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Current Psychiatry Research and Reviews

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ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

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Research Article

Leveraging Social Networks to Integrate Depression Treatment into Primary Health and Tuberculosis Care in Brazil

Author(s): Annika C. Sweetland*, Claudio Gruber Mann, Maria Jose Fernandes, Camila Matsuzaka, Fatima Virginia de Silva, Jae Lee, Christopher McCarty, Afranio Kritski, Sandra Fortes, Maria Cavalcanti, Marcelo Feijó Mello, Maria A. Oquendo, Thomas Valente, Harold Pincus and Milton L. Wainberg

Volume 20, Issue 4, 2024

Published on: 17 October, 2023

Page: [350 - 365] Pages: 16

DOI: 10.2174/0126660822243332230921052022

Price: $65

Abstract

Background: Tuberculosis (TB) and depression are highly comorbid and linked to higher rates of death and disability. Several evidence-based treatments for depression have been successfully implemented in low- and middle-income countries, but more knowledge is needed on how to bring these innovations to scale within complex 'real world' public health systems.

Objective: To explore whether the principles of social network analysis could be used to enhance receptivity to integrating depression treatment into primary care for individuals with and without TB in Brazil.

Methods: We used existing scales to identify settings and providers with high receptivity and connectivity within the primary care network. We trained and supervised existing staff in three primary care sites to deliver a brief evidence-based intervention over one year, coupled with active dissemination activities. Afterwards, we reassessed receptivity among individuals involved, and not involved, in the pilot.

Results: Highly significant changes were observed in mental health literacy, attitudes towards evidence-based practices, work self-efficacy, and implementation leadership supporting our hypothesis. Limited social connections between primary care clinics precluded the examination of the hypothesis that targeting settings with high connectivity could capitalize on the information flow between and transcend the decentralized structure of the network, but leveraging the centralized nature of the TB program to integrate mental health services emerged as a promising alternative.

Conclusion: The findings of this study strongly suggest that social networks may be leveraged to change individual providers’ attitudes, thereby contributing to the enhanced dissemination of evidence-based interventions.

