{
  "abstract": "Introduction Depression and post-traumatic stress disorder (PTSD) significantly contribute to the global disease burden, adversely affecting health, medical costs and economic productivity. The SMART-DAPPER project in western Kenya approached this challenge by deploying trained non-specialists to administer proven depression and PTSD treatments.Methods Participants were public sector primary care outpatients at Kiumu County Hospital with major depression and/or PTSD. They were randomised to first-line treatment with interpersonal psychotherapy (IPT) or fluoxetine. We evaluated three measures of economic productivity: income, absenteeism and presenteeism (lowered work efficiency). Change over baseline and comparisons between treatments were conducted using generalised estimating equations regression.Results There were statistically significant gains in economic productivity from baseline to the end of first-line treatment. The percentage of participants earning a monthly income rose from 54.9% at baseline to 59.8% after treatment in the IPT group and from 54.5% to 61.5% in the Fluoxetine group. Improvement was significantly associated with illness remission. Average monthly income among earners increased by Kenya shillings (KES) 1920 (46 Intl$) with IPT and KES 1350 (31 Intl$) with fluoxetine. Absenteeism dropped in both treatment arms, by 1.5 days per month for IPT and 1.9 days per month for fluoxetine. Presenteeism decreased more with fluoxetine (4.8 days per month) than with IPT (3.3 days per month).Conclusion Treating common mental disorders with IPT and fluoxetine in public sector primary care settings was associated with economic productivity. Leveraging a non-specialist workforce for treatment delivery at scale may build individual and community economic well-being.Funding R01MH113722(NIMH), R01MH115512(NIMH-GACD).Trial registration number ClinicalTrials.gov Identifier: NCT03466346.",
  "authors": [
    {
      "affiliations": [
        "University of Nairobi, Nairobi, Nairobi, Kenya"
      ],
      "name": "Daniel Mwai"
    },
    {
      "affiliations": [
        "Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Susan M Meffert"
    },
    {
      "affiliations": [
        "Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya"
      ],
      "name": "Easter E Olwanda"
    },
    {
      "affiliations": [
        "University of Nairobi, Nairobi, Nairobi, Kenya"
      ],
      "name": "Muthoni A Mathai"
    },
    {
      "affiliations": [
        "Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya"
      ],
      "name": "Linnet Ongeri"
    },
    {
      "affiliations": [
        "Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Rachel L Burger"
    },
    {
      "affiliations": [
        "University of Nairobi, Nairobi, Nairobi, Kenya"
      ],
      "name": "Anne Mbwayo"
    },
    {
      "affiliations": [
        "University of Nairobi, Nairobi, Nairobi, Kenya"
      ],
      "name": "Grace Rota"
    },
    {
      "affiliations": [
        "University of Nairobi, Nairobi, Nairobi, Kenya"
      ],
      "name": "Ammon Otieno"
    },
    {
      "affiliations": [
        "Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Craig R Cohen"
    },
    {
      "affiliations": [
        "University of Nairobi, Nairobi, Nairobi, Kenya"
      ],
      "name": "David Bukusi"
    },
    {
      "affiliations": [
        "Department of Psychiatry, University of California San Diego, La Jolla, California, USA"
      ],
      "name": "Gregory A Aarons"
    },
    {
      "affiliations": [
        "Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Thomas C Neylan"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Charles E McCulloch"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Chengshi Jin"
    },
    {
      "affiliations": [
        "Makerere University, Kampala, Kampala, Uganda"
      ],
      "name": "Dickens Akena"
    },
    {
      "affiliations": [
        "Kenya Ministry of Health, Nairobi, Kenya"
      ],
      "name": "Simon Kahonge"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "James G Kahn"
    }
  ],
  "title": "Productivity benefits of treatment of depression and post-traumatic stress disorder in Kenya",
  "uid": "c946ebc4-55c5-5707-a7cd-64a77ebb0176"
}