23:15.678Z Has data issue: false hasContentIssue false
  • English
  • Français

Development and feasibility assessment of a collaborative stepped care intervention for management of depression in the mental health in primary care (MeHPriC) project, Lagos, Nigeria

Published online by Cambridge University Press:  17 October 2018

Abiodun O. Adewuya Open the ORCID record for Abiodun O. Adewuya [Opens in a new window] ,
Tomilola Adewumi ,
Olufisayo Momodu ,
Olushola Olibamoyo ,
Olabanji Adesoji ,
Adedayo Adegbokun ,
Suraju Adeyemo ,
Olufikunayo Manuwa  and
Dapo Adegbaju
Abiodun O. Adewuya*
Affiliation:
Department of Behavioural Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria Centre for Mental Health Research and Initiative, Lagos, Nigeria
Tomilola Adewumi
Affiliation:
Centre for Mental Health Research and Initiative, Lagos, Nigeria
Olufisayo Momodu
Affiliation:
Centre for Mental Health Research and Initiative, Lagos, Nigeria Lagos State Health Services Commission, Lagos, Nigeria
Olushola Olibamoyo
Affiliation:
Department of Psychiatry, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
Olabanji Adesoji
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Adedayo Adegbokun
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Suraju Adeyemo
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Olufikunayo Manuwa
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Dapo Adegbaju
Affiliation:
Federal Neuropsychiatric Hospital, Yaba, Lagos, Nigeria
*
Author for correspondence: Abiodun O. Adewuya, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This study aimed to develop and test the feasibility of a primary care worker-led psychological intervention as the main feature of a collaborative stepped care for depression that is effective, affordable, culturally acceptable, tailored to patients’ clinical condition and easily integrate-able into the primary care schedule in Nigeria.

Methods

Using the Medical Research Council framework, in the first stage (modelling/theoretical development), experts reviewed and distilled evidence from literature to form the intervention components. In the second (formative) stage, local stakeholders were consulted on the practical application and feasibility of the proposed intervention. The third (piloting) stage involved testing for the clinical efficacy and acceptability of the components of the draft intervention

Results

The final intervention components included a 2-stage screening (red-flagging and further evaluation), psychoeducation, low-intensity psychological therapy (problem-solving therapy for primary care), antidepressant prescription, proactive mobile telephony adherence support and referral to the mental health specialist if needed. At 3 months, 71.6% of depressed patients on the intervention improved. The intervention was perceived to be acceptable and useful by over 70% of health workers and clients and had high ratings (>70% score) by expert panels on intervention simplicity, facilitation strategies, and quality of delivery.

Conclusions

The development and feasibility testing of our integrated intervention encompassed review of current literature, expert opinions and consultation with local stakeholders and end users. Our intervention package was largely deemed acceptable, relevant, useful, and feasible. Important lessons learnt with this process will help in future intervention developments.

