Academic journal article Journal of Cognitive Psychotherapy

The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations

Academic journal article Journal of Cognitive Psychotherapy

The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations

Article excerpt

In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program, which was designed to provide evidence-based depression care services in lowresource, non-Western settings such as Vietnam. The article provides the program development background; the social, economic, and political context in which the program was developed; and the structure and content of the program and their underlying rationale in the context of rural Vietnam. Although the program was found to be acceptable, feasible, and effective in reducing depression outcomes, we did face challenges in implementation, which are outlined in this article. Key challenges included cultural factors (e.g., a lack of recognition of depression as a health-related entity amenable to professional treatment, relatively low levels of psychological mindedness useful for understanding of psychological interventions) and health system (e.g., lack of mental health specialists, overburdened health providers unfamiliar with behavioral interventions) factors. We discuss the strategies we employed to resolve these challenges and our successes and failures therein. We conclude with recommendations for others interested in implementing similar programs in low- and middle-income countries settings.

Keywords: depression care; low- and middle-income countries (LMIC); collaborative care; task shifting; primary care integration

By 2030, unipolar depression is projected to be among the largest contributor to the world's healthcare burden in both high-income countries (HIC) as well as low- and middle-income countries (LMIC; Mathers & Loncar, 2006). It has been estimated that at any point in time, about 99 million people around the world would be suffering from depression (World Health Organization [WHO], 2008). Although effective mental health treatments exist for depression, most individuals experiencing depression fail to receive appropriate treatment. According to the WHO Mental Health Atlas (2011), this mental health resources and treatment gap is particularly large in Asia, the world's most populous continent. Several factors underlie this treatment gap, including individuals' lack of awareness of or access to resources, poor quality of care, stigma regarding mental health treatments, and cost of services (WHO, 2011); foremost among these factors, however, is a severe shortage of mental health professionals globally (WHO, 2006).


This article focuses on the Southeast Asian nation of Vietnam. With a population of more than 92 million, it is the 14th most populous country in the world (Central Intelligence Agency, 2013). The per capita annual gross domestic product (GDP) is $1,596, placing it in low- to middle-income national status (World Bank, 2012). As with many LMIC, because Vietnam began to transition from a primarily rural, agricultural economy to a more mixed industrial economy, its government made an explicit decision to focus the nation's limited resources on expanding infrastructure most directly connected to economic development (e.g., roads, seaports) with health-in particular mental health-and other social services receiving relatively little investment (Stern, 1998). The focus on economic development was successful at the national level: Vietnam is considered "a development success story" by the World Bank, with current GDP growth of about 5% per annum, having dropped from about 7.5% per annum subsequent to the 2007 world recession (World Bank, 2012). However, health and related services' infrastructure has not developed comparably. Despite the general economic development, access to health care has actually become more difficult for some segments of the population as demand has expanded, and certain aspects of the system have become privatized and less supported by government subsidies (Vuong, Van Ginneken, Morris, Ha, & Busse, 2011).

Comparable to its Southeast Asian neighbors, Vietnam spends about 6. …

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