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Packages of Care for Depression in Low- and Middle-Income Countries

Packages of Care for Depression in Low- and Middle-Income Countries

  • Vikram Patel, 
  • Gregory Simon, 
  • Neerja Chowdhary, 
  • Sylvia Kaaya, 
  • Ricardo Araya
PLOS
x

This is the first in a series of articles highlighting the delivery of “packages of care” for mental health disorders in low- and middle-income countries. Packages of care are combinations of treatments aimed at improving the recognition and management of conditions to achieve optimal outcomes.

Introduction

Depression is the leading cause of disease burden in most regions of the world [1]. The International Classification of Disease (ICD) 10 diagnostic criteria for depressive episode are shown in Box 1. Somatic presentations are very common, especially tiredness, sleep problems, and aches and pains. Of these, only tiredness is considered a “core” feature in current classifications. Anxiety symptoms often coexist with depressive symptoms, particularly in community or primary care samples. The term “common mental disorders” is used to describe the heterogeneous presentation of anxiety, depressive, and somatic symptoms in these contexts [2].

Box 1. International Classification of Disease 10 Criteria for Depressive Episode

F 32: Depressive Episode. In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called “somatic” symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe. Source: World Health Organization [74].

The World Mental Health Surveys have described the prevalence and help-seeking behaviours of people with depression in a large number of countries [3],[4]. The major observations about the epidemiology of depression from these and other studies on depression can be summarized as follows: (1) the constellation of symptoms used to characterize depression can be identified in all cultures; (2) the prevalence rates of depression vary considerably between populations, with rates ranging from about 6% in China to over 20% in the US; (3) the age of onset is most commonly in young adulthood; (4) the disorder often runs a relapsing or chronic course; (5) the disorder is two to three times more common in women, although a few studies, particularly from Africa, have not shown this female excess; and (6) social factors, particularly related to economic or social disadvantages such as low education and violence, are major determinants of the risk for depression [5].

Depression is the leading neuropsychiatric cause of the burden of disease globally and in low- and middle-income countries (LMIC), and is projected to be, overall, the second leading cause of burden of disease by 2020 [6],[7]. Apart from its profound impact on function, depression is associated with increased mortality (particularly through suicide). The condition is often comorbid with other chronic diseases such as diabetes and is responsible for a significant proportion of the disability associated with these conditions [8]. Depression has been associated with a range of poor health outcomes, including poor infant growth (in the case of maternal depression in some countries in South Asia, for example) and worse physical health (for example, cardiovascular or HIV outcomes through poor adherence) [9],[10].

In this article we focus on the effective management of depression in LMICs, reviewing the evidence on efficacy of treatments and delivery of interventions derived from LMICs to the extent possible. Because that evidence is often limited, we also cite systematic reviews or meta-analyses based on global evidence and key trials from high income countries (HIC) where appropriate. On the basis of our review we propose a package of care—a combination of treatments aimed at improving the recognition and management of conditions to achieve optimal outcomes—for depression.

The Evidence on the Treatment of Depression

Detection of Depression

A critical first step in the provision of treatments for any disorder is its effective recognition (Table 1). An extensive literature has examined the validity of depression severity measures in HICs. A systematic review [11] examined the accuracy of several commonly used measures including the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D), the Zung Self-Rated Depression Scale (SDS), and the Hopkins Symptom Checklist (HSCL). That review found that all commonly used measures performed well in identifying depression among primary care patients, and no measure was recommended over others. The Patient Health Questionnaire (PHQ) was specifically designed to identify and monitor depression severity among primary care patients. Considerable research in the US and Western Europe supports its validity [12],[13].

A relatively large body of research has examined the validity of depression case-finding measures among primary care patients and community residents, and this body of work has focused on measures with more international lineage including the General Health Questionnaire (GHQ), the Self-Reporting Questionnaire (SRQ), and the Kessler Distress Scale (K6). Studies focused on these measures have been done in LMICs including India [14], Ethiopia [15], Burkina Faso [16], Chile [17][19], Brazil [20],[21], Mongolia [22], as well as the 15-site World Health Organization Collaborative study [23], and support the validity of each of these measures in primary care and community settings.

Drug Therapies

Given requirements for drug licensure in the US and Western Europe, a large research literature examines the efficacy of antidepressants in HICs. In its original guidelines for depression treatment in primary care [24], the US Agency for Healthcare Policy and Research summarized data regarding older antidepressants, with an emphasis on studies conducted in primary care settings. That meta-analysis found strong evidence for the efficacy of antidepressant pharmacotherapy and no evidence of advantage for any specific drug over any other. Two subsequent meta-analyses [25],[26] reached a similar conclusion regarding newer antidepressant drugs.

However, one recent meta-analysis found that differences do exist between various newer antidepressants with sertraline emerging as the drug of choice on the basis of superior efficacy and acceptability and lower cost [27]. Furthermore, there is evidence of the greater tolerability of selective serotonin reuptake inhibitors (SSRIs) over tricyclic antidepressants [28], and, for the treatment of depression in adolescents, fluoxetine has been identified as the antidepressant with the optimal balance of benefit versus harm [29].

Following a therapeutic response, antidepressant continuation treatment for a period of 9 to 12 mo has been found to significantly reduce the risk of relapse/recurrence [30].

Conversely, there are some studies that refute the efficacy of antidepressants in the treatment of depression, attributing the perceived effect to publication bias [31] or to the decreased responsiveness to placebo in severely depressed patients (rather than increased responsiveness to antidepressants) [32]. These findings have led to some investigators recommending the need to enhance transparent reporting of clinical trials and reinvigorate antidepressant drug discovery [33].

