Intervention(s)
We conducted our prior study 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. In 2017, 24 percent of local adults aged 18 to 50 had some depression symptoms and 10 percent had symptoms of at least moderate depression.
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.
The psychiatric care (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 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.
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 independent effects short or medium term. Thus, it is not the focus of our study of impacts on labor migration.
We used a cluster-randomized design to cross-randomize PC and 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. Both the modal and median number of participants per locality is 2. This design minimized spillovers and cross-arm contamination. Treating few people per locality limited information leakages, protecting patient confidentiality.
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.
We studied the effects of the intervention for about 20 months after its end. We found that pharmacotherapy reduced symptoms of depression, with stronger and more prolonged effects when paired with LA, despite having no independent effect on mental health. We also found suggestive evidence that the intervention increased school enrollment for children aged 13 and older.
To study the impact of the intervention on labor migration, we will track down all males aged 18 to 35 who lived in the household of the original study participants at baseline. We will interview as many people as possible in person, and contact the unreachable ones on the phone, or obtain information through their parents. We will measure both concurrent and retrospective migration, education, savings, income, and remittances.