Can this mental health protocol help primary health care centres diagnose depression? Decoding a Harvard study

“This is a result of misdiagnosis and inappropriate treatment,” says Dr Patel, who is also one of the senior authors of a new study ‘Depression Diagnosis, Treatment, and Remission Among Adults in India.’ Published in the Journal of American Medical Association (Psychiatry) recently, the study finds that more than 95 per cent of middle-aged and older adults with depression, (estimated at 29-30 million people) did not receive care that could have helped them recover because of misdiagnosis.

“This is despite two-thirds of these patients having visited a health centre,” Prof Patel says, arguing why frontline health workers can close the diagnosis gap and help the elderly population in remote areas with a simple psychosocial intervention like the Healthy Activity Program.

WHAT THE STUDY SAYS

The study tracked 65,121 participants from 2017 to 2018. Findings show that of the 64 per cent of 45-plus adults with depression who accessed primary healthcare services, only three per cent were diagnosed with depression, two per cent received treatment and one per cent were in remission. An estimated 29 million middle-aged and older adults had untreated depression, 22 million of whom lived in rural areas.

HOW CAN ONE CLOSE THE GAP OF DIAGNOSIS?

“These findings suggest large care gaps for depression diagnosis and treatment among adults in India despite a relatively high use of health services,” says Prof Patel. He suggests including a lay counsellor-delivered psychological treatment into primary care. The Healthy Activity Programme (HAP) is a brief psychological treatment for severe depression that is delivered by lay counsellors in primary care settings. Consisting of behavioural activation, problem-solving and activation of social networks, randomised trials have shown it helped reduce the prevalence of depression after six to eight sessions or two months. It also found that HAP participants maintained the gains they showed at the end of treatment.

Previous studies from India have reported sustained effectiveness and scalability of such interventions, Dr Patel pointed out.

WHY ADDRESSING DEPRESSION IN OLDER ADULTS IS CRITICAL

The World Health Organisation (WHO)’s Comprehensive Mental Health Action Plan aims to increase service coverage for mental health conditions by at least half by 2030. “Given that the prevalence of depression in India increases linearly with age, middle-aged and older adults are a particularly important target group for increasing coverage,” the report says.