The literature supporting the efficacy of antidepressant pharmacotherapies for primary care patients in LMICs is relatively small. A randomized trial in India found fluoxetine superior to placebo (specifically at 2-mo follow up) among primary care patients with raised levels of psychological distress [34]. In two Chilean studies [35],[36],which evaluated stepped care, including antidepressants, for women with depression, significant improvements were seen at 6 mo in the intervention group compared to the control group (70% versus 30% in one study and 34% versus 9% in the other study). Although we are not aware of any evidence that medications proven efficacious in HICs are ineffective in other settings, there is some evidence of interethnic differences in the dosing requirements of antidepressant medication that may be attributable to pharmacogenetic polymorphism [37],[38]. This observation may have important implications for drug side effects and adherence to antidepressant medication, and is an important area of future study.

Structured Psychotherapies

Several randomized trials from HICs support the efficacy of depression-specific structured psychotherapies. Meta-analyses [39],[40] found strong evidence that cognitive therapy for depression is superior to no treatment or a wait-list control condition and some evidence that it is superior to other unstructured or nonspecific psychotherapies. A systematic review [41] found consistent evidence for the efficacy of interpersonal psychotherapy among depressed outpatients.

Most trials of cognitive therapy and interpersonal psychotherapy have been conducted in specialty mental health clinics. In primary care settings, there is consistent evidence favouring brief psychological treatments over treatment as usual [42]. In addition, behavioural activation has been found to be effective in reducing depressive symptoms and is said to be a relatively simple and potentially feasible form of psychological treatment in nonspecialised health care settings [43]. A meta-analysis [44] found that problem-solving therapy had a strong therapeutic effect, but that this effect varied considerably between studies. Most trials of problem-solving therapy have been conducted in primary care settings. A separate meta-analysis by Cuijpers and colleagues [45] compared all of these structured therapies, finding no evidence that one was superior to any other although they were reported to be superior to nonspecific supportive therapy.

As for the evidence from LMICs, several randomized trials have evaluated the effectiveness of structured psychotherapy programs, mostly comparing adapted psychotherapy programs to usual care or no-treatment control conditions. A randomized trial in Pakistan by Rahman and colleagues showed the effectiveness of a cognitive-behavioural therapy delivered by community health workers [46]. Two trials in Chile [35],[36] found a benefit from stepped-care depression treatment, based upon a structured group cognitive-behavioural therapy program, for women presenting to primary care clinics. Two trials from Uganda showed the effectiveness of group interpersonal psychotherapy for depressed residents of rural villages [47] and among depressed adolescents residing in refugee camps [48]. One primary care-based trial in India found no benefit of problem-solving therapy [34]; poor adherence and the high prevalence of severe psychosocial stressors were said to be possible reasons for this poor response [49].

Electroconvulsive Therapy

A recent meta-analysis of the efficacy of electroconvulsive therapy (ECT) in depression reported a significant benefit of ECT over antidepressants, placebo, and simulated ECT particularly for severe and resistant forms [50]. This review consisted of evidence from randomized and nonrandomized controlled trials mostly from HICs. Additionally, ECT has been argued to be the treatment of choice for severe depression in late life [51]. However, a prospective naturalistic study found that the rate of remission of depression with ECT in community settings is substantially less than that reported in clinical trials [52]. There are no recent studies of ECT efficacy in LMICs where the practice of ECT may in fact be suboptimal due to poor provider methods such as use of bilateral electrode placement, use of sine wave ECT, lack of EEG monitoring, and in some cases, use of unmodified ECT [53].

Delivery of Effective Interventions

Depression screening and outcome questionnaires appear to perform well across a wide range of settings. Conventional depression treatments, including medications, structured psychotherapies, and ECT appear to have therapeutic benefits. Although the evidence base for the efficacy of depression treatments is not large in LMICs, the evidence we reviewed suggests that depression treatments are just as effective in more disadvantaged patient populations or under-resourced systems of care. All treatments seem to achieve about the same degree of benefit, with combination treatments (both medication and psychotherapy, and ECT for selected individuals), having greater effect in more severe or monotherapy-resistant cases.

Interventions to Increase Demand for Services

Stigma and the lack of awareness of mental disorders lead to the under-use of available mental health services (Table 2). In HICs awareness campaigns for depression have sought to address this problem by targeting the public, medical professionals, and educational institutions [54],[55]. In LMICs we found one study that aimed to increase community awareness of mental health problems by implementing a school mental health program [56]. The 4-mo program of mental health education in rural Pakistan was conducted by a team of experts in collaboration with teachers and schoolchildren. The program led to a significant improvement in mental health awareness among students and, through them, other members of the local community. However, the impact of this intervention on increasing demand for services was not reported.

Interventions to Improve Capacity of Health Care Teams

A recent report by the World Health Organisation (WHO) and the World Organisation of Family Doctors (WONCA) on integrating mental health into primary care reviewed training initiatives in different settings [57]. Two examples are described here.

The program in Sembabule, Uganda consisted of specialist outreach services from the hospital to the primary care level providing training and ongoing mentoring of primary care workers to provide mental health services. The primary care workers were trained to identify mental health problems, treat patients with uncomplicated common mental disorders, and provide emergency care and referral services. In-service training of general health workers was found to be especially challenging because of understaffing and hence increased workload resulting from added mental health tasks. This training was complemented by the formation of village health teams consisting of trained volunteers. The formation of these teams turned out to be a key step in the mental health integration process.

