Researchers have worked with health partners in east Africa to unveil an integrated care model for treating major depressive disorder.
Integrated care can help improve treatment for major depressive disorder.
Research carried out in East Africa reveals that people with major depressive disorder and chronic health conditions can benefit from a new form of integrated care that reduces symptoms, improves quality of life and reduces the odds of depression.
Researchers from the University of Birmingham, worked with Partners In Health and the Ministry of Health in Malawi, to unveil a study on the effectiveness and cost-efficiency of an integrated care model for treating major depressive disorder (MDD).
The experts carried out a controlled trial across 14 health facilities in Neno District, Malawi – screening 15,562 people and enrolling 487 MMD patients onto the trial. They have now published their findings in The Lancet.
Our study demonstrates that integrating mental health care into existing health services is not only effective but also cost-efficient. This approach can transform mental health care delivery in low-resource settings, providing much-needed support to those suffering from major depressive disorder.
The integrated approach comprised of screening, diagnosis, and psychoeducation along with two interventional components - group Problem Management Plus (PM+) and anti-depressant therapy. Participants learned about managing stress, managing problems, behavioural activation, strengthening social support, and maintenance routines.
Co-author Dr Samuel Watson, from the University of Birmingham, commented: “Our study demonstrates that integrating mental health care into existing health services is not only effective but also cost-efficient. This approach can transform mental health care delivery in low-resource settings, providing much-needed support to those suffering from major depressive disorder.
“Leveraging existing infrastructure, this model is scalable and can be implemented in similar low-resource settings, making it a viable solution for widespread mental health challenges. Many LMICs have a good infrastructure for HIV care and chronic illnesses, so integrating mental health care into this framework may be more effective and cost-efficient than creating a programme from scratch.”
In low-income and middle-income countries (LMIC), common mental disorders—including major depressive disorder—account for more years lived with disability than HIV and malaria combined.
Yet, more than three-quarters of individuals with common mental disorders receive no treatment. This treatment gap is persistent, despite behavioural and pharmacological
interventions that show efficacy in trials. The funding landscape contributes to this disparity - for example, development assistance for HIV was US$9·9 billion in 2021, compared with $217 million for common mental disorders—more than a 45-fold difference.
Researchers believe that this integrated approach trialled in Malawi can bring significant improvements in mental health care for low-resource settings.
The integrated care model significantly reduced depressive symptoms and improved overall functioning among participants. It is also highly cost-effective, with an incremental cost-effectiveness ratio (ICER) of $481 per disability-adjusted life year (DALY) averted. When accounting for household benefits, the ICER improved to $329 per DALY averted.
The model can be integrated into existing chronic care clinics, enhancing the overall healthcare delivery system by addressing both mental and physical health needs. By improving mental health outcomes, it indirectly benefits households and communities, fostering a healthier and more productive society.
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The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 8,000 international students from over 150 countries.
'Effectiveness, cost-effectiveness, and positive externalities of integrated chronic care for adults with major depressive disorder in Malawi (IC3D): a stepped-wedge, cluster-randomised, controlled trial’ - Ryan K McBain, Owen Mwale, Kondwani Mpinga, Myrrah Kamwiyo, Waste Kayira, Todd Ruderman, Emilia Connolly, Samuel I Watson, Emily B Wroe, Fabien Munyaneza, Luckson Dullie, Giuseppe Raviola, Stephanie L Smith, Kazione Kulisewa, Michael Udedi, Vikram Patel, and Glenn J Wagne is published in The Lancet.
Staff profile page for Sam Watson, Senior Lecturer at the Institute of Applied Health Research.
