DiaDeM aims to develop and test a culturally appropriate treatment for depression in people with diabetes in Bangladesh and Pakistan. This will be based on a relatively simple psychological talking treatment called “Behavioural Activation” (BA), that has been shown to treat depression effectively and can be delivered by non-specialist health workers. BA helps people make the link between what they do and how they feel, and supports them to make changes to improve their health.
- Modify BA to fit the cultural and economic context. This will be done through a series of workshops working with people with experience of depression and diabetes, their families, healthcare professionals and policymakers, individually and in groups, to design and refine the BA treatment.
- Test (and if needed, further refine) the modified BA treatment in a small-scale trial to see if it is acceptable and can be delivered successfully and learn how best to collect the information we will need in the next stage of research.
- Evaluate the modified BA intervention using a large-scale randomised controlled trial, in which a group of people with diabetes and depression will be randomly allocated to receive either BA or usual care. We will find out whether BA improves depression, self-care of diabetes, blood sugar levels, physical health and quality of life, and if it offers value for money.
- Examine what it means to have both depression and diabetes from an economic perspective e.g. how much time and money patients and carers spend in accessing care. This information will help policymakers in their decisions about provision of appropriate healthcare Alongside the research, we will develop expertise in the research team and local policymakers to make use of research findings in practice and to initiate further research in this area.
We will establish ‘Community Panels’ comprising people with mental-physical illness and organisations that advocate for them. Panels will be fully involved in the programme, providing advice on the conduct of studies and helping to interpret and publicise findings. Our findings will be of value to people with depression and diabetes, their families, health professionals, policymakers and researchers. We will develop detailed plans together with Community Panels and policymakers to integrate the intervention into routine care (if it is shown to be effective) and to disseminate findings using social media, websites, reports, conferences and newspaper and journal article.
As with IMPACT there will also be a strong capacity building element to the programme. A working group will be established to build our strategy in this area.
We already have a great output from the team with a Featured Review by the Cochrane Library. Our Systematic Reviews on Behavioural Activation are important and well-conducted reviews that Cochrane are placing in the spotlight. You can see featured animations explaining Behavioural Activation, and Behavioural Activation in non-communicable diseases. You can also access the individual reviews on the IMPACT Outputs and Resources page under the Academic Publications section.
This research was funded by the National Institute for Health and Care Research (NIHR) (NIHR200806) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.