A lay-counsellor delivered brief psychological treatment for men with comorbid Alcohol Use Disorder and depression in primary care: Secondary analysis of data from a randomized controlled trial.

Adult Alcoholism / epidemiology Cost-Benefit Analysis Counselors Depression / complications Humans Male Primary Health Care Single-Blind Method Treatment Outcome
Alcohol Use Disorder Brief intervention Comorbidity Depression Task sharing

Journal

Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587

Informations de publication

Date de publication:
01 10 2021
Historique:
received: 11 02 2021
revised: 14 06 2021
accepted: 10 07 2021
pubmed: 25 8 2021
medline: 28 10 2021
entrez: 24 8 2021
Statut: ppublish

Résumé

We investigated the feasibility, acceptability, safety, and preliminary effectiveness of the Counselling for Alcohol Problems (CAP) psychological intervention delivered by non-specialist health workers (NSHW) to participants with alcohol use disorder (AUD) and comorbid depression in primary care. We used data from a single blind randomised controlled trial conducted in ten primary health care centres in Goa, India. Adult male harmful or dependent drinkers with or without depression were randomized (1:1) to receive either CAP & enhanced usual care (EUC) or EUC only. Process indicators such as the number of completed counselling sessions were assessed and compared between comorbid and non-comorbid participants. Remission from AUD and depression along with abstinence were measured at 3 and 12 months post randomisation. Analyses were on an intention-to-treat basis, employing multivariable regression analyses. 271 participants had symptoms of comorbid depression; 241 did not. Both groups completed a similar number of counselling sessions (adjusted Mean Difference 0.05, 95 %CI -0.24-0.34;p = 0.72). Among comorbid participants, CAP did not lead to more frequent adverse events compared to EUC only (adjusted Odds Ratio [aOR] 0.84, 0.43-1.64;p = 0.62), and there was no evidence for an effect of CAP on remission from AUD or depression at 3 months (aOR 1.51, 0.84-2.74;p = 0.17 and aOR 0.74, 0.43-1.27;p = 0.28) and 12 months follow-up, respectively (aOR 1.69, 0.96-3.01;p = 0.08 and aOR 1.08, 0.62-1.87;p = 0.79). Brief therapies like CAP can be safely delivered by NSHWs to patients with comorbid AUD and depression, but their effectiveness may be limited and requires further investigation.

Sections du résumé

BACKGROUND
We investigated the feasibility, acceptability, safety, and preliminary effectiveness of the Counselling for Alcohol Problems (CAP) psychological intervention delivered by non-specialist health workers (NSHW) to participants with alcohol use disorder (AUD) and comorbid depression in primary care.
METHODS
We used data from a single blind randomised controlled trial conducted in ten primary health care centres in Goa, India. Adult male harmful or dependent drinkers with or without depression were randomized (1:1) to receive either CAP & enhanced usual care (EUC) or EUC only. Process indicators such as the number of completed counselling sessions were assessed and compared between comorbid and non-comorbid participants. Remission from AUD and depression along with abstinence were measured at 3 and 12 months post randomisation. Analyses were on an intention-to-treat basis, employing multivariable regression analyses.
RESULTS
271 participants had symptoms of comorbid depression; 241 did not. Both groups completed a similar number of counselling sessions (adjusted Mean Difference 0.05, 95 %CI -0.24-0.34;p = 0.72). Among comorbid participants, CAP did not lead to more frequent adverse events compared to EUC only (adjusted Odds Ratio [aOR] 0.84, 0.43-1.64;p = 0.62), and there was no evidence for an effect of CAP on remission from AUD or depression at 3 months (aOR 1.51, 0.84-2.74;p = 0.17 and aOR 0.74, 0.43-1.27;p = 0.28) and 12 months follow-up, respectively (aOR 1.69, 0.96-3.01;p = 0.08 and aOR 1.08, 0.62-1.87;p = 0.79).
CONCLUSIONS
Brief therapies like CAP can be safely delivered by NSHWs to patients with comorbid AUD and depression, but their effectiveness may be limited and requires further investigation.

Identifiants

DOI: 10.1016/j.drugalcdep.2021.108961 PMID: 34428630 PMC: PMC8504199
pubmed: 34428630
pii: S0376-8716(21)00456-7
doi: 10.1016/j.drugalcdep.2021.108961
pmc: PMC8504199
pii:
doi:

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

108961

Subventions

Organisme : Wellcome Trust
ID : 091834
Pays : United Kingdom

Informations de copyright

Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

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Auteurs

Jasper Synowski (J)

Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India; Charité - Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany.

Helen A Weiss (HA)

London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.

Richard Velleman (R)

Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India; Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.

Vikram Patel (V)

Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India; London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.

Abhijit Nadkarni (A)

Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India; London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: Abhijit.Nadkarni@LSHTM.ac.uk.

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › A lay-counsellor delivered brief psychological...
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