The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations

Abstract

In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program, which was designed to provide evidence-based depression care services in low-resource, non-Western settings such as Vietnam. The article provides the program development background; the social, economic, and political context in which the program was developed; and the structure and content of the program and their underlying rationale in the context of rural Vietnam. Although the program was found to be acceptable, feasible, and effective in reducing depression outcomes, we did face challenges in implementation, which are outlined in this article. Key challenges included cultural factors (e.g., a lack of recognition of depression as a health-related entity amenable to professional treatment, relatively low levels of psychological mindedness useful for understanding of psychological interventions) and health system (e.g., lack of mental health specialists, overburdened health providers unfamiliar with behavioral interventions) factors. We discuss the strategies we employed to resolve these challenges and our successes and failures therein. We conclude with recommendations for others interested in implementing similar programs in low- and middle-income countries settings.

Community‐based intervention for depression management at the primary care level in Ha Nam Province, Vietnam: a cluster‐randomised controlled trial

“…In our opinion, the study results may also be generalisable to the whole population of Vietnam, due to the uniform organisation of the Vietnamese national healthcare system. Integrating the intervention in the primary healthcare setting would result in an improvement of access to mental healthcare service, reduce stigma due to the provision of treatment through non-mental health specialists [5] and allow the detection of depression at an earlier stage of severity, thus potentially preventing suicide. Also, timely treatment may thus be ensured through the intervention for people in greatest need [16].…”

“…One approach to realise that is by task-shifting [5,14], which relies on training non-mental health workers in depression screening and treatment while supervised by mental health specialists. Studies in other resource-scarce settings have demonstrated the effectiveness of simple treatments provided by non-mental health workers [15][16][17][18].…”

Changes in depressive symptoms and correlates in HIV+ people at An Hoa Clinic in Ho Chi Minh City, Vietnam

“…Fourth, as depression treatment was not controlled for, it is possible that some received depression treatment elsewhere during the three-month study period. However, the chance was minimal because depression care was very limited in Vietnam [34]. Mental health services, even in big cities such as Hanoi and Ho Chi Minh city, do not focus on depression but mainly on schizophrenia, bipolar disorder, and epilepsy [34].…”

“…However, the chance was minimal because depression care was very limited in Vietnam [34]. Mental health services, even in big cities such as Hanoi and Ho Chi Minh city, do not focus on depression but mainly on schizophrenia, bipolar disorder, and epilepsy [34]. Finally, since this is an observational study without a comparison group, many factors which could affect depression could not be fully controlled.…”

“…Because HIV is usually linked to drug use and commercial sex workers [29, 30], which are illegal and culturally unacceptable in Vietnam, PLWH are likely to experience mental health problems, particularly depression, due to stigma and discrimination [31]. Social support and access to mental health care for PLWH are also insufficient in Vietnam [32–34]. …”