title: The onset and duration of benefit from counselling by minimally trained counsellors on anxiety and depression in women.
abstract: OBJECTIVE
  To assess the onset and duration of benefit of counselling by minimally trained community counsellors on level of anxiety and/or depression in women of their own community.
  
  
  METHODS
  A randomized controlled trial for assessing the effectiveness of 4 and 8 weeks of counselling by minimally trained community women in reducing the levels of anxiety and depression was carried out in a lower middle class, semi-urban community in Karachi, Pakistan. In the baseline survey, 366 anxious and/or depressed women were identified and randomized to intervention and control arms. The intervention arm was re-screened for anxiety and depression after 4 and 8 weeks of counselling and again 8 weeks after the last counselling session. As the results showed a significant benefit in the intervention arm, for ethical reasons the controls were also counselled; and were screened in the same way. This study is a sub-analysis from the RCT specifically looking at the onset and the duration of benefit.
  
  
  RESULTS
  A significant reduction in the mean scores of both the groups was found after 4 weeks of counselling which further improved at 8 weeks. The gradient of improvement was steeper at 4 weeks. At 8 weeks post counselling some loss of effect was detected but the levels still remained below the initial mean score.
  
  
  CONCLUSIONS
  This study indicates that literate women from semi urban communities can be trained as counsellors and their counselling can lead to a significant benefit in just 4 counselling sessions of 1 hour each, and could last at least till 8 weeks after the last session. Keeping in view the current high prevalence, the available facilities for treatment and the stigma attached to psychiatric treatment in our communities; this modality of intervention at the PHC level could be an alternative strategy for the management of depression.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi.
authors.forename: A
authors.initials: A
authors.lastname: Gul
authors.forename: B S
authors.initials: BS
authors.lastname: Ali
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy*; D003376:Counseling; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D010154:Pakistan