November 1, 2017Open Access
View Full PaperPreventing Late-Life Depression: Lessons in Intervention Development From Goa, India
Key Result
The DIL intervention, delivered by lay health counselors to older adults with subsyndromal depression, demonstrated feasibility, acceptability, and benefit in a preliminary 21-participant case series.
Structured PICO
Does the DIL intervention delivered by lay health counselors improve outcomes in older adults with subsyndromal depression in Goa, India?
P
Population
Older adults living in Goa, India with subsyndromal symptoms of depression (n=21 in preliminary case series, n=181 enrolled in larger confirmatory trial).
I
Intervention
"DIL" intervention strategy delivered by lay health counselors, grounded in problem solving therapy for primary care, brief behavioral treatment for insomnia, psychoeducation in self-management of co-occurring medical disorders, and assistance in navigation to social and economic resources.
O
Outcome
Feasibility, acceptability, and benefit to participantspatient reported
A lay health counselor-delivered intervention for late-life depression prevention is feasible and acceptable in a low-resource setting like Goa, India.
Abstract
We describe the development of an intervention strategy for the indicated prevention of depression in older adults living in Goa, India. Of particular novelty, the intervention is deliverable by lay health counselors and is grounded in problem solving therapy for primary care and brief behavioral treatment for insomnia. We have named the intervention "DIL" (the Hindi word for "heart" and an acronym for "depression in late life.") Additional DIL strategies include psychoeducation in self-management of co-occurring medical disorders such as diabetes mellitus, together with assistance in navigation to needed social and economic resources. We present the results of a preliminary open-trial case series involving 21 participants with subsyndromal symptoms of depression, demonstrating feasibility, acceptability, and benefit to participants. We then present the design of a larger confirmatory trial into which 181 participants have been enrolled. "DIL" is a novel and large depression prevention trial conducted with lay health counselors in a low-resource country. Its results are likely to have implications for depression prevention in older adults in other low- and middle-income countries and to inform contemporary models of the staging of depressive illness in later life.