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

Marcia Scazufca , Carina Akemi Nakamura, Nadine Seward, Darío Moreno-Agostino , Pepijn van de Ven, William Hollingworth, TJ Peters, Ricardo Araya*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

15 Citations (Scopus)
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Abstract

Background There is an urgent need to reduce the burden of depression among older adults in low- and middle-income countries (LMICs). We evaluated the effectiveness of a task-shared, collaborative psychosocial intervention (PROACTIVE) in improving depression outcomes among older adults in Brazil. Methods Pragmatic two-arm parallel cluster randomised controlled trial. Clusters (primary care clinics) were stratified by educational level and randomised to either intervention (n=10) or control (n=10) arms. Researchers conducting recruitment and outcome assessments were unaware of intervention group. We used a list of all older adults (≥60 years) registered with the primary care clinics for the initial screening. Subsequently, face-to-face baseline assessments were conducted among those with PHQ-9≥10 and meeting eligibility criteria. The PROACTIVE intervention consisted of a 17-week psychosocial programme based on psychoeducation and behavioural activation approaches. Community health workers (task-sharing) delivered home sessions supported by a dedicated tablet application. Additionally, both arms received enhanced usual care. The primary outcome was recovery from depressive symptomatology (PHQ-9<10) eight months after inclusion. Adaptations to the protocol were made due to the COVID-19 pandemic, recruitment and intervention home sessions were stopped, and follow-up assessments were conducted by phone. ISRCTN registry, number ISRCTN57805470. Findings Recruitment took place between May 2019 and February 2020; 360 participants were included in the intervention and 355 in the control arm. At 8-month follow-up, 158 (62·5%) of the participants in the intervention arm had recovered from depression compared with 125 (44·0%) in the control arm. The adjusted odds ratio for
this difference after imputing missing values was 2·08 (95% CI: 1·42, 3·03). These findings were maintained in the complete case analysis. Interpretation Although the COVID-19 pandemic altered delivery of the intervention, PROACTIVE, a low intensity treatment delivered mainly by non-mental health professionals, was highly effective in improving recovery from depression. Our results have important implications for reducing the treatment gap in LMICs.
Original languageEnglish
Pages (from-to)E690-E702
JournalTHE LANCET HEALTHY LONGEVITY
Volume3
Issue number10
DOIs
Publication statusPublished - 1 Oct 2022

Bibliographical note

Funding Information:
We thank the staff of the Unidades Básicas de Saúde-Guarulhos who participated in this study. We thank the Health Secretariat of Guarulhos, and the Escola SUS-Guarulhos, particularly Maria de Jesus A Ribeiro, Walter Freitas Júnior, and Marcelo B da Silva, for their support throughout the study. Antonio Seabra contributed to the conceptualisation of the initial proposal, Ehidee G La Rotta worked as the intervention coordinator, and Renato M Franzini gave technical support. We are thankful for the discussions and contributions given by Simon Gilbody, Roberto Lourenço, Paula VM Maciel and Rodrigo FM Leite, members of the Trial Steering Committee. We extend our gratitude to Walter Colli for his enthusiasm and support with this project. This study was funded by the São Paulo Research Foundation (process number 2017/50094–2) and the Joint Global Health Trials initiative, jointly funded by the Medical Research Council, Wellcome Trust, and the UK Department for International Development (process number MR/R006229/1). MS is supported by the CNPq-Brazil (307579/2019–0), CAN is supported by the São Paulo Research Foundation (2018/19343–0), and DM-A is part supported by the Economic and Social Research Council Centre for Society and Mental Health at King's College London (ES/S012567/1). The views expressed are those of the authors and not necessarily those of the ESRC or King's College London.

Funding Information:
We thank the staff of the Unidades Básicas de Saúde-Guarulhos who participated in this study. We thank the Health Secretariat of Guarulhos, and the Escola SUS-Guarulhos, particularly Maria de Jesus A Ribeiro, Walter Freitas Júnior, and Marcelo B da Silva, for their support throughout the study. Antonio Seabra contributed to the conceptualisation of the initial proposal, Ehidee G La Rotta worked as the intervention coordinator, and Renato M Franzini gave technical support. We are thankful for the discussions and contributions given by Simon Gilbody, Roberto Lourenço, Paula VM Maciel and Rodrigo FM Leite, members of the Trial Steering Committee. We extend our gratitude to Walter Colli for his enthusiasm and support with this project. This study was funded by the São Paulo Research Foundation (process number 2017/50094–2) and the Joint Global Health Trials initiative, jointly funded by the Medical Research Council, Wellcome Trust, and the UK Department for International Development (process number MR/R006229/1). MS is supported by the CNPq-Brazil (307579/2019–0), CAN is supported by the São Paulo Research Foundation (2018/19343–0), and DM-A is part supported by the Economic and Social Research Council Centre for Society and Mental Health at King's College London (ES/S012567/1). The views expressed are those of the authors and not necessarily those of the ESRC or King's College London.

Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licence

Research Groups and Themes

  • HEHP@Bristol

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