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ORIGINAL ARTICLE
Year : 2014  |  Volume : 139  |  Issue : 2  |  Page : 236-245

Enhanced care by community health workers in improving treatment adherence to antidepressant medication in rural women with major depression


1 Departments of Psychiatry, St. John's Medical College & Hospital, St. John's National Academy of Health Sciences, Bangalore, India
2 Monash University, Department of Rural & Indigenous Health, Victoria, Australia
3 Department of Community Medicine, St. John's Medical College & Hospital, St. John's National Academy of Health Sciences, Bangalore, India
4 Division of Epidemiology & Biostatistics, St. John's Medical College & Hospital, St. John's National Academy of Health Sciences, Bangalore, India

Correspondence Address:
Krishnamachari Srinivasan
Professor of Psychiatry, St. Johnís Medical College Hospital & Dean, St. Johnís Research Institute, St. Johnís National Academy of Health Sciences, Sarjapur Road, Bangalore 560 034
India
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Source of Support: None, Conflict of Interest: None


PMID: 24718398

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Background & objectives: Depression remains largely undiagnosed in women residing in rural India and consequently many do not seek help. Moreover, among those who are diagnosed, many do not complete treatment due to high rates of attrition. This study was aimed to compare the effectiveness of enhanced care with usual care in improving treatment seeking and adherence to antidepressant medication in women with depression living in rural India. Methods: Six villages from rural Bangalore were randomized to either community health worker supported enhanced care or usual care. A total of 260 adult depressed women formed the final participants for the analysis. The outcome measures were number of women who sought and completed treatment, number of clinic visits, duration of treatment with antidepressant, changes in severity of depression (HDRS) and changes in quality of life [WHO-QOL (Brev) scale]. Results: A significantly greater number of women from the treatment intervention (TI) group completed the treatment and were on treatment for a longer duration compared to the treatment as usual (TAU) group. However, there were no significant differences in the severity of depression or quality of life between the TI and the TAU groups or between treatment completers and treatment dropouts at six months. Interpretation & conclusions: Enhanced care provided by the trained community health workers to rural women with major depression living in the community resulted in greater number of women seeking help and adhering to treatment with antidepressants. However, despite enhanced care a significant number of rural women diagnosed with depression either did not seek help or discontinued treatment prematurely. These findings have significant public health implications, as untreated depression is associated with considerable disability.


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