A mental health program in Kerala, India faced the added challenge of the transfer of trained health workers from the participating clinics to new locations at regular intervals as mandated by government regulations. Thus, frequent ongoing training of newly arrived health workers led to an added burden on resources. Additionally, for the treatment of a chronic condition such as depression, training alone is ineffective and adequate specialist supervision is a vital component of any training initiative.

Interventions to Improve the Recognition of Depression

There is evidence that locally validated screening instruments can be used by nonphysician and community health workers. When used in such settings, these instruments have comparable psychometric properties and clinical utility to one another. When systematically adapted for use in the local context, such instruments show good criterion validity against both biomedical diagnostic criteria and local descriptions of depression. One such example is the HSCL. When compared with a locally described syndrome approximating depression derived from ethnographic research, this instrument had a sensitivity of 95% [58], Further, HSCL-25 and its depression subscale the HSCL-15, both had sensitivities of 89% for detection of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) major depression with specificities of 80% and 79%, respectively [59]. A comparison of five screening questionnaires in a primary care setting in India, administered by a school graduate with 1 wk of training, found that they all had comparable case detection psychometric properties [14].

A recent meta-analysis of studies from HICs suggested that screening may not necessarily be the most efficient method for case detection; it reported that intervention effect sizes were larger when patients were referred by general practitioners (GPs) than when referred through systematic screening [42]. A possible explanation may be that those identified by GPs tend to have more severe symptoms than those identified through screening. The Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) study, which enrolled participants by screening and by GP referrals but used the same entry criteria for both, found equal benefit of the collaborative care intervention (involving a collaboration between the primary care team and a supervising psychiatrist) program in the two groups [60]. In any event, although screening questionnaires are a useful tool in primary care, given the variability in GP practice, they need to be supplemented with clinical judgment.

Interventions to Increase the Acceptability and Reduce the Costs of Treatments

According to the WHO/WONCA report [57], psychological treatments such as interpersonal therapy and cognitive-behavioural therapy have almost all been developed in HICs and need to be adapted to be culturally relevant in LMICs. For example, the Thinking Healthy Program, an adaptation of cognitive-behavioural therapy, has been successfully adapted and used by Lady Health Workers (women from local communities who are trained to deliver basic health care interventions) in the treatment of postnatal depression in Pakistan [46]. Adaptations were made to render the therapy more acceptable, such as using pictorial information to address low levels of literacy and reducing the training period to address the time pressures for the health workers. Providing psychological treatments in the group setting builds on social mechanisms and networks that are already in place in many nonwestern cultures. For example in Uganda, a group interpersonal therapy program was based on interpersonal triggers for depression and group relationship building, concepts that were judged to be compatible with Ugandan culture, and was adapted for treatment of depression both in adults in a rural community and in adolescent war survivors [47],[48]. Providing these treatments in the rural setting, group setting, and using local community workers to deliver the interventions appear also to be effective methods for reducing costs of treatment [35],[46],[47],[61].

Practice-Based Interventions to Deliver Efficacious Treatments

Collaborative care models that incorporate systematic identification of patients, active case management by competent staff, and specialist supervision are effective for the integration of depression treatment into primary care [62]. These models have largely been developed in HICs. For example, the IMPACT trial successfully used these principles in the treatment of late life depression in primary care settings [60]. Here, intervention patients had access to a case manager who offered education, care management, antidepressant treatment support, and brief psychotherapy, all done under the supervision of a psychiatrist and a primary care expert. This treatment was significantly more effective than usual care at the end of 12 mo. The model, however, may require alteration in LMIC settings with few or no mental health specialists; in such settings, other types of health practitioners with appropriate training in mental health care may provide leadership for the collaborative care program. A cluster randomized controlled trial of such a collaborative care model is currently being conducted in India [63].

Another practice-based intervention may involve tailoring depression treatment to match individual needs, which was the principle behind the multicomponent stepped care intervention used in primary care management of depression in Chile. Two trials in this setting have produced amongst the highest recovery rates recorded in any depression treatment studies and, notably, did not involve a psychiatrist [35],[36]. The intervention delivered by a nonmedical health worker consisted of psychoeducational groups, treatment adherence support, and pharmacotherapy for those with severe depression. Commentators have noted that stepped-care interventions for depression call for brief psychoeducational interventions as first line treatment, reserving pharmacotherapy for those with more severe or treatment-resistant depression [36],[64].

In addition, practice-based quality improvement programs can help improve delivery of efficacious treatments. These programs have largely been developed in HICs to include strategies such as institutional commitment, training of local leaders and health care staff, and detection of depression. These measures can improve both mental health and quality of care outcomes of primary care depression programs [65]. Finally, a practice-based intervention to improve adherence to medicines is periodic telephone contacts, which was found to reinforce adherence to depression treatment in women attending primary care in Chile [35],[66].

Community-Based Interventions to Deliver Efficacious Treatments

Evidence for community-based interventions to deliver mental health care derives from both LMICs and HICs. A systematic review of the effects of community-based models of mental health care in LMICs found that these lead to improvement in mental health outcomes and cost saving [67]. The study in rural Pakistan cited earlier showed the effectiveness on maternal depression of cognitive behavioural-based psychological intervention integrated into the routine work of community-based primary level workers [46]. A cluster randomized study conducted in urban and rural areas of the Trent region in the UK showed the effectiveness of training health visitors to detect postnatal depression and deliver psychologically informed sessions in women's homes [68].

