Improving services for identifying and treating depression in primary healthcare clinics

Plain English summary of protocol

Background and study aims
People attending primary or basic health facilities for any physical illnesses such as diabetes, hypertension, and heart disease are more likely to have depression. When people have both depression and physical illnesses, outcomes for both are worse, resulting in poorer health, quality of life, earlier deaths, and increased costs for individuals, families and healthcare services. Depression in people attending primary care, particularly in Pakistan, is usually not identified and treated. Collaborative care is a team approach in which healthcare workers in primary healthcare facilities (who are not mental health specialists) are trained to treat depression alongside physical illness. This study aims to implement collaborative care for depression in primary healthcare facilities in Karachi, Pakistan; and to test, in a trial, i) the effectiveness of collaborative care for treating depression, ii) the extent to which depression care is successfully implemented and iii) costs of collaborative care, compared to usual best practice. The study will also investigate the barriers and facilitators for implementing collaborative care, and how implementation can be improved.

Who can participate?
Participants aged 18 years or above, identified with depression, currently not taking any treatment for depression and attending SINA Health, Education and Welfare Trust primary care facilities in Karachi, Pakistan.

What does the study involve?
Twenty-four clinics will be randomly allocated to the intervention group (12 clinics) or the control group (12 clinics). Collaborative care will be implemented in the intervention clinics, while clinics in the control group will work according to best usual practice. Researchers will recruit about 30 patients per clinic; participants will be assessed at baseline and then 3, 6 and 12 months later to determine whether people in intervention clinics have better outcomes for depression, anxiety, physical health and quality of life, if collaborative care offers value for money, and how successfully it is implemented. Researchers will collect data from consenting participants on these variables, and will also use routinely collected data (including electronic patient records) from clinics.

What are the possible benefits and risks of participating?
The findings will benefit people with depression and physical illnesses, their caregivers, healthcare professionals, policymakers, and researchers. These results and recommendations will guide how to better identify and treat depression in primary care settings in Pakistan. This will enhance the management and treatment practices for individuals with depression who visit primary care facilities.
There are no significant additional risks involved in participating in the study. Those participants who will be taking antidepressants can experience adverse effects associated with using antidepressants. However, the physicians will use antidepressants which are already used in common practice, and their safety has been tested. Also, physicians will monitor any study participants on antidepressants, and experienced psychiatrists will supervise physicians. Participants may be asked about their experience of living with depression and physical illnesses, which may cause them to feel distressed, upset or uncomfortable.

Where is the study run from?
The study is led by the University of York (UK), The Aga Khan University (Pakistan), The Initiative, Islamabad (Pakistan), Institute of Psychiatry, Rawalpindi (Pakistan) and SINA Health, Education & Welfare Trust (Pakistan).

When is the study starting and how long is it expected to run for?
November 2022 to March 2027

Who is funding the study?
NIHR-Global Health Research Centre programme (UK)

Who is the main contact?
Prof. Najma Siddiqi, najma.siddiqi@york.ac.uk

Contact information

Prof Najma Siddiqi
Principal investigator

Department of Health Sciences
Room A/RRC/203b
ARRC Building
University of York
Heslington
York
YO10 5DD
United Kingdom

ORCID ID	0000-0003-1794-2152
Phone	+44 (0)1904 32 1681
Email	najma.siddiqi@york.ac.uk

Dr Mehreen Faisal
Scientific

Department of Health Sciences
University of York
Heslington
York
YO10 5DD
United Kingdom

ORCID ID	0000-0002-2725-572X
Phone	+44 (0)1904 32 2505
Email	mehreen.faisal@york.ac.uk

Mr Mujeeb Bhatti
Public

Institute of Psychiatry
Murree Rd
Chah Sultan
Rawalpindi
46000
Pakistan

ORCID ID	0000-0003-1061-6709
Phone	+92 (0)317-1170359
Email	mmb546@york.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• Pakistan

Study participating centres

Results and Publications

Study outputs

Editorial Notes

23/10/2025: The following changes were made to the trial record:
1. The date of final enrolment was changed from 31/10/2025 to 31/03/2026.
2. The completion date was changed from 31/12/2026 to 31/03/2027.
21/05/2025: The following changes were made to the study record:
1. The recruitment start date was changed from 19/05/2025 to 02/06/2025.
2. The recruitment end date was changed from 18/09/2025 to 31/10/2025.
23/04/2025: The following changes were made:
1. The recruitment start date was changed from 07/04/2025 to 19/05/2025.
2. The recruitment end date was changed from 06/08/2025 to 18/09/2025.
21/01/2025: The following changes were made:
1. The recruitment start date was changed from 01/01/2025 to 07/04/2025.
2. The recruitment end date was changed from 31/05/2025 to 06/08/2025.
3. The VPT Clinic, Hingora Goth Gadap Town Near New Sabzi Mandi in Karachi study participating centre was replaced with the Muhammad Jafar Ebrahim Center. The address of the VPT clinic at Govt Dispensary, Liyari 36 B, Khuda ki Basti Karachi was amended to Suhrab Goth Gadap Town.
27/09/2024: Study's existence confirmed by the University of York Health Sciences Research Governance Committee.