Proactive Depression Treatment System
Depression is a debilitating mental disorder affecting a large part of the population. In their lifetimes, 7-12% of men and 20-25% of women will have to face depression. Effective behavioural interventions are available and are often preferable to pharmacological interventions. However, especially in low-to-middle-income countries, large parts of the population do not have access to behavioural interventions due to costs and the requirement for highly skilled therapists. As a result, depression often remains untreated, or is treated with medication, resulting in suboptimal outcomes.
The goal of this project was to develop and clinically trial a solution using so-called task-shifting, in which a task is shifted away from scarce and expensive resources. Proactive consists of a psycho-social intervention implemented on Android tablets. Due to the use of in-app diagnostics, treatment content, multi-media information and decision rules, the Proactive system was able to support health workers without formal (mental) health training to provide an effective depression intervention to older inhabitants of Sao Paulo’s favellas. These carers are known as community health workers (CHWs) in Brazil’s health care system and have typically completed secondary education. CHWs received one week of training in delivering the Proactive intervention.
The results of our trial were published in the Lancet Health Longevity and demonstrated 62.5% of participants in the intervention showed recovery at 8-month follow up versus 44% of participants in the control group.
Status: Completed resulting in the following outputs:
Scazufca, M., Nakamura, C.A., Seward, N., Moreno-Agostino, D., Van de Ven P., Hollingworth, W., Peters, T. and Araya, R. (2022) A task-shared, collaborative care psychosocial intervention for improving depressive symptomatology among older adults in a socioeconomically deprived area of Brazil (PROACTIVE): a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial, The Lancet Health Longevity, Volume 3, Issue 10, E690-E720