Evidence suggests that advances in information and communication technology have increased the range of options available for delivery of interventions in the community. Telephone counselling, for example, can increase accessibility, and is private and nonstigmatising. In a trial in Ontario, Canada, telephone-based support by former service users was found to be effective in women identified as high risk for postnatal depression [69].

Interventions to Address other Health and Social Outcomes

Other interventions to deliver efficacious mental health care treatments include psychosocial stimulation programs [70],[71] and befriending to reduce suicide [72], which may have a role in mitigating the effects of maternal depression on infant development and of depression on suicidal behaviour. A US trial incorporating depression screening, vigorous outreach, and care management of depressed individuals improved not only clinical outcomes but overall work functioning including job retention [73].

Packages of Care for Depression

Depression is clearly a global health priority. Improving the recognition of this disorder in clinical populations in LMICs is aided by the successful adaption of depression-screening instruments from HIC settings into settings with few resources and weaker health systems. Our review suggests that evidence-based treatments such as antidepressants and psychotherapy are effective in managing depression; it is important, however, that such treatments are adapted when used in LMICs to increase their acceptability, accessibility, and manage their costs. We propose two packages of care on the basis of the availability of mental health specialist resources (Table 3). The delivery of these treatments should ideally be carried out through an integration of depression programs into existing health services or community settings with task-shifting to nonspecialist health workers to deliver front-line care and a supervisory framework of appropriately skilled mental health workers.

Acknowledgments

We thank developmental editor Jane Bradbury.

Author Contributions

ICMJE criteria for authorship read and met: VP GS NC SK RA. Wrote the first draft of the paper: VP. Contributed to the writing of the paper: VP GS NC SK RA.

