The Effectiveness of a Multi-Pronged Psycho-Social Intervention Among People With Mental Health and Epilepsy Problems - A Pre-Post Prospective Cohort Study Set in North India

Abstract

<jats:p> <jats:bold>Background:</jats:bold> In low- and middle-income settings, many people with mental health problems cannot or do not access psychiatric services. Few studies of people with epilepsy and mental problems have evaluated the effectiveness of a predominantly psycho-social intervention, delivered by lay community workers. The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders (CMDs), and epilepsy. <jats:bold>Methods:</jats:bold> In this observational, prospective cohort study set in Uttarakhand, India, the lay-worker led intervention included psychoeducation, behavioural activation, facilitation of access to care, and facilitated psycho-social support groups. Participants were categorised as having a severe or CMD or epilepsy and assessed 5 times over 24 months using primary outcome measures, including the Patient Health Questionnaire (PHQ9) (severity of depression), the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Recovery Star, and scoring of a bespoke Engagement Index. Analysis included descriptive statistics as well as hierarchical linear regression models to report fixed effects as regression coefficients. <jats:bold>Results:</jats:bold> Among the 297 (baseline) participants only 96 people (31%) regularly used psychotropic medication (at least 4 weeks) and over 60% could not or did not consult a psychiatrist at all in the study period. Nonetheless, people with CMDs showed a significant reduction in their depression severity (PHQ9: B=-6.94, 95% CI -7.37 to -6.51), while people with severe mental disorders (SMDs) showed a significant reduction in their disability score (WHODAS 2.0: B=-4.86, 95% CI - 7.14 to- 2.57). People with epilepsy also reduced their disability score (WHODAS 2.0: B=-5.22, 95% CI -7.29 to -3.15). <jats:bold>Conclusion:</jats:bold> This study shows significant improvements in mental health, depression, recovery, disability and social engagement for people with common and SMDs, and epilepsy, through a community-based intervention that was nonpharmaceutical. It provides preliminary evidence of the value of predominantly psycho-social interventions implemented by lay health workers among people with limited or no access to psychiatric services.</jats:p>

“A Man Never Cries”: A Mixed-Methods Analysis of Gender Differences in Depression and Alcohol Use in Moshi, Tanzania

“…Previous research and clinical trials have also shown the value of incorporating a multi-level approach to mental health and substance use treatment, addressing individual-, family-, and community-level interventions. Mathias et al found that incorporating multi-pronged elements to care delivery, including increased access to services, greater education around mental health topics, and robust social support networks, was effective in treating patients with severe mental health problems in India (68). In Tanzania specifically, multi-level approaches to mental health care are gaining support (69) and have been locally implemented in the treatment of other medical issues like HIV (70).…”

“…In contrast, for men, the linear relationship between alcohol use and depressive symptoms (68). In Tanzania specifically, multi-level approaches to mental health care are gaining support (69) and have been locally implemented in the treatment of other medical issues like HIV (70).…”

Home-Based Transcranial Direct Current Stimulation for the Treatment of Symptoms of Depression and Anxiety in Temporal Lobe Epilepsy: A Randomized, Double-Blind, Sham-Controlled Clinical Trial

“…In our study, the researcher-participant interaction through frequent monitoring via social media (Whatsapp) during the intervention period, interviews about psychosocial content and application of a physical intervention (tDCS) may act as a social intervention and can explain in part the clinical improvement observed in both groups. Around the world, many types of social and educational interventions are being developed as effective interventions for the improvement of psychiatric disorders and quality of life ( Elafros et al, 2013 ; Nagy and Moore, 2017 ; He et al, 2019 ; Mathias et al, 2020 ; Pandey et al, 2020 ). These models of care provided by a multidisciplinary team specialized in epilepsy can improve the quality of care provided when compared to exclusive medical care, since they provide greater availability of time for care if they are divided among professionals.…”

Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health?

“…The majority of PPSD experience common mental health problems such as anxiety and depression and do not have access to biomedical care and do not have a formal diagnosis. Further detail of the types of problems experienced and demographics of PPSD within the Burans programme are described elsewhere [ 30 , 32 ]. The CHWs working with Burans are women from the local informal urban community, who have completed high schooling and have shown evidence of engaging in their neighbourhood as change agents.…”