Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 19, 2019
Date Accepted: Dec 16, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project: A technology-enabled mental health services delivery model implemented in rural India
ABSTRACT
Background:
Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The SMART Mental Health project aimed to address this gap.
Objective:
The main objective was to evaluate the effectiveness of an intervention in increasing use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders
Methods:
A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community anti-stigma campaign, with training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression and suicide risk using an electronic clinical decision support system.
Results:
Altogether 900 of 22,046 adults (4.1%) screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 (81.2%) reported visiting the doctor for their mental health symptoms, compared to 3.3% at baseline (Odds Ratio 133.3, 95%CI 89.0-199.7, P <0.0001). Mean depression and anxiety scores were significantly lower post-intervention compared to baseline from 13.4 to 3.1 (P<0.001), and 12.9 to 1.9 (P <0.001), respectively.
Conclusions:
The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomised controlled trial.
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