References

  1. 1. WHO (2004) The global burden of disease: 2004 update. Geneva: World Health Organisation. WHO2004The global burden of disease: 2004 updateGenevaWorld Health Organisation
  2. 2. Goldberg D, Huxley P (1992) Common mental disorders: a biosocial model. London: Tavistock/Routledge. D. GoldbergP. Huxley1992Common mental disorders: a biosocial modelLondonTavistock/Routledge
  3. 3. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, et al. (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370: 841–850.PS WangS. Aguilar-GaxiolaJ. AlonsoMC AngermeyerG. Borges2007Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.Lancet370841850
  4. 4. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, et al. (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291: 2581–2590.K. DemyttenaereR. BruffaertsJ. Posada-VillaI. GasquetV. Kovess2004Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.JAMA29125812590
  5. 5. Patel V, Lund C, Heatherill S, Plagerson S, Corrigal J, et al. (2009) Social determinants of mental disorders. In: Blas E, Sivasankara Kurup A, editors. Priority public health conditions: from learning to action on social determinants of health. Geneva: World Health Organization. V. PatelC. LundS. HeatherillS. PlagersonJ. Corrigal2009Social determinants of mental disorders.E. BlasA. Sivasankara KurupPriority public health conditions: from learning to action on social determinants of healthGenevaWorld Health Organization
  6. 6. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3: e442.CD MathersD. Loncar2006Projections of global mortality and burden of disease from 2002 to 2030.PLoS Med3e442
  7. 7. Lopez DA, Mathers DC, Ezzati M, Jamison TD, Murray JLC (2006) Global burden of disease and risk factors. New York: Oxford University Press and The World Bank. DA LopezDC MathersM. EzzatiTD JamisonJLC Murray2006Global burden of disease and risk factorsNew YorkOxford University Press and The World Bank
  8. 8. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, et al. (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370: 851–858.S. MoussaviS. ChatterjiE. VerdesA. TandonV. Patel2007Depression, chronic diseases, and decrements in health: results from the World Health Surveys.Lancet370851858
  9. 9. Sarna A, Pujari S, Sengar AK, Garg R, Gupta I, et al. (2008) Adherence to antiretroviral therapy & its determinants amongst HIV patients in India. Indian J Med Res 127: 28–36.A. SarnaS. PujariAK SengarR. GargI. Gupta2008Adherence to antiretroviral therapy & its determinants amongst HIV patients in India.Indian J Med Res1272836
  10. 10. Prince M, Patel V, Saxena S, Maj M, Maselko J, et al. (2007) No health without mental health. Lancet 370: 859–877.M. PrinceV. PatelS. SaxenaM. MajJ. Maselko2007No health without mental health.Lancet370859877
  11. 11. Mulrow CD, Williams JW Jr, Gerety MB, Ramirez G, Montiel OM, et al. (1995) Case-finding instruments for depression in primary care settings. Ann Intern Med 122: 913–921.CD MulrowJW Williams JrMB GeretyG. RamirezOM Montiel1995Case-finding instruments for depression in primary care settings.Ann Intern Med122913921
  12. 12. Kroenke K, Spitzer RL, Williams JB (2003) The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 41: 1284–1292.K. KroenkeRL SpitzerJB Williams2003The Patient Health Questionnaire-2: validity of a two-item depression screener.Med Care4112841292
  13. 13. Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC (2007) Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry 29: 388–395.KA WittkampfL. NaeijeAH ScheneJ. HuyserHC van Weert2007Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review.Gen Hosp Psychiatry29388395
  14. 14. Patel V, Araya R, Chowdhary N, King M, Kirkwood B, et al. (2008) Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychol Med 38: 221–228.V. PatelR. ArayaN. ChowdharyM. KingB. Kirkwood2008Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires.Psychol Med38221228
  15. 15. Hanlon C, Medhin G, Alem A, Araya M, Abdulahi A, et al. (2008) Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale. J Affect Disord 108: 251–262.C. HanlonG. MedhinA. AlemM. ArayaA. Abdulahi2008Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale.J Affect Disord108251262
  16. 16. Baggaley RF, Ganaba R, Filippi V, Kere M, Marshall T, et al. (2007) Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso. Trop Med Int Health 12: 1225–1229.RF BaggaleyR. GanabaV. FilippiM. KereT. Marshall2007Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso.Trop Med Int Health1212251229
  17. 17. Araya R, Wynn R, Lewis G (1992) Comparison of two self administered psychiatric questionnaires (GHQ-12 and SRQ-20) in primary care in Chile. Soc Psychiatry Psychiatr Epidemiol 27: 168–173.R. ArayaR. WynnG. Lewis1992Comparison of two self administered psychiatric questionnaires (GHQ-12 and SRQ-20) in primary care in Chile.Soc Psychiatry Psychiatr Epidemiol27168173
  18. 18. Lewis G, Araya RI (1995) Is the General Health Questionnaire (12 item) a culturally biased measure of psychiatric disorder? Soc Psychiatry Psychiatr Epidemiol 30: 20–25.G. LewisRI Araya1995Is the General Health Questionnaire (12 item) a culturally biased measure of psychiatric disorder?Soc Psychiatry Psychiatr Epidemiol302025
  19. 19. Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 22: 465–486.G. LewisAJ PelosiR. ArayaG. Dunn1992Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers.Psychol Med22465486
  20. 20. Mari JJ, Williams P (1985) A comparison of the validity of two psychiatric screening questionnaires (GHQ-12 and SRQ-20) in Brazil, using Relative Operating Characteristic (ROC) analysis. Psychol Med 15: 651–659.JJ MariP. Williams1985A comparison of the validity of two psychiatric screening questionnaires (GHQ-12 and SRQ-20) in Brazil, using Relative Operating Characteristic (ROC) analysis.Psychol Med15651659
  21. 21. Mari JJ, Williams P (1986) A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. Br J Psychiatry 148: 23–26.JJ MariP. Williams1986A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo.Br J Psychiatry1482326
  22. 22. Pollock JI, Manaseki-Holland S, Patel V (2006) Detection of depression in women of child-bearing age in non-Western cultures: a comparison of the Edinburgh Postnatal Depression Scale and the Self-Reporting Questionnaire-20 in Mongolia. J Affect Disord 92: 267–271.JI PollockS. Manaseki-HollandV. Patel2006Detection of depression in women of child-bearing age in non-Western cultures: a comparison of the Edinburgh Postnatal Depression Scale and the Self-Reporting Questionnaire-20 in Mongolia.J Affect Disord92267271
