Care facilitation by Accredited Social Health Activists (ASHAs) to improve outcomes of persons with psychiatric disorders: Results from a randomized controlled trial in South India.

BACKGROUND

The role of Accredited Social Health Activists (ASHAs) in improving short-term outcomes-symptoms, burden, and disability-for individuals with severe mental disorders (SMDs), common mental disorders (CMDs), and alcohol use disorders (AUDs) remains inadequately studied.

METHODS

This randomized controlled trial compared enhanced ASHA training (one-day in-person plus seven online modules over 18 months; Study Group (SG), n = 35) to training-as-usual (one-day in-person; Control Group (CG), n = 36). Both groups supported persons with SMDs (SG = 24; CG = 37), CMDs (SG = 15; CG = 20), and AUDs (SG = 31; CG = 20). Outcomes were measured using standardized disability (Indian Disability Evaluation and Assessment Scale; IDEAS), burden (Burden Assessment Scale; BAS), quality of life [EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L)], and disorder-specific scales (Clinical Global Impression-Schizophrenia; CGI-SCH, Kessler Psychological Distress Scale (K-10); Brief Addiction Rating Scale (BARS) and Timeline Follow back scores; TLFB) at baseline and 6-8 weeks post-baseline.

RESULTS

For CMDs, the SG showed significant improvements (P < 0.05) across IDEAS, WHO-DAS, BAS and K-10 than CG (only IDEAS and WHO-DAS had improved significantly), though no group-by-time interaction emerged. For SMDs, both groups improved (P < 0.05) on IDEAS, WHO-DAS and BAS; CG did better on CGI-SCH and EuroQol-5 as well. Additionally, only CG had a significant group-by-time effect for CGI-SCH (P < 0.05). In AUDs, both groups improved (P < 0.05) on BARS, WHO-DAS and EuroQol-5, with SG showing additional gains (P < 0.05) in TLFB, BAS, and IDEAS. Time*Group interaction was not significant for any of these scores.

CONCLUSION

Trained ASHAs, with or without supplementary support, can facilitate notable short-term clinical improvements for psychiatric disorders in community settings.