IMPRESS

To explore the implementation of two scalable models- delivery of an evidence-based psychosocial intervention in primary health centres and a community-based intervention in a low-and-middle-income country context to reduce treatment gap for depression by addressing both, supply and demand side barriers

Overview

IMPRESS aims to reduce the treatment gap for depression by addressing both, supply and demand side barriers by combing two strategies previously developed by Sangath. The supply-side will be targeted by scaling up the Healthy Activity Program (HAP), a manualised psychological treatment based on behavioural activation, which was shown to reduce symptom severity and increase remission among depressed participants in Sangath’s PREMIUM study. The demand side will be targeted by developing a community-based intervention, building on Sangath’s VISHRAM program’s work to ensure increase in awareness, uptake and adherence to treatment.

Rationale

Depression is the leading cause of disability worldwide and accounts for about 40% of disability-adjusted life years (DALYs) attributable to mental and substance use disorders. Present estimates suggest that the prevalence of depression in India is 2.7%, and the treatment gap stands at 85%. Access to mental healthcare in LMICs remains limited due to both demand and supply side barriers such as lack of mental health professionals, low recognition rates of depression, stigma associated with mental disorders and the lack of contextualized evidence based psychosocial interventions.

IMPRESS is an effectiveness-implementation hybrid type 2-cluster randomized controlled trial, comparing two models of delivery of the psychological intervention, in an attempt to tackle one of the major unanswered questions in global mental health i.e. the coordination between community and primary care-based approaches to reduce the treatment gap for depression.