Keywords

Collaborative stepped caredepressionfeasibilityNigeriaprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 13 , October 2019 , pp. 2149 - 2157
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abas, M, Baingana, F, Broadhead, J, Iacoponi, E and Vanderpyl, J (2003) Common mental disorders and primary health care: current practice in low-income countries. Harvard Review of Psychiatry 11, 166–173.Google Scholar
Abiodun, OA (1993) A study of mental morbidity among primary care patients in Nigeria. Comprehensive Psychiatry 34, 10–13.Google Scholar
Adewuya, AO, Ola, BA and Afolabi, OO (2006) Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. Journal of Affective Disorders 96, 89–93.Google Scholar
Adewuya, AO, Adewumi, T, Ola, B, Abosede, O, Oyeneyin, A, Fasawe, A and Idris, O (2017) Primary health care workers' knowledge and attitudes towards depression and its management in the MeHPric-P project, Lagos, Nigeria. General Hospital Psychiatry 47, 1–6.Google Scholar
Adewuya, AO, Atilola, O, Ola, BA, Coker, OA, Zachariah, MP, Olugbile, O, Fasawe, A and Idris, O (2018) Current prevalence, comorbidity and associated factors for symptoms of depression and generalized anxiety in the Lagos State Mental Health Survey (LSMHS), Nigeria. Comprehensive Psychiatry 81, 60–65.Google Scholar
Amoran, O, Lawoyin, T and Lasebikan, V (2007) Prevalence of depression among adults in Oyo state, Nigeria: a comparative study of rural and urban communities. Australian Journal of Rural Health 15, 211–215.Google Scholar
Bower, P, Gilbody, S, Richards, D, Fletcher, J and Sutton, A (2006) Collaborative care for depression in primary care: making sense of a complex intervention: systematic review and meta-regression. British Journal of Psychiatry 189, 484–493.Google Scholar
Chibanda, D, Mesu, P, Kajawu, L, Cowan, F, Araya, R and Abas, MA (2011) Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health 11, 828.Google Scholar
Chibanda, D, Weiss, HA, Verhey, R, Simms, V, Munjoma, R, Rusakaniko, S, Chingono, A, Munetsi, E, Bere, T, Manda, E and Abas, M (2016) Effect of a primary care-based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. JAMA 316, 2618–2626.Google Scholar
Craig, P, Dieppe, P, Macintyre, S, Michie, S, Nazareth, I and Petticrew, M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337, a1655.Google Scholar
GBD (2013) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study. Lancet 386, 743–800.Google Scholar
Griffiths, S and Steen, S (2013) Improving Access to Psychological Therapies (IAPT) programme: setting key performance indicators in a more robust context: a new perspective. The Journal of Psychological Therapies in Primary Care 2, 133–141.Google Scholar
Gureje, O (2002) Psychological disorders and symptoms in primary care. Association with disability and service use after 12 months. Social Psychiatry and Psychiatric Epidemiology 37, 220–224.Google Scholar
Gureje, O, Oladeji, BD, Araya, R and Montgomery, AA (2015) A cluster randomized clinical trial of a stepped care intervention for depression in primary care (STEPCARE) – study protocol. BMC Psychiatry 15, 148.Google Scholar
Hegel, MT, Barrett, JE, Oxman, TE, Mynors-Wallis, LM and Gath, D (1999) Problem-solving Treatment for Primary Care (PST-PC): A Treatment Manual for Depression. Hanover, NH: Dartmouth University.Google Scholar
Honikman, S, van Heyningen, T, Field, S, Baron, E and Tomlinson, M (2012) Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa. PLoS Medicine 9, e1001222.Google Scholar
Kroenke, K, Spitzer, RL and Williams, JB (2001) The PHQ-9. Journal of General Internal Medicine 16, 606–613.Google Scholar
Kroenke, K, Spitzer, RL and Williams, JB (2003) The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care 41, 1284–1292.Google Scholar
Lund, C (2018) Improving quality of mental health care in low-resource settings: lessons from PRIME. World Psychiatry 17, 47–48.Google Scholar
McMillan, D, Gilbody, S and Richards, D (2010) Defining successful treatment outcome in depression using the PHQ-9: a comparison of methods. Journal of Affective Disorders 127, 122–129.Google Scholar
National Collaborating Centre for Mental Health (2010) Depression: The NICE Guideline on the Treatment and Management of Depression in Adults, Updated edition. London: The British Psychological Society and The Royal College of Psychiatrists.Google Scholar
National Institute for Health and Clinical Excellence (2011). Common Mental Health disorders: Identification and Pathways to Care - NICE guidance (Clinical Guidelines CG123). UK.Google Scholar
Oladeji, BD, Kola, L, Abiona, T, Montgomery, AA, Araya, R and Gureje, O (2015) A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria. BMC Psychiatry 15, 96.Google Scholar
Shinde, S, Andrew, G, Bangash, O, Cohen, A, Kirkwood, B and Patel, V (2013) The impact of a lay counselor led collaborative care intervention for common mental disorders in public and private primary care: a qualitative evaluation nested in the MANAS trial in Goa, India. Social Science & Medicine 88, 48–55Google Scholar
Spijker, J, van Vliet, IM, Meeuwissen, JAC and van Balkom, AJLM (2010) Update of the multidisciplinary guidelines for anxiety and depression. Tijdschrift Voor Psychiatrie 52, 715–718.Google Scholar
Thornicroft, G, Chatterji, S, Evans-Lacko, S, Gruber, M, Sampson, N, Aguilar-Gaxiola, S, Al-Hamzawi, A, Alonso, J, Andrade, L, Borges, G and Bruffaerts, R (2017) Undertreatment of people with major depressive disorder in 21 countries. British Journal of Psychiatry 210, 119–124.Google Scholar
Wernher, I, Bjerregaard, F, Tinsel, I, Bleich, C, Boczor, S, Kloppe, T, Scherer, M, Härter, M, Niebling, W, König, HH and Hüll, M (2014) Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial. Trials 15, 351.Google Scholar
Whiteford, HA, Ferrari, AJ, Degenhardt, L, Feigin, V and Vos, T (2015) The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS ONE 10, e0116820.Google Scholar
WHO (2010) Mental Health Gap Action Programme: MhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings, Version 1.0. Geneva: WHO.Google Scholar
WHO (2017a) mhGAP Training Manuals for the mhGAP Intervention Guide for Mental, Neurological and Substance use Disorders in Non-Specialized Health Settings-Version 2.0 (for Field Testing). Geneva: WHO.Google Scholar
WHO (2017b) Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization.Google Scholar