LATIN-MH: Latin America Treatment & Innovation Network in Mental Health
The increasing availability and decreasing costs of new communication technologies, such as smartphones, in Latin America have opened new opportunities for the delivery of interventions at a much larger scale than ever considered possible.
Latin-MH created a technological platform (CONEMO) to deliver a behavioural activation intervention for patients with hypertension and/or diabetes who also presented clear depressive symptoms. CONEMO is an 18-session intervention, based on behavioural activation principles, delivered by a smartphone application and supported by non-specialist health workers through a tablet-based dashboard.
We conducted two multicentre RCTs, in Brazil (n=880), and Peru (n=432) with adults presenting with depressive symptoms and comorbid hypertension or diabetes, attending Family Health Units in São Paulo and public outpatient healthcare services in Lima. The participants were randomly assigned to receive either enhanced usual care or the CONEMO intervention. The primary outcome was a reduction of 50% or more in depressive symptoms measured by the PHQ-9. The secondary outcomes included measures of behavioural activation, quality of life, disability, and health services usage. Overall, the intervention proved to be clinically effective in both settings, with a difference of 11% in São Paulo and 20% in Lima in favour of CONEMO. The platform is currently being tested in two other regional countries.
Impact
This is the first RCT of a technology-based system to treat depression with a psychological intervention among people with co-morbid chronic diseases. Depression is common and disabling and there is a massive treatment gap in most low-and-middle income countries. There is a lack of trained human resources to deliver psychological treatments in most LMICs. Technology supported and delivered interventions can be accessed by a large proportion of the population, something that was unthinkable before. There are plans to implement this intervention at a much larger scale in both countries.