Cluster randomised controlled trial for late life Depression in socieconomically deprived areas of São Paulo, Brazil

• Grant number: 17/50094-2
• Support Opportunities: Research Projects - Thematic Grants
• Field of knowledge: Health Sciences - Medicine - Psychiatry
• Agreement: MRC, UKRI
• Principal Investigator: Marcia Scazufca
• Grantee: Marcia Scazufca
• Principal researcher abroad: Ricardo Araya
• Institution abroad: King's College London, England
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated scholarship(s): 21/10148-1 - Cluster randomized controlled trial (RCT) for late-life Depression in socioeconomically deprived areas of São Paulo, Brazil, BP.IC; 21/04493-8 - MRC-FAPESP cluster Randomised Controlled Trial (RCT) for late life depression in socioeconomically deprived areas of São Paulo, Brazil, BP.PD; 21/04230-7 - Cluster randomised controlled trial (RCT) for late life Depression in socioeconomically deprived areas of São Paulo, Brazil, BP.IC; + associated scholarships 21/03849-3 - Cluster Randomised Controlled Trial (RCT) for late life Depression in socioeconomically deprived areas of São Paulo, Brazil, BP.DD; 20/14768-1 - Technological health communication strategies to prevent depression in the elderly with mild depressive symptoms: technical training in information technology at the public health interface, BP.TT; 20/14504-4 - Randomized controlled trial for late life Depression in socioeconomically deprived areas of São Paulo, Brazil, BP.IC; 20/02272-1 - Randomized, group-controlled clinical trial for elderly people with depression living in underprivileged areas of Sao Paulo, Brazil (FAPESP-RCUK), BP.TT; 19/14839-9 - MRC-FAPESP cluster randomised controlled trial (RCT) for late life depression in socioeconomically deprived areas of Sao Paulo, Brazil, BP.PD; 18/19343-9 - MRC-FAPESP cluster randomised controlled trial (RCT) for late life depression in socioeconomically deprived areas of São Paulo, Brazil, BP.PD; 18/19339-1 - MRC-FAPESP cluster randomised controlled trial (RCT) for late life depression in socioeconomically deprived areas of São Paulo, Brazil, BP.PD; 18/21643-0 - Cluster randomized controlled trial (RCT) for late life depression in elderly from in socieconomically deprived areas of São Paulo, Brazil, BP.TT - associated scholarships

Abstract

Depression among the elderly is common and is often unrecognized, untreated, or receive sub-optimal treatment. Health care services in Brazil are all prepared to serve the health needs of this population. This proposal aims to estimate to what extent adding to usual care a psychosocial, community-based intervention mostly delivered by Community Health Workers (CHWs) and integrated within the existing primary care system improves recovery rates among depressed older adults from poor socioeconomic background in São Paulo, Brazil. The cost-effectiveness of this intervention will also be compared with 'enhanced' usual care. This will be a two-arm cluster randomized controlled trial involving moderately or severely depressed participants aged 60 or older who are registered with the participating Family Health Units (FHU). FHUs are randomized to one of two treatment groups; usual care or usual care plus a collaborative care psychosocial intervention for Depression. Potentially eligible participants are identified and invited to participate in the study. The intervention, with strong community-based and task shifting components, consists of 8-to11 home sessions, depending on severity of Depression delivered over 17 weeks. CHWs will be supported with tablet computers to deliver the intervention, and will receive further training and supervision. The control group will receive 'enhanced' usual care alone in so far as cases being identified at the start of the trial. The primary outcome measure is the Patient Health Questionnaire-9 (PHQ-9). We will compare the recovery of cases (PHQ-9<10) across arms at 8 and 12 months after entering the trial using an intention-to-treat analysis. Several secondary outcomes will be also measured including quality of life, levels of functioning, stressful life events, and others. Direct and indirect costs in both arms will be measured to undertake a cost-effectiveness analysis. We anticipate a total of 1440 participants, registered in 20 FHUs (clusters) yielding a power of 86.5% for 15% difference (25% to 40%) in recovery between the control and intervention groups at 8 months. Our research team has developed and successfully tested the feasibility and acceptability of the proposed intervention in primary care in São Paulo (RCUK/FAPESP). This project, if it proves cost-effective, has the potential for a noticeable impact and may constitute a timely contribution on treatment options for depressed older adults reducing dependency on specialized mental health resources, problem seen in Brazil and most LMIC. (AU)

Scientific publications

(5)

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

NAKAMURA, CARINA AKEMI; SCAZUFCA, MARCIA; MORETTI, FELIPE AZEVEDO; NADALETO DIDONE, THIAGO VINICIUS; DE SA MARTINS, MARIANA MENDES; PEREIRA, LUARA ARAGONI; QUEIROZ DE SOUZA, CAIO HUDSON; DE OLIVEIRA, GABRIEL MACIAS; DA COSTA, MARCELO OLIVEIRA; MACHADO, MARCELO; et al. Digital psychosocial intervention for depression among older adults in socioeconomically deprived areas in Brazil (PRODIGITAL-D): protocol for an individually randomised controlled trial. Trials, v. 23, n. 1, p. 12-pg., 2022-09-07. (21/03849-3, 21/10148-1, 20/14504-4, 21/04493-8, 18/19343-9, 17/50094-2, 21/04230-7, 20/02272-1, 20/14768-1)

SCAZUFCA, MARCIA; NAKAMURA, CARINA AKEMI; PETERS, TIM J.; HENRIQUE, MAIARA GARCIA; SEABRA, ANTONIO; LA ROTTA, EHIDEE GOMEZ; FRANZIN, RENATO M.; MARTINS, DANIELE FERREIRA; VAN DE VEN, PEPIJN; HOLLINGWORTH, WILLIAM; et al. A collaborative care psychosocial intervention to improve late life depression in socioeconomically deprived areas of Guarulhos, Brazil: the PROACTIVE cluster randomised controlled trial protocol. Trials, v. 21, n. 1, NOV 5 2020. (17/50094-2)

MORENO-AGOSTINO, DARIO; CHUA, KIA-CHONG; PETERS, TIM J.; SCAZUFCA, MARCIA; ARAYA, RICARDO. Psychometric properties of the PHQ-9 measure of depression among Brazilian older adults. AGING & MENTAL HEALTH, AUG 2021. (17/50094-2)

NAKAMURA, CARINA A.; MITCHELL, PAUL M.; PETERS, TIM J.; MORENO-AGOSTINO, DARIO; ARAYA, RICARDO; SCAZUFCA, MARCIA; HOLLINGWORTH, WILLIAM. A Validation Study of the EQ-5D-5L and ICEpop Capability Measure for Older People Among Older Individuals With Depressive Symptoms in Brazil. VALUE IN HEALTH REGIONAL ISSUES, v. 30, p. 9-pg., 2022-07-01. (17/50094-2)

NAKAMURA, CARINA AKEMI; SCAZUFCA, MARCIA; PETERS, TIM J.; FAJERSZTAJN, LAIS; VAN DE VEN, PEPIJN; HOLLINGWORTH, WILLIAM; ARAYA, RICARDO; MORENO-AGOSTINO, DARIO. Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil. INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, DEC 2021. (17/50094-2)