  23. 23. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, et al. (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27: 191–197.DP GoldbergR. GaterN. SartoriusTB UstunM. Piccinelli1997The validity of two versions of the GHQ in the WHO study of mental illness in general health care.Psychol Med27191197
  24. 24. Panel DG (1993) Clinical practice guideline number 5: depression in primary care. Rockville (Maryland): U.S. Dept of Health and Human Services, Agency for Health Policy and Research. DG Panel1993Clinical practice guideline number 5: depression in primary careRockville (Maryland)U.S. Dept of Health and Human Services, Agency for Health Policy and ResearchAHCPR publication number 93-0550. AHCPR publication number 93-0550.
  25. 25. Williams J, Mulrow C, Chiquette E, Noel P, Aguilar C, et al. (2000) A systematic review of newer pharmacotherapies for depression in adults: evidence review summary. Ann Intern Med 132: 743–756.J. WilliamsC. MulrowE. ChiquetteP. NoelC. Aguilar2000A systematic review of newer pharmacotherapies for depression in adults: evidence review summary.Ann Intern Med132743756
  26. 26. Gartlehner G, Gaynes BN, Hansen RA, Thieda P, DeVeaugh-Geiss A, et al. (2008) Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians. Ann Intern Med 149: 734–750.G. GartlehnerBN GaynesRA HansenP. ThiedaA. DeVeaugh-Geiss2008Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians.Ann Intern Med149734750
  27. 27. Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, et al. (2009) Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 373: 746–758.A. CiprianiTA FurukawaG. SalantiJR GeddesJP Higgins2009Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis.Lancet373746758
  28. 28. National Institute for Clinical Excellence (2004) Depression: management of depression in primary and secondary care. London: NICE. National Institute for Clinical Excellence2004Depression: management of depression in primary and secondary careLondonNICE
  29. 29. Hetrick SE, Merry SN, McKenzie J, Sindahl P, Proctor M (2007) Selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in children and adolescents. SE HetrickSN MerryJ. McKenzieP. SindahlM. Proctor2007Selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in children and adolescents.Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD004851. doi:10.1002/14651858.CD004851.pub2. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD004851. doi:10.1002/14651858.CD004851.pub2.
  30. 30. Kaymaz N, van Os J, Loonen AJ, Nolen WA (2008) Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation: a meta-analysis of placebo-controlled randomized trials. J Clin Psychiatry 69: 1423–1436.N. KaymazJ. van OsAJ LoonenWA Nolen2008Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation: a meta-analysis of placebo-controlled randomized trials.J Clin Psychiatry6914231436
  31. 31. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R (2008) Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 358: 252–260.EH TurnerAM MatthewsE. LinardatosRA TellR. Rosenthal2008Selective publication of antidepressant trials and its influence on apparent efficacy.N Engl J Med358252260
  32. 32. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. (2008) Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 5: e45.I. KirschBJ DeaconTB Huedo-MedinaA. ScoboriaTJ Moore2008Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration.PLoS Med5e45
  33. 33. Mathew SJ, Charney DS (2009) Publication bias and the efficacy of antidepressants. Am J Psychiatry 166: 140–145.SJ MathewDS Charney2009Publication bias and the efficacy of antidepressants.Am J Psychiatry166140145
  34. 34. Patel V, Chisholm D, Rabe-Hesketh S, Dias-Saxena F, Andrew G, et al. (2003) The efficacy and cost-effectiveness of a drug and psychological treatment for common mental disorders in general health care in Goa, India: a randomised controlled trial. Lancet 361: 33–39.V. PatelD. ChisholmS. Rabe-HeskethF. Dias-SaxenaG. Andrew2003The efficacy and cost-effectiveness of a drug and psychological treatment for common mental disorders in general health care in Goa, India: a randomised controlled trial.Lancet3613339
  35. 35. Rojas G, Fritsch R, Solis J, Jadresic E, Castillo C, et al. (2007) Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial. Lancet 370: 1629–1637.G. RojasR. FritschJ. SolisE. JadresicC. Castillo2007Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial.Lancet37016291637
  36. 36. Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, et al. (2003) Treating depression in primary care among low-income women in Santiago, Chile: a randomised controlled trial. Lancet 361: 995–1000.R. ArayaG. RojasR. FritschJ. GaeteM. Rojas2003Treating depression in primary care among low-income women in Santiago, Chile: a randomised controlled trial.Lancet3619951000
  37. 37. Kilonzo GP, Kaaya SF, Rweikiza JK, Kassam M, Moshi G (1994) Determination of appropriate clomipramine dosage among depressed African outpatients in Dar es Salaam, Tanzania. Cent Afr J Med 40: 178–182.GP KilonzoSF KaayaJK RweikizaM. KassamG. Moshi1994Determination of appropriate clomipramine dosage among depressed African outpatients in Dar es Salaam, Tanzania.Cent Afr J Med40178182
  38. 38. Dandara C, Masimirembwa CM, Magimba A, Sayi J, Kaaya S, et al. (2001) Genetic polymorphism of CYP2D6 and CYP2C19 in east- and southern African populations including psychiatric patients. Eur J Clin Pharmacol 57: 11–17.C. DandaraCM MasimirembwaA. MagimbaJ. SayiS. Kaaya2001Genetic polymorphism of CYP2D6 and CYP2C19 in east- and southern African populations including psychiatric patients.Eur J Clin Pharmacol571117
  39. 39. Dobson K (1989) A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psychol 57: 414–419.K. Dobson1989A meta-analysis of the efficacy of cognitive therapy for depression.J Consult Clin Psychol57414419
  40. 40. Gloaguen V, Cottraux J, Cucherat M, Blackburn I (1998) A meta-analysis of the effects of cognitie therapy in depressed patients. J Affect Disord 49: 59–72.V. GloaguenJ. CottrauxM. CucheratI. Blackburn1998A meta-analysis of the effects of cognitie therapy in depressed patients.J Affect Disord495972
  41. 41. de Mello M, de Jesus Mari J, Bacaltchuk J, Verdeli H, Neugelbauer R (2005) A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci 255: 75–82.M. de MelloJ. de Jesus MariJ. BacaltchukH. VerdeliR. Neugelbauer2005A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders.Eur Arch Psychiatry Clin Neurosci2557582
