JAMA Psychiatry Article by Reynolds and Colleagues Demonstrates How Training Lay Counselors Helps to Prevent Depression in Low Income Communities in India

In many disadvantaged communities, where mental health professionals are scarce, training local lay counselors chosen from the very communities they serve offers an effective, boots-on-the-ground approach to preventing depression among older adults. University of Pittsburgh Department of Psychiatry investigators, led by Professor Emeritus Dr. Charles F. Reynolds III, in collaboration with researchers from Goa, India, trained lay health counselors in Goa to help at-risk residents avoid depression. Lay counselors, some of whom also have been diagnosed with depression and are successfully managing it, provide problem-solving therapy and act as mentors. The results of this randomized, clinical trial were published online on November 7, 2018 in JAMA Psychiatry.

“There’s a real shortage of trained mental health professionals – psychiatrists and the like – whereas it’s relatively easy to train lay counselors and then provide ongoing oversight,” Dr. Reynolds said. “That allows the expertise of people like me to be multiplied so we can reach out to far greater numbers of people than would otherwise be possible.”

One hundred and eighty-one adults aged 60 and older in Goa with subsyndromal depressive symptoms participated in the project. Of this group, 91 older adults were assigned to the intervention arm of the study and engaged with lay counselors. Dr. Reynolds and his team assessed major depressive episodes, depressive symptom change, functional status, and cognition as well blood pressure and body mass index over 12 months.  Among the older adults who received the intervention, 95% remained depression-free in the following year vs. 87% in the control group over the same time period. The intervention was also associated with a significant lowering of systolic blood pressure and a change in body mass index. 

Dr. Reynolds originally tried out this problem-solving approach to depression prevention among the African-American population of Pittsburgh’s East Liberty neighborhood, with great success and shared those findings in a 2014 Psychiatric Services article. He has partnered with the Depression and Bipolar Support Alliance to train lay health counselors within the Hispanic community of Mission Hills, Los Angeles, and plans to bring the intervention to rural communities in northern New England in the future. Dr. Reynolds stressed that the training program must be adapted to each patient population for it to be effective. For instance, in Goa, limited literacy of some participants necessitated the use of visual aids. In East Liberty, there was a strong interest in education specific to healthy food choices and managing chronic illnesses. “It’s important to spend time in the community to learn what residents find important so the program can be adapted to suit their needs,” said Dr. Reynolds. “One size does not necessarily fit all. You have to learn to speak their language, to engage them so they can take ownership and really run with it.”

Effect of a Lay Counselor Intervention on Prevention of Major Depression in Older Adults Living in Low- and Middle-Income Countries: A Randomized Clinical Trial
Dias A, Azariah F, Anderson SJ, Sequeira M, Cohen A, Morse JQ, Cuijpers P, Patel V, Reynolds CF 3rd.

JAMA Psychiatry. 2018 Nov 7. doi: 10.1001/jamapsychiatry.2018.3048. [Epub ahead of print]