ArticleBMJ open2021
Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06834867 (A Randomized Controlled Trial of a Multi-component Family Intervention to Lower Depression and Address Intimate Partner Violence), which is not on this map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized Controlled Trial of a Multi-component Family Intervention to Lower Depression and Address Intimate Partner Violence (MILAP) Among Young Women in Nepal
Who cites it
12 citing papers in PubMed.
- The Influence of Depression, Positive Health Behaviors, and Weight Status on Glycated Hemoglobin: A Sequential Mediation Analysis of the INDEPENDENT Trial.Journal of general internal medicine · 2025Trial
- Strategies for Successful Integration of Mental Health Care Delivery into Community Health Worker Programs.Journal of public mental health · 2026Article
- First implementation of a collaborative care model for common mental disorders in primary care in France: fidelity of care manager intervention matters.BMC health services research · 2026Article
- Patients', caregivers' and healthcare workers' perspectives on integrating anxiety care in tuberculosis services in Pakistan: a qualitative interview study.BMC psychology · 2026Article
- Article
- Acceptability and feasibility of a task-shifted collaborative care model for depression and anxiety in primary HIV clinics in the Philippines: a qualitative inquiry.BMC health services research · 2025Article
- Global mental health and psychosocial support programming: An expert review of major implementation and funding challenges.Global mental health (Cambridge, England) · 2025Review
- Addressing challenges for psychotherapy supervision in global mental health through experiential learnings from rural Nepal.Discover public health · 2025Article
- Community health workers' barriers and facilitators to use a novel mHealth tool for motivational interviewing to improve adherence to care among youth living with HIV in rural Nepal.PLOS global public health · 2024Article
- Article
- Global Mental Health: Where We Are and Where We Are Going.Current psychiatry reports · 2023Review
- Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review.Global mental health (Cambridge, England) · 2023Review
Corrections and comments
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Authors and funding
27 authors.
Funding
Abstract
introductionDespite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings.
methodsWe conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers' behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period.
resultsProviders experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:-9, Q3:-2) decrease in PHQ-9 scores (p<0.0001).
conclusionUsing the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers' positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.
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Registered trials
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