DOI: 10.4103/indianjpsychiatry_1013_24 ISSN: 0019-5545

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

Gajanan G. Sabhahit, R. Madan, Aishwarya John, P. Lakshmi Nirisha, Rahul Patley, Nithesh Kulal, Nisha R. Harshitha, Sivakami S. Subramanian, Narayana Manjunatha, Jagadisha Thirthalli, Naveen Kumar, Adarsha A. Manjappa, Rajani Parthasarathy, Prabhat K. Chand, Sanjeev Arora, Suresh B. Math
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ABSTRACT

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.

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