Substantial co-morbidity between depression and chronic physical conditions is common, impairing the health outcomes of both conditions. Most of the disease burden in Latin America is now attributed to chronic diseases, including depression and cardiovascular diseases (mostly hypertension-related), and diabetes. Depression is strongly associated with diabetes, heart disease, non-adherence to medical treatments, and progression of disability across a range of chronic conditions. Unfortunately, most interventions focus mostly on single disease management. There is a need to integrate the management of multiple chronic diseases across all health services, particularly in primary care, with special consideration in the context of scarce human resources that create a gap in the treatment of mental conditions.
The increasing availability and decreasing costs of new communication technologies in Latin America (e.g. smartphones) open new opportunities for the delivery of public health interventions. Latin-MH created a system to deliver and monitor a behavioral activation intervention to patients with hypertension and/or diabetes who demonstrate depressive symptoms. The intervention is delivered three times a week for six weeks, and is supported by public health nurse assistants in a task-shifting model. The sessions delivered by the app help patients be more active and regain control of their lives, ultimately seeking to improve their quality of life and, most significantly, their depression. The pilot study results demonstrate that the intervention is feasible and effective in reducing depressive symptoms in most participants.
Three pilot studies were performed in São Paulo and Lima to assess the feasibility of the intervention and to test whether the intervention was effective before conducting a full trial.
- 88% of participants had reduced depressive symptoms
- Most participants gave a positive evaluation of the app
“It is fundamental to incorporate technology to effectively address the existing treatment gap for mental health problems in Latin America.”
- Paulo Rossi Menezes, Department of Preventive Medicine, University of São Paulo Faculty of Medicine
- University of São Paulo School of Medicine (Brazil)
- Universidad Cayetano Heredia (Peru)
- National Institute of Mental Health
- Faculdad de Medicina da Universidade de São Paulo (University of São Paulo Faculty of Medicine)
- Universidad Peruana Cayetano Heredia (Peruvian University Cayetano Heredia)
- Northwestern University
- London School of Hygiene and Tropical Medicine