  42. 42. Cuijpers P, van Straten A, van Schaik A, Andersson G (2009) Psychological treatment of depression in primary care: a meta-analysis. Br J Gen Pract 59: e51–e60.P. CuijpersA. van StratenA. van SchaikG. Andersson2009Psychological treatment of depression in primary care: a meta-analysis.Br J Gen Pract59e51e60
  43. 43. Ekers D, Richards D, Gilbody S (2008) A meta-analysis of randomized trials of behavioural treatment of depression. Psychol Med 38: 611–623.D. EkersD. RichardsS. Gilbody2008A meta-analysis of randomized trials of behavioural treatment of depression.Psychol Med38611623
  44. 44. Cuijpers P, van Straten A, Warmerdam L (2007) Problem solving therapies for depression: a meta-analysis. Eur Psychiatry 22: 9–15.P. CuijpersA. van StratenL. Warmerdam2007Problem solving therapies for depression: a meta-analysis.Eur Psychiatry22915
  45. 45. Cuijpers P, van Straten A, Andersson G, van Oppen P (2008) Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol 76: 909–922.P. CuijpersA. van StratenG. AnderssonP. van Oppen2008Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies.J Consult Clin Psychol76909922
  46. 46. Rahman A, Malik A, Sikander S, Roberts C, Creed F (2008) Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372: 902–909.A. RahmanA. MalikS. SikanderC. RobertsF. Creed2008Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial.Lancet372902909
  47. 47. Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, et al. (2003) Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA 289: 3117–3124.P. BoltonJ. BassR. NeugebauerH. VerdeliKF Clougherty2003Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial.JAMA28931173124
  48. 48. Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, et al. (2007) Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA 298: 519–527.P. BoltonJ. BassT. BetancourtL. SpeelmanG. Onyango2007Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial.JAMA298519527
  49. 49. Patel V, Weiss H, Mann A (2009) Predictors of outcome in patients with common mental disorders receiving a brief psychological treatment: an exploratory analysis of a randomised controlled trial from Goa, India. African Journal of Psychiatry. V. PatelH. WeissA. Mann2009Predictors of outcome in patients with common mental disorders receiving a brief psychological treatment: an exploratory analysis of a randomised controlled trial from Goa, India.African Journal of PsychiatryIn press. In press.
  50. 50. Pagnin D, de Queiroz V, Pini S, Cassano GB (2004) Efficacy of ECT in depression: a meta-analytic review. J Ect 20: 13–20.D. PagninV. de QueirozS. PiniGB Cassano2004Efficacy of ECT in depression: a meta-analytic review.J Ect201320
  51. 51. Tharyan P (2007) The evidence for electroconvulsive therapy (ECT) in the treatment of severe late-life depression. ECT for depressed elderly: what is the evidence and is the evidence enough? Int Psychogeriatr 19: 19–23.27–35; discussion 24–26P. Tharyan2007The evidence for electroconvulsive therapy (ECT) in the treatment of severe late-life depression. ECT for depressed elderly: what is the evidence and is the evidence enough?Int Psychogeriatr19192327–35; discussion 24–26
  52. 52. Prudic J, Olfson M, Marcus SC, Fuller RB, Sackeim HA (2004) Effectiveness of electroconvulsive therapy in community settings. Biol Psychiatry 55: 301–312.J. PrudicM. OlfsonSC MarcusRB FullerHA Sackeim2004Effectiveness of electroconvulsive therapy in community settings.Biol Psychiatry55301312
  53. 53. Chanpattana W, Kramer BA, Kunigiri G, Gangadhar BN, Kitphati R, et al. (2009) A survey of the practice of electroconvulsive therapy in Asia. J ECT. W. ChanpattanaBA KramerG. KunigiriBN GangadharR. Kitphati2009A survey of the practice of electroconvulsive therapy in Asia.J ECTIn press. In press.
  54. 54. Regier DA, Hirschfeld RM, Goodwin FK, Burke JD Jr, Lazar JB, et al. (1988) The NIMH Depression Awareness, Recognition, and Treatment Program: structure, aims, and scientific basis. Am J Psychiatry 145: 1351–1357.DA RegierRM HirschfeldFK GoodwinJD Burke JrJB Lazar1988The NIMH Depression Awareness, Recognition, and Treatment Program: structure, aims, and scientific basis.Am J Psychiatry14513511357
  55. 55. Paykel ES, Tylee A, Wright A, Priest RG, Rix S, et al. (1997) The Defeat Depression Campaign: psychiatry in the public arena. Am J Psychiatry 154: 59–65.ES PaykelA. TyleeA. WrightRG PriestS. Rix1997The Defeat Depression Campaign: psychiatry in the public arena.Am J Psychiatry1545965
  56. 56. Rahman A, Mubbashar MH, Gater R, Goldberg D (1998) Randomised trial of impact of school mental-health programme in rural Rawalpindi, Pakistan. Lancet 352: 1022–1025.A. RahmanMH MubbasharR. GaterD. Goldberg1998Randomised trial of impact of school mental-health programme in rural Rawalpindi, Pakistan.Lancet35210221025
  57. 57. WHO (2008) Integrating mental health into primary care: a global perspective. Geneva: World Health Organization and World Organization of Family Doctors (Wonca). WHO2008Integrating mental health into primary care: a global perspectiveGenevaWorld Health Organization and World Organization of Family Doctors (Wonca)
  58. 58. Bolton P (2001) Cross-cultural validity and reliability testing of a standard psychiatric assessment instrument without a gold standard. J Nerv Ment Dis 189: 238–242.P. Bolton2001Cross-cultural validity and reliability testing of a standard psychiatric assessment instrument without a gold standard.J Nerv Ment Dis189238242
  59. 59. Kaaya SF, Fawzi MC, Mbwambo JK, Lee B, Msamanga GI, et al. (2002) Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand 106: 9–19.SF KaayaMC FawziJK MbwamboB. LeeGI Msamanga2002Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania.Acta Psychiatr Scand106919
  60. 60. Unutzer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, et al. (2002) Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 288: 2836–2845.J. UnutzerW. KatonCM CallahanJW Williams JrE. Hunkeler2002Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.JAMA28828362845
  61. 61. Chisholm D, Sekar K, Kumar K, Saeed S, James S, et al. (2000) Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan. Br J Psychiatry 176: 581–588.D. ChisholmK. SekarK. KumarS. SaeedS. James2000Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan.Br J Psychiatry176581588
  62. 62. Bower P, Gilbody S, Richards D, Fletcher J, Sutton A (2006) Collaborative care for depression in primary care: making sense of a complex intervention: systematic review and meta-regression. Br J Psychiatry 189: 484–493.P. BowerS. GilbodyD. RichardsJ. FletcherA. Sutton2006Collaborative care for depression in primary care: making sense of a complex intervention: systematic review and meta-regression.Br J Psychiatry189484493
