Patel V, Weobong B, Weiss HA, et al. (2016). The Healthy Activity Program (HAP), a lay counsellor-delivered psychological treatment for severe depression, in primary care in India: A randomised controlled trial. The Lancet. 389-10065: 176-185. doi: 10.1016/S0140-6736(16)31589-6
The Healthy Activity Program (HAP) was designed by the Program for Effective Mental Health Interventions in Under-Resourced Health Systems to address the need for culturally appropriate, affordable, and feasible treatment for severe depression delivered in primary care in under-resourced settings. HAP is delivered by health workers as lay counsellors who have not received specialized training in mental health. HAP is delivered over six to eight 30-40 minute sessions and is based on behavioral activation. Strategies employed by HAP include psychoeducation, behavioral assessment, activity monitoring, activity structuring and scheduling, problem solving, and activation of social networks. Additionally, HAP involves strategies to address interpersonal communication, rumination, sleep problems, tobacco cessation, and relaxation as needed. Researchers conducted a randomized controlled trial where 493 participants were randomized to receive enhanced usual care (i.e. usual care at primary health center, screening results provided to patient and clinician, a contextualized manual for treating depression by the World Health Organization’s Mental Health Gap Action Program; EUC) or EUC and HAP. Participants completed assessments of depression severity, depression remission, disability, and behavioral activation at baseline and three months after baseline. After three months, participants receiving EUC and HAP experienced greater reductions in depression severity than participants receiving EUC alone. More participants receiving EUC and HAP met criteria for being in depression remission (PHQ-9 score <10) than participants receiving EUC alone. Participants receiving EUC and HAP also experienced greater improvements in disability and behavioral activation.