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A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria

Oladeji, Ayodele; Kola, Lola; Abiona, Taiwo; Montgomery, Alan A.

Authors

Ayodele Oladeji

Lola Kola

Taiwo Abiona

Alan A. Montgomery



Abstract

Background
Depression is common in primary care and is often unrecognized and untreated. Studies are needed to demonstrate the feasibility of implementing evidence-based depression care provided by primary health care workers (PHCWs) in sub-Saharan Africa. We carried out a pilot two-parallel arm cluster randomized controlled trial of a package of care for depression in primary care.

Methods
Six primary health care centers (PHCC) in two Local Government Areas of Oyo State, South West Nigeria were randomized into 3 intervention and 3 control clinics. Three PHCWs were selected for training from each of the participating clinics. The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation, activity scheduling, problem solving treatment and medication for severe depression. Providers from the control clinics delivered care as usual, enhanced by a refresher training on depression diagnosis and management. Outcome measures Patient’s Health Questionnaire (PHQ-9), WHO quality of Life instrument (WHOQOL-Bref) and the WHO disability assessment schedule (WHODAS) were administered in the participants’ home at baseline, 3 and 6 months.

Results
About 98% of the consecutive attendees to the clinics agreed to have the screening interview. Of those screened, 284 (22.7%) were positive (PHQ-9 score ≥ 8) and 234 gave consent for inclusion in the study: 165 from intervention and 69 from control clinics. The rates of eligible and consenting participants were similar in the control and intervention arms. In all 85.9% (92.8% in intervention and 83% in control) of the participants were successfully administered outcome assessments at 6 months. The PHCWs had little difficulty in delivering the intervention package. At 6 months follow up, depression symptoms had improved in 73.0% from the intervention arm compared to 51.6% control. Compared to the mean scores at baseline, there was improvement in the mean scores on all outcome measures in both arms at six months.

Conclusion
The results provide support for the feasibility of conducting a fully-powered randomized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms.

Journal Article Type Article
Journal BMC Psychiatry
Electronic ISSN 1471-244X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 15
Issue 96
APA6 Citation Oladeji, A., Kola, L., Abiona, T., & Montgomery, A. A. (in press). A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria. BMC Psychiatry, 15(96), https://doi.org/10.1186/s12888-015-0483-0
DOI https://doi.org/10.1186/s12888-015-0483-0
Keywords Depression, Primary care, Clinical trial, Stepped care intervention
Publisher URL https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-015-0483-0
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Stepped care intervention package for depression in primary care in Nigeria BMC Psychiatry 20151596.pdf (1.2 Mb)
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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