Integration of mental health services into primary healthcare is proliferating in low-resource countries. We aimed to evaluate the impact of different compositions of primary care mental health services for depression and alcohol use disorder (AUD), when compared to usual primary care services. We conducted a non-randomized controlled study in rural Nepal. We compared treatment outcomes among patients screening positive and receiving: (a) primary care mental health services without a psychological treatment component (TG); (b) the same services including a psychological treatment (TG + P); and (c) primary care treatment as usual (TAU). Primary outcomes included change in depression and AUD symptoms, as well as disability. Disability was measured using the 12-item WHO Disability Assessment Schedule. Symptom severity was assessed using the 9-item Patient Health Questionnaire for depression, the 10-item Alcohol Use Disorders Identification Test for AUD. We used negative binomial regression models for the analysis. For depression, when combining both treatment groups (TG, n = 77 and TG + P, n = 60) compared to TAU (n = 72), there were no significant improvements. When only comparing the psychological treatment group (TG + P) with TAU, there were significant improvements for symptoms and disability (aβ = − 2.64; 95%CI − 4.55 to − 0.74, p = 0.007; aβ = − 12.20; 95%CI − 19.79 to − 4.62; p = 0.002, respectively). For AUD, when combining both treatment groups (TG, n = 92 and TG + P, n = 80) compared to TAU (n = 57), there were significant improvements in AUD symptoms and disability (aβ = − 15.13; 95%CI − 18.63 to − 11.63, p < 0.001; aβ = − 9.26; 95%CI − 16.41 to − 2.12, p = 0.011; respectively). For AUD, there were no differences between TG and TG + P. Patients’ perceptions of health workers’ skills in common psychological factors were associated with improvement in depression patient outcomes (β = − 0.36; 95%CI − 0.55 to − 0.18; p < 0.001) but not for AUD patients. Primary care mental health services for depression may only be effective when psychological treatments are included. Health workers’ competencies as perceived by patients may be an important indicator for treatment effect. AUD treatment in primary care appears to be beneficial even without additional psychological services.

中文翻译：

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尼泊尔地区性地区综合精神卫生保健对抑郁症和酗酒者的临床和功能结局的影响：一项非随机对照研究。

在资源匮乏的国家，精神卫生服务与初级卫生保健的融合正在迅速发展。与常规的初级保健服务相比，我们旨在评估初级保健精神卫生服务的不同组成对抑郁症和酒精使用障碍（AUD）的影响。我们在尼泊尔农村地区进行了非随机对照研究。我们比较了筛查阳性和接受筛查的患者的治疗结果：（a）没有心理治疗成分（TG）的初级保健精神卫生服务；（b）相同的服务，包括心理治疗（TG + P）；（c）照常进行初级保健治疗（TAU）。主要结果包括抑郁症和AUD症状的改变，以及残疾。使用12个项目的WHO残障评估时间表对残障进行了测量。使用针对抑郁症的9项患者健康调查问卷，针对AUD的10项酒精使用障碍识别测试评估症状严重程度。我们使用负二项式回归模型进行分析。对于抑郁症，与TAU（n = 72）相比，将两个治疗组（TG，n = 77和TG + P，n = 60）组合使用时，均无明显改善。仅将心理治疗组（TG + P）与TAU进行比较时，症状和残疾显着改善（aβ=-2.64; 95％CI-4.55至-0.74，p = 0.007;aβ=-12.20; 95％CI − 19.79至− 4.62； p = 0.002）。对于AUD，与TAU（n = 57）相比，将两个治疗组（TG，n = 92和TG + P，n = 80）组合使用时，AUD症状和残疾显着改善（aβ= − 15.13； 95％CI − 18.63至− 11.63，p <0.001;aβ= − 9.26; 95％CI − 16.41至− 2.12，p = 0.011; 分别）。对于AUD，TG和TG + P之间没有差异。患者对卫生工作者技能的常见心理因素感知与抑郁症患者预后的改善相关（β= − 0.36； 95％CI − 0.55至− 0.18； p <0.001），但对于AUD患者则不适用。抑郁症的初级保健心理健康服务仅在包括心理治疗后才有效。患者所感知的卫生工作者的能力可能是治疗效果的重要指标。即使没有额外的心理服务，初级保健中的澳元治疗似乎也是有益的。患者对医务人员在常见心理因素中技能的理解与抑郁症患者预后的改善相关（β= − 0.36； 95％CI − 0.55至− 0.18； p <0.001），而对于AUD患者则没有。抑郁症的初级保健心理健康服务仅在包括心理治疗后才有效。患者所感知的卫生工作者的能力可能是治疗效果的重要指标。即使没有额外的心理服务，初级保健中的澳元治疗似乎也是有益的。患者对医务人员在常见心理因素中技能的理解与抑郁症患者预后的改善相关（β= − 0.36； 95％CI − 0.55至− 0.18； p <0.001），而对于AUD患者则没有。抑郁症的初级保健心理健康服务仅在包括心理治疗后才有效。患者所感知的卫生工作者的能力可能是治疗效果的重要指标。即使没有额外的心理服务，初级保健中的澳元治疗似乎也是有益的。患者所感知的卫生工作者的能力可能是治疗效果的重要指标。即使没有额外的心理服务，初级保健中的澳元治疗似乎也是有益的。患者所感知的卫生工作者的能力可能是治疗效果的重要指标。即使没有额外的心理服务，初级保健中的澳元治疗似乎也是有益的。