Development of Depression Care for Low- and Middle-Income Nations
In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program , which was designed to provide evidence-based depression care services in low-resource, non- Western settings such as Vietnam. The article provides the program development background; the social, economic, and political context in which the program was developed; and the structure and content of the program and their underlying rationale in the context of rural Vietnam. Although the program was found to be acceptable, feasible, and effective in reducing depression outcomes, we did face challenges in implementation, which are outlined in this article. Key challenges included cultural factors (e.g., a lack of recognition of depression as a health-related entity amenable to professional treatment, relatively low levels of psychological mindedness useful for understanding of psychological interventions) and health system (e.g., lack of mental health specialists, overburdened health providers unfamiliar with behavioral interventions) factors. We discuss the strategies we employed to resolve these challenges and our successes and failures therein. We conclude with recommendations for others interested in implementing similar programs in low- and middle-income countries settings.
- Treatment acceptability was high: more than 90% of patients offered treatment accepted it.
- More than 70% of patients completed treatment.
- The program significantly reduced depression and anxiety.
- Successful implementation required overcoming substantial social, cultural, and political challenges.
- Developing evidence of program success helps to generate both local and national-level support.
- Strong community partnerships that fostered trust, openness, and commitment were critical to development of the program.
- Successful program implementation also requires the leadership of local partners, engaging all levels of the health care system in advance, and establishing linkages across service sectors.