  63. 63. Patel VH, Kirkwood BR, Pednekar S, Araya R, King M, et al. (2008) Improving the outcomes of primary care attenders with common mental disorders in developing countries: a cluster randomized controlled trial of a collaborative stepped care intervention in Goa, India. Trials 9: 4.VH PatelBR KirkwoodS. PednekarR. ArayaM. King2008Improving the outcomes of primary care attenders with common mental disorders in developing countries: a cluster randomized controlled trial of a collaborative stepped care intervention in Goa, India.Trials94
  64. 64. Chatterjee S, Chowdhary N, Pednekar S, Cohen A, Andrew G, et al. (2008) Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India. World Psychiatry 7: 39–46.S. ChatterjeeN. ChowdharyS. PednekarA. CohenG. Andrew2008Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India.World Psychiatry73946
  65. 65. Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, et al. (2000) Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA 283: 212–220.KB WellsC. SherbourneM. SchoenbaumN. DuanL. Meredith2000Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial.JAMA283212220
  66. 66. Fritsch R, Araya R, Solis J, Montt E, Pilowsky D, et al. (2007) [A randomized trial of pharmacotherapy with telephone monitoring to improve treatment of depression in primary care in Santiago, Chile]. Rev Med Chil 135: 587–595.R. FritschR. ArayaJ. SolisE. MonttD. Pilowsky2007[A randomized trial of pharmacotherapy with telephone monitoring to improve treatment of depression in primary care in Santiago, Chile].Rev Med Chil135587595
  67. 67. Wiley-Exley E (2007) Evaluations of community mental health care in low- and middle-income countries: a 10-year review of the literature. Soc Sci Med 64: 1231–1241.E. Wiley-Exley2007Evaluations of community mental health care in low- and middle-income countries: a 10-year review of the literature.Soc Sci Med6412311241
  68. 68. Morrell CJ, Slade P, Warner R, Paley G, Dixon S, et al. (2009) Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. BMJ 338: a3045.CJ MorrellP. SladeR. WarnerG. PaleyS. Dixon2009Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care.BMJ338a3045
  69. 69. Dennis CL, Hodnett E, Kenton L, Weston J, Zupancic J, et al. (2009) Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ 338: a3064.CL DennisE. HodnettL. KentonJ. WestonJ. Zupancic2009Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial.BMJ338a3064
  70. 70. Hamadani JD, Huda SN, Khatun F, Grantham-McGregor SM (2006) Psychosocial stimulation improves the development of undernourished children in rural Bangladesh. J Nutr 136: 2645–2652.JD HamadaniSN HudaF. KhatunSM Grantham-McGregor2006Psychosocial stimulation improves the development of undernourished children in rural Bangladesh.J Nutr13626452652
  71. 71. Gardner JM, Walker SP, Powell CA, Grantham-McGregor S (2003) A randomized controlled trial of a home-visiting intervention on cognition and behavior in term low birth weight infants. J Pediatr 143: 634–639.JM GardnerSP WalkerCA PowellS. Grantham-McGregor2003A randomized controlled trial of a home-visiting intervention on cognition and behavior in term low birth weight infants.J Pediatr143634639
  72. 72. Vijayakumar L, Pirkis J, Whiteford H (2005) Suicide in developing countries (3): prevention efforts. Crisis 26: 120–124.L. VijayakumarJ. PirkisH. Whiteford2005Suicide in developing countries (3): prevention efforts.Crisis26120124
  73. 73. Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, et al. (2007) Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 298: 1401–1411.PS WangGE SimonJ. AvornF. AzocarEJ Ludman2007Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial.JAMA29814011411
  74. 74. WHO (2005) ICD-10. 2nd edition. Geneva: WHO. WHO2005ICD-10. 2nd editionGenevaWHO
  75. 75. Patel V, Chisholm D, Rabe-Hesketh S, Dias-Saxena F, Andrew G, et al. (2003) Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: a randomised, controlled trial. Lancet 361: 33–39.V. PatelD. ChisholmS. Rabe-HeskethF. Dias-SaxenaG. Andrew2003Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: a randomised, controlled trial.Lancet3613339
  76. 76. Tol WA, Komproe IH, Susanty D, Jordans MJ, Macy RD, et al. (2008) School-based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial. JAMA 300: 655–662.WA TolIH KomproeD. SusantyMJ JordansRD Macy2008School-based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial.JAMA300655662
  77. 77. Kaaya SF, Lee B, Mbwambo JK, Smith-Fawzi MC, Leshabari MT (2008) Detecting depressive disorder with a 19-item local instrument in Tanzania. Int J Soc Psychiatry 54: 21–33.SF KaayaB. LeeJK MbwamboMC Smith-FawziMT Leshabari2008Detecting depressive disorder with a 19-item local instrument in Tanzania.Int J Soc Psychiatry542133
  78. 78. Rahman A (2007) Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan–a multi-method study. Arch Womens Ment Health 10: 211–219.A. Rahman2007Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan–a multi-method study.Arch Womens Ment Health10211219
  79. 79. Bolton P, Tang AM (2004) Using ethnographic methods in the selection of post-disaster, mental health interventions. Prehosp Disaster Med 19: 97–101.P. BoltonAM Tang2004Using ethnographic methods in the selection of post-disaster, mental health interventions.Prehosp Disaster Med1997101
  80. 80. Dietrich AJ, Oxman TE, Williams JW Jr, Schulberg HC, Bruce ML, et al. (2004) Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial. BMJ 329: 602.AJ DietrichTE OxmanJW Williams JrHC SchulbergML Bruce2004Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial.BMJ329602
  81. 81. WHO (2003) Adherence to long-term therapies: evidence for action. Geneva: World Health Organisation Noncomunicable Diseases and Mental Health Adherence to long-term therapies project. WHO2003Adherence to long-term therapies: evidence for actionGenevaWorld Health Organisation Noncomunicable Diseases and Mental Health Adherence to long-term therapies project
  82. 82. Morrell CJ, Spiby H, Stewart P, Walters S, Morgan A (2000) Costs and effectiveness of community postnatal support workers: randomised controlled trial. BMJ 321: 593–598.CJ MorrellH. SpibyP. StewartS. WaltersA. Morgan2000Costs and effectiveness of community postnatal support workers: randomised controlled trial.BMJ321593598
  83. 83. van Oostrom SH, Anema JR, Terluin B, de Vet HC, Knol DL, et al. (2008) Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial. BMC Public Health 8: 12.SH van OostromJR AnemaB. TerluinHC de VetDL Knol2008Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial.BMC Public Health812