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By Jonathan Block
Providing adequate mental health care in low and middle-income countries, such as Vietnam, is a challenge, often because of a lack of human resources. As a result, mental health treatment in these countries most often consists of medication only, neglecting psychotherapy which has been shown to be superior to medication-only treatment. Recognizing an urgent need to address this treatment gap, Victoria Ngo, PhD, and colleagues developed a new program, the Multicomponent Collaborative Care for Depression (MCCD) program, which provides a stepped care model for medication and behavioral activation therapy in Vietnam’s primary health care system.
The study was conducted at eight commune health centers throughout Vietnam, the main places where individuals receive health care in the country. A total of 473 patients, all screened for depression, were randomized to receive either antidepressant medication or take part in the MCCD program. With a clinician, behavioral activation involves increasing the positive reinforcement one can experience while ending negative behaviors that can cause depression to worsen, and replacing such behaviors with rewarding ones.
“We were quite surprised to see how much better our Multi-component Collaborative Care program performed than guideline medications for depression, which is also an evidence-based practice”, Dr. Ngo, director of the CUNY School of Public Health and Health Policy Center for Innovation in Public Health, said. “We expected that by changing the model of care, introducing new supervision approach, and providing more options for care would result in poorer implementation initially, which could also impact patient outcomes, so we were not sure that results would be positive. Once we crunched the numbers, we were quite delighted to see that the system could handle these changes and that task-shifting depression care to nurses and community health workers is not only feasible but also more effective than medications provided by primary care providers.”
The study lasted for four years and each patient was followed for 24 weeks. The primary outcome was reduction in depressive symptoms, while secondary outcomes included anxiety reduction and improvement in health functioning. While patients in both cohorts saw improvement throughout the trial, those in the MCCD group saw significantly greater improvement across all outcomes. Full results of the trial are expected to be published in a peer-reviewed journal in the future.
Ngo believes the results demonstrate that the MCCD program can be task-shifted to primary care providers in low-resource areas, providing better outcome for patients with depression compared to medication alone.
“This is the first study in Vietnam to demonstrate that task-shifting depression care to providers with minimal mental health training is not only effective, but even better than the gold standard of antidepressant medication, providing evidence that this is an effective strategy for closing the mental health treatment gap in Vietnam.”