Management of depression in chronic care patients using a task‑sharing approach in a real‑world primary health care setting in South Africa: Outcomes of a cohort study

Tasneem Kathree, Max O. Bachmann, Arvin Bhana, Merridy Grant, Ntokozo Mntabo, C. G. Kemp, Deepa Rao, Inge Petersen

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Depressive symptoms are common in South African primary care patients with chronic medical conditions, but are usually unrecognised and untreated. This study evaluated an integrated, task-sharing collaborative approach to management of depression comorbid with chronic diseases in primary health care (PHC) patients in a real-world setting. Existing HIV clinic counsellors provided a manualised depression counselling intervention with stepped-up referral pathways to PHC doctors for initiation of anti-depressant medication and/ or referral to specialist mental health services. Using a comparative group cohort design, adult PHC patients in 10 PHC facilities were screened with the Patient Health Questionnaire-9 with those scoring above the validated cut-off enrolled. PHC nurses independently assessed, diagnosed and referred patients. Referral for treatment was independently associated with substantial improvements in depression symptoms three months later. The study confirms the viability of task-shared stepped-up collaborative care for depression treatment using co-located counselling in underserved real-world PHC settings.
Original languageEnglish
Pages (from-to)1261–1274
Number of pages14
JournalCommunity Mental Health Journal
Issue number7
Early online date24 Mar 2023
Publication statusPublished - Oct 2023


  • Chronic disorders
  • Depression
  • Evaluation
  • Implementation science
  • Integrated collaborative care
  • Primary health
  • Scale-up
  • South Africa

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