A study by researchers from NIMHANS and the University of York, the United Kingdom, aimed at addressing the increasing burden of depression and anxiety in patients with non-communicable diseases (NCD), has found brief psychological therapies such as behavioural activation (BA) to be effective in management of these issues.
The study that has been accepted for publication in a peer reviewed journal was done to evaluate the feasibility and effectiveness of BA in the Indian community setting where the burden of NCDs is high.
NCDs and depression
“A systematic review of 96 studies conducted in India, Bangladesh, and Pakistan done by our team revealed that 40% of patients with diabetes, cancer, hypertension, stroke, and chronic obstructive pulmonary disease (COPD) have depression while 30% with these chronic conditions have anxiety,” Arun Kandasamy, Professor of Psychiatry at NIMHANS, told The Hindu on Monday.
According to the National Mental Health Survey of India, there is a huge gap between the number of people who have some common mental illness and the number who actually received treatment for the same.
“One of the reasons for the same is dearth in trained mental health professionals and simpler intervention. So we understood the need to develop such an intervention which can be delivered by non-mental health professionals within the existing health care system itself,” he said.
Pilot study in Kolar
“We did a pilot study involving 56 patients from primary health centres (PHCs) in Kolar district. Our intention was to first develop an intervention that can be used by those handling patients in the NCD clinics in the Indian setting and test the feasibility of integrating the same into our existing healthcare system. We came out with the behavioural activation counselling for treatment of depression in non-communicable disease (BEACON) module,” he said.
“BA is a brief therapy that helps the patient to do regular activities (routine and necessary as well as social and pleasurable) that he/she has stopped or reduced due to health conditions. Under the BEACON module, the patient needs to do a little bit of these activities every day and increase the time and number of activities gradually,” said Dr. Kandasamy, who is the lead author of the study.
“The fact that the patients with NCDs cannot complete routine activities due to their health condition or having a chronic medical illness can make them depressed. Also as they tend to get tired easily, they gradually stop doing the routine and recreational activities and this only worsens their depression. So we have trained NCD counsellors in community health centres of Kolar district to help such patients gradually restart these activities. This sets in a positive attitude and a sense of accomplishment in these patients, which in turn help in reducing the depression,” the doctor explained.
Chronic diseases
NCDs, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioural factors.
There is increasing evidence that comorbid mental health conditions such as depression can greatly affect people with physical health conditions.
“For example, people with NCDs are two-three times more likely to experience depression. The presence of depression worsens NCD symptoms, adversely impacts quality of life, and increases the financial burden for patients and their families. Therefore, it is important to recognize and treat depression to improve overall management of NCDs and improve health, quality of life and economic outcomes for these patients,” the doctor said.
Asserting that there is an identified need to integrate mental health care in NCD care settings to help address the high burden of co-morbid depression with NCDs, Dr. Kandasamy said: “However, there is a notable gap worldwide between the number of people in need of mental health care and those who receive treatment. This treatment gap is especially high in low- and middle-Income countries (LMICs).”
“Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural and resource context) for delivery in the PHCs. The intervention was also adapted for potential remote delivery via telephone as the pilot study was through the pandemic,” he said.
“This was a pilot trial and we are planning to take up the trial in a bigger way in multiple places,” he added.