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[1]
Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ 2004; 82(11): 858-66.
[PMID: 15640922]
[2]
Moitra M, Santomauro D, Collins PY, et al. The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: A systematic review and Bayesian meta-regression analysis. PLoS Med 2022; 19(2): e1003901.
[http://dx.doi.org/10.1371/journal.pmed.1003901] [PMID: 35167593]
[3]
World Health Organization Global Tuberculosis Report 2021. Geneva, Switzerland: World Health Organization 2021.
[4]
Sweetland AC, Kritski A, Oquendo MA, et al. Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic. Int J Tuberc Lung Dis 2017; 21(8): 852-61.
[5]
Sweetland A, Oquendo M, Wainberg ML. Depression: A silent driver of the global tuberculosis epidemic. World Psychiatry 2014; 13(3): 325-6.
[6]
Njie GJ, Khan A. Prevalence of tuberculosis and mental disorders comorbidity: A systematic review and meta-analysis. J Immigr Minor Health 2021; 24(6): 1550-6.
[PMID: 34796457]
[7]
Koyanagi A, Vancampfort D, Carvalho AF, et al. Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries. BMC Med 2017; 15(1): 209.
[http://dx.doi.org/10.1186/s12916-017-0975-5] [PMID: 29179720]
[8]
Ruiz-Grosso P, Cachay R, de la Flor A, Schwalb A, Ugarte-Gil C. Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis. PLoS One 2020; 15(1): e0227472.
[http://dx.doi.org/10.1371/journal.pone.0227472] [PMID: 31923280]
[9]
Alene KA, Wangdi K, Colquhoun S, et al. Tuberculosis related disability: A systematic review and meta-analysis. BMC Med 2021; 19(1): 203.
[http://dx.doi.org/10.1186/s12916-021-02063-9] [PMID: 34496845]
[10]
Hoger S, Lykens K, Beavers SF, Katz D, Miller TL. Longevity loss among cured tuberculosis patients and the potential value of prevention. Int J Tuberc Lung Dis 2014; 18(11): 1347-52.
[11]
World Health Organization. Implementing the End TB Strategy: The Essentials 2015.
[12]
Sweetland AC, Jaramillo E, Wainberg ML, et al. Tuberculosis: An opportunity to integrate mental health services in primary care in low-resource settings. Lancet Psychiatry 2018; 5(12): 952-4.
[http://dx.doi.org/10.1016/S2215-0366(18)30347-X] [PMID: 30241700]
[13]
Sweetland AC, Galea J, Shin SS, et al. Integrating tuberculosis and mental health services: Global receptivity of national tuberculosis program directors. Int J Tuberc Lung Dis 2019; 23(5): 600-5.
[14]
Patel V, Belkin GS, Chockalingam A, et al. Grand challenges: integrating mental health services into priority health care platforms. PLoS Med 2013; 10(5): e1001448.
[http://dx.doi.org/10.1371/journal.pmed.1001448] [PMID: 23737736]
[15]
World Health Organization mhGAP Mental Health Gap Action Programme: Scaling up care for mental, neurological, and substance use disorders. Geneva, Switzerland: World Health Organization 2008.
[16]
de Jesus Mari J, Tófoli LF, Noto C, et al. Pharmacological and psychosocial management of mental, neurological and substance use disorders in low- and middle-income countries: Issues and current strategies. Drugs 2013; 73(14): 1549-68.
[http://dx.doi.org/10.1007/s40265-013-0113-4] [PMID: 24000001]
[17]
Barbui C, Purgato M, Abdulmalik J, et al. Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: An umbrella review. Lancet Psychiatry 2020; 7(2): 162-72.
[http://dx.doi.org/10.1016/S2215-0366(19)30511-5] [PMID: 31948935]
[18]
Karyotaki E, Araya R, Kessler RC, et al. Association of task-shared psychological interventions with depression outcomes in low- and middle-income countries. JAMA Psychiatry 2022; 79(5): 430-43.
[http://dx.doi.org/10.1001/jamapsychiatry.2022.0301] [PMID: 35319740]
[19]
Wainberg ML, Gouveia ML, Stockton MA, et al. Technology and implementation science to forge the future of evidence-based psychotherapies: The PRIDE scale-up study. Evid Based Ment Health 2021; 24(1): 19-24.
[http://dx.doi.org/10.1136/ebmental-2020-300199] [PMID: 33177149]
[20]
Valente TW. Diffusion of innovations. Genet Med 2003; 5(2): 69.
[21]
Rogers EM. Diffusion of innovations. (5th ed.), New York: Free Press 2003.
[22]
Greenhalgh T, Robert G, MacFarlane F, et al. Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q 2004; 82(4): 581-629.
[http://dx.doi.org/10.1111/j.0887-378X.2004.00325.x] [PMID: 15595944]
[23]
Bauer MS, Kirchner J. Implementation science: What is it and why should I care? Psychiatry Res 2020; 283: 112376.
[http://dx.doi.org/10.1016/j.psychres.2019.04.025] [PMID: 31036287]
[24]
Valente TW. Social Networks and Health: Models, Methods, and Applications. New York: Oxford University Press 2010.
[http://dx.doi.org/10.1093/acprof:oso/9780195301014.001.0001]
[25]
Borgatti SB, Everett MG, Johnson JC. Analyzing Social Networks. Los Angeles: Sage 2013.
[26]
Yamey G. Scaling up global health interventions: A proposed framework for success. PLoS Med 2011; 8(6): e1001049.
[http://dx.doi.org/10.1371/journal.pmed.1001049] [PMID: 21738450]
[27]
Valente TW. Social network thresholds in the diffusion of innovations. Soc Networks 1996; 18(1): 69-89.
[http://dx.doi.org/10.1016/0378-8733(95)00256-1]
[28]
Jippes E, Achterkamp MC, Brand PLP, et al. Disseminating educational innovations in health care practice: Training versus social networks. Soc Sci Med 2010; 70(10): 1509-17.
[http://dx.doi.org/10.1016/j.socscimed.2009.12.035] [PMID: 20199840]
[29]
Roger EM, Kincaid DL. Communication networks: A new paradigm for research. New York, NY: Free Press 1981.
