Proactive Depression Treatment System

Project Motivation

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. 

Project Description

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. 

Team Members

Partners

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

• Nakamura, C.A., Scazufca, M., Peters, T.J., Fajersztajn, L., Van de Ven, P., Hollingworth, W., Araya, R. and Moreno-Agostino, D. (2021) 'Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil', International Journal of Geriatric Psychiatry

• Henrique, M.G., De Paula Couto, M.C.P., Araya, R., Mendes, A.V., Nakamura, C.A., Hollingworth, W., Van De Ven, P., Peters, T.J. and Scazufca, M. (2021) 'Acceptability and fidelity of a psychosocial intervention (PROACTIVE) for older adults with depression in a basic health unit in São Paulo, Brazil: a qualitative study', BMC public health, 21(1)

• Scazufca, M., Nakamura, C.A., Peters, T.J., Henrique, M.G., Seabra, A., La Rotta, E.G., Franzin, R.M., Martins, D.F., Van de Ven, P., Hollingworth, W. and Araya, R. (2020) 'A collaborative care psychosocial intervention to improve late life depression in socioeconomically deprived areas of Guarulhos, Brazil: the PROACTIVE cluster randomised controlled trial protocol', Trials, 21(1), 1-14.

• Scazufca, M., de Paula Couto, M.C.P., Henrique, M.G., Mendes, A.V., Matijasevich, A., Pereda, P.C., Franzin, R.M., Seabra, A.C., Van De Ven, P., Hollingworth, W. and Araya, R. (2019) 'Pilot study of a two-arm non-randomized controlled cluster trial of a psychosocial intervention to improve late life depression in socioeconomically deprived areas of São Paulo, Brazil (PROACTIVE): feasibility study of a psychosocial intervention for late life depression in São Paulo', BMC public health, 19(1), 1-14.

• Van de Ven, P., Araya, R., de Paula Couto, M.C.P., Henrique, M.G., Meere, D., Mendes, A.V., Peters, T.J., Seabra, A., Franzin, R.M. and Pereda, P.C. (2019) 'Investigating software requirements for systems supporting task-shifted interventions: usability study', Journal of medical Internet research, 21(11), e11346.