Group interventions on stress management with non-professionals to improve mental health in India

According to the WHO, depression affects around 5% of adults worldwide. In low- and middle-income countries, people with depression face additional barriers to accessing care, and more than 75% of them receive no treatment at all. These common barriers to low- and middle-income countries include:

• A limited number of qualified healthcare professionals. India has only 0.3 psychiatrists per 100,000 inhabitants, compared to 16.6 in the US.
• Strong stigma towards mental illness: This deters people from seeking appropriate care.
• Lack of awareness: People in low- and middle-income countries know little about the subject and are not always able to recognize the early symptoms of depression.

Researchers involved in this program conducted a preliminary study to identify mental health needs in the district where the project is being deployed. They found that between 10% and 24% of adults had some form of depression (Angelucci and Bennett, 2023). In addition, they pointed out that depression has economic repercussions that contribute to perpetuating individual poverty such as slower adaptation to new technologies, increased job absenteeism, less investment in their children, and a diminished ability to cope with economic shocks.

Self Help Plus (SH+) is a group-based program for people experiencing a common form of psychological distress such as depression, anxiety, or stress in low- and middle-income countries. This program includes stress management sessions provided by non-professional staff trained by mental health specialists. This method makes up for the lack of trained professionals and provides support to people dealing with theseconditions.

This therapy model has already been tested in other African and European countries in a variety of groups (asylum seekers, refugees, and healthcare professionals), but the empirical evidence is not yet unanimous. In fact, some research supports its positive effects on mental health 6 months after participation (Acaturk et al., 2022; Turrini et al., 2022), while another study indicates immediate effects that diminish after 6 months.

Thus, this pilot test will help us understand the barriers to joining the program, the main reasons for dropping out, and how to adapt the program to local communities, so as to be able to scale it up in the future.

The program aims to have an impact on several aspects:

• Improving psychological well-being
• Reducing the perception of stigma
• Improving mental health knowledge

The team will conduct a pilot study to understand the mechanisms around SH+ membership by testing two different group sizes and a follow-up session 6 months after the standard program. In addition, it plans on incorporating the lessons learned from this study into the design of a future, larger-scale impact assessment.