Both mental health and cardio-metabolic disorders (such as diabetes) are leading causes of disability and death in India. Depression affects 12-15% of Indian adults, much higher than the 6-9% of adults in the US with the condition. Additionally, there are higher rates of depression among those at risk of cardio-metabolic diseases. While conceptually simple, organizing and coordinating care delivery for cardio-metabolic diseases and mental health is hindered by barriers at multiple levels (limited local capacity, infrastructure, and health systems for chronic diseases).
The INDEPENDENT study aims to evaluate the effectiveness of an integrated multi-condition depression and diabetes care intervention for diabetes patients in four cities in India (Chennai, Delhi, Visakhapatnam, and Bengaluru) who have clinically significant depression symptoms. Trained nurse case managers (NCM) provide behavioral activation to motivate effective self-care in study patients and proactively follow-up to help patients solve problems and adhere to medications. An electronic decision support and health record system provides evidence-based care prompts and prioritizes patients for weekly review and management plan adjustment by a care team consisting of the NCM, a diabetologist, and a psychiatrist.
The intended impact of the INDEPENDENT study is to deliver comprehensive, usable evidence for policy makers on integrating cost-neutral and scalable depression and diabetes care into India’s existing care delivery structures.
Dr. Nida Shaikh spoke at the DEBATE 2017 event to share baseline results from this study. Her talk was titled "Dietary, exercise, and substance use practices among adult with diabetes and depression: baseline results from INDEPENDENT study".