The Long-Term Impact of Pharmacotherapy in India

This study resurveys the participants in a depression treatment study described in Angelucci and Bennett (2024). The trial was conducted from 2016-2018. The PC intervention provided eight months of free psychiatric care through the Shridevi Institute of Medical Sciences and Research Hospital. Shridevi is an accredited private hospital in Tumkur, Karnataka, near the study area. The facility has 750 beds, 80 percent of which are allocated for pro bono care of disadvantaged patients. The hospital sometimes receives patients from GASS. The initial visit included a diagnosis, an explanation of the significance of mental illness, and an individualized course of medical treatment. Patients returned for monthly follow-up visits. The most commonly prescribed anti-depressants were Selective Serotonin Reuptake Inhibitors (SSRIs). These drugs are generally not under patent and are available inexpensively in India. They are widely used and have relatively few well-tolerated side effects. In addition to treating depression, the PC intervention may raise awareness and increase the salience of depression in the household, which could lead to additional effects.

The livelihoods assistance (LA) intervention provided two group meetings and personalized livelihoods assistance during the first two months of the study. Overall, this intervention had no short- or medium-term independent effects. Thus, it is not the focus of our study of long-run impacts.

2016-11-01

2018-11-01

There 2 primary outcomes: (1) contemporaneous depression severity, which we will measure by standardizing the PHQ-9 score; (2) retrospective history of depression, which we will measure as the total number of months in which the respondent has been depressed since 2018 (summing up multiple spells of depression).

Depression awareness
Depression stigma
Educational attainment for children aged 13-18 at baseline
Human capital investment among current children
Exposure to negative economic shocks
Work time and earnings (from 7-day recall)
Household consumption
Durable good ownership
Hygiene and sanitation
Risk intolerance
Cognitive performance
Subjective wellbeing
Participation in household decisions

In this study, we will resurvey the participants in our previous project (Angelucci and Bennett, 2024) to study the 7-year impacts of depression treatment.

In the first study, we conducted field work in a peri-urban region northwest of Bangalore, Karnataka. Our study area comprises 506 localities with at least 40 households within the catchment area of our partner NGO in the Doddaballapur, Korategere, and Gauribidanur districts.

We collaborated with Grameena Abudaya Seva Samsthe (GASS), a local social service organization that has worked with people with physical and mental disabilities since 2001. GASS aims to improve mental health and patient wellbeing by facilitating psychiatric care and providing livelihoods assistance. To support psychiatric care, GASS organizes walk-in clinics, sets up appointments, and helps transport people to health centers. It provides livelihoods assistance by counseling patients about employment and other earnings opportunities and by helping patients obtain training and small loans as appropriate.

We used a cluster-randomized design to cross-randomize psychiatric care (PC) and livelihoods assistance (LA) by locality. Before starting recruitment, we stratified the randomization by district and terciles of a locality socioeconomic index based on the 2011 Census of India. We screened about forty households per locality, with the target of selecting 1-2 participants per locality.

We sampled participants through a door-skip pattern in which the skips were proportional to locality size. Once at the household, surveyors randomly chose an available adult to screen for eligibility. We screened people for depression symptoms with the PHQ-9 depression severity scale. To obtain a sample of mildly or moderately depressed people, we recruited subjects with PHQ-9 scores of 9-20. In total, surveyors screened 6446 people in order to enroll a study sample of 1000 participants across 506 localities. We ultimately enrolled 395 participants (from 204 localities) in the control arm, 207 participants (from 99 localities) in the PC arm, 205 participants (from 102 localities) in the LA arm, and 195 participants (from 101 localities) in the PC/LA arm.

Not available

We randomly assigned localities to treatment arms using a computer.

Locality

Yes

506

About 700 (assuming a 30% attrition).

We ultimately enrolled 395 participants (from 204 localities) in the control arm, 207 participants (from 99 localities) in the PC arm, 205 participants (from 102 localities) in the LA arm, and 195 participants (from 101 localities) in the PC/LA arm. We expect 30% attrition from these figures.