[30]
Valente TW. Network interventions. Science 2012; 337(6090): 49-53.
[http://dx.doi.org/10.1126/science.1217330] [PMID: 22767921]
[31]
Dearing JW. Applying diffusion of innovation theory to intervention development. Res Soc Work Pract 2009; 19(5): 503-18.
[http://dx.doi.org/10.1177/1049731509335569] [PMID: 20976022]
[32]
Aarons GA. Measuring provider attitudes toward evidence-based practice: Consideration of organizational context and individual differences. Child Adolesc Psychiatr Clin N Am 2005; 14(2): 255-71.
[http://dx.doi.org/10.1016/j.chc.2004.04.008] [PMID: 15694785]
[33]
Weissman MM, Hankerson SH, Scorza P, et al. Interpersonal counseling (IPC) for depression in primary care. Am J Psychother 2014; 68(4): 359-83.
[http://dx.doi.org/10.1176/appi.psychotherapy.2014.68.4.359] [PMID: 26453343]
[34]
Brazilian Ministry of Health. National Primary Care Policy. Brazil: Brazilian Ministry of Health. 2012.
[35]
Macinko J, Harris MJ. Brazil’s family health strategy--delivering community-based primary care in a universal health system. N Engl J Med 2015; 372(23): 2177-81.
[http://dx.doi.org/10.1056/NEJMp1501140] [PMID: 26039598]
[36]
Population Census. Brazilian Institute of Geography and Statistics 2010.
[37]
Sweetland A, Fernandes MJ, Santos E, et al. Community resource mapping to integrate evidence-based depression treatment in primary care in Brazil: A pilot project. Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: Advancing efficient methodologies through community partnerships and team science. Implement Sci 2016; 11(S1): A59.
[38]
Brazilian Ministry of Health. Brazilialn End TB National Plan 2021-2025 2021. Available from: http://wwwaidsgovbr/pt-br/pub/2021/brasil-livre-datuberculose (Accessed on July 25, 2022)
[39]
Lee GE, Scuffell J, Galea JT, et al. Impact of mental disorders on active tuberculosis treatment outcomes: A systematic review and meta-analysis. medRxiv 2020.
[http://dx.doi.org/10.1101/2020.06.19.20135913]
[40]
O’Connor M, Casey L. The mental health literacy scale (MHLS): A new scale-based measure of mental health literacy. Psychiatry Res 2015; 229(1-2): 511-6.
[http://dx.doi.org/10.1016/j.psychres.2015.05.064] [PMID: 26228163]
[41]
Aarons GA, Glisson C, Hoagwood K, et al. Psychometric properties and U.S. national norms of the Evidence-Based Practice Attitude Scale (EBPAS). Psychol Assess 2010; 22(2): 356-65.
[http://dx.doi.org/10.1037/a0019188] [PMID: 20528063]
[42]
Silvia P, Maria Luisa F, Francesco A, et al. Work self-efficacy scale and search forwork self-efficacy scale: A validation study in spanish and italian cultural contexts. J Work Organ Psychol 2010; 26(3): 201-10.
[http://dx.doi.org/10.5093/tr2010v26n3a4]
[43]
Aarons GA, Ehrhart MG, Farahnak LR. The implementation leadership scale (ILS): Development of a brief measure of unit level implementation leadership. Implement Sci 2014; 9(1): 45.
[http://dx.doi.org/10.1186/1748-5908-9-45] [PMID: 24731295]
[44]
Green LW, Kreuter MW, Green LW. Health Program Planning: An Educational and Ecological Approach. (4th ed.), New York, NY: McGraw-Hill 2005.
[45]
Jorm AF, Korten AE, Jacomb PA, et al. “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 1997; 166(4): 182-6.
[http://dx.doi.org/10.5694/j.1326-5377.1997.tb140071.x] [PMID: 9066546]
[46]
Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: The evidence-based practice attitude scale (EBPAS). Ment Health Serv Res 2004; 6(2): 61-74.
[http://dx.doi.org/10.1023/B:MHSR.0000024351.12294.65] [PMID: 15224451]
[47]
World Health Organization. mhGAP Intervention Guide: Version 2.0. 2016. https://wwwwhoint/publications/i/item/mhgapintervention- guide---version-20(Accessed on: January 8, 2021).
[48]
Murray LK, Dorsey S, Bolton P, et al. Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. Int J Ment Health Syst 2011; 5(1): 30.
[http://dx.doi.org/10.1186/1752-4458-5-30] [PMID: 22099582]
[49]
Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: A systematic review. Soc Sci Med 2013; 97: 82-6.
[http://dx.doi.org/10.1016/j.socscimed.2013.08.004] [PMID: 24161092]
[50]
Shahmalak U, Blakemore A, Waheed MW, et al. The experiences of lay health workers trained in task-shifting psychological interventions: A qualitative systematic review. Int J Ment Health Syst 2019; 13(1): 64.
[http://dx.doi.org/10.1186/s13033-019-0320-9] [PMID: 31636699]
[51]
Esponda GM, Hartman S, Qureshi O, et al. Barriers and facilitators of mental health programmes in primary care in low-income and middle-income countries. Lancet Psychiatry 2020; 7(1): 78-92.
[http://dx.doi.org/10.1016/S2215-0366(19)30125-7] [PMID: 31474568]
[52]
Valente TW, Davis RL. Accelerating the diffusion of innovations using opinion leaders. Ann Am Acad Political Soc Sci 1999; 566(1): 55-67.
[53]
Valente TW, Pumpuang P. Identifying opinion leaders to promote behavior change. Health Educ Behav 2007; 34(6): 881-96.
[54]
Blanchet K, James P. How to do (or not to do)... a social network analysis in health systems research. Health Policy Plan 2012; 27(5): 438-46.
[http://dx.doi.org/10.1093/heapol/czr055] [PMID: 21840934]
[55]
Perkins JM, Subramanian SV, Christakis NA. Social networks and health: A systematic review of sociocentric network studies in low- and middle-income countries. Soc Sci Med 2015; 125: 60-78.
[http://dx.doi.org/10.1016/j.socscimed.2014.08.019] [PMID: 25442969]

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