abstract: 'Background Co-morbidity of depression with other non-communicable

  diseases (NCDs) worsens clinical outcomes for both conditions. Low- and

  middle-income countries need to strengthen mechanisms for detection and

  management of co-morbid depression within NCDs. The Behavioural

  Activation for Comorbid Depression in Non-communicable Disease (BEACON)

  study explored the acceptability and feasibility of integrating a brief

  depression intervention (behavioural activation, BA) into NCD services

  in healthcare facilities in Bangladesh and Pakistan. Methods

  Face-to-face qualitative interviews were conducted with 43 patients and

  18 health workers attending or working in NCD centres in four healthcare

  facilities in Bangladesh and Pakistan, and with three policy makers in

  each country. The interviews addressed four research questions (1) how

  NCD care is delivered, (2) how NCD patients experience distress, (3) how

  depression care is integrated within NCD provision, and (4) the

  challenges and opportunities for integrating a brief depression

  intervention into usual NCD care. The data were analysed using framework

  analysis, organised by capability, opportunity and motivation factors,

  cross-synthesised across countries and participant groups. Results

  Patients and health workers described NCD centres as crowded and time

  pressured, with waiting times as long as five hours, and consultation

  times as short as five minutes; resulting in some patient frustration.

  They did not perceive direct links between their distress and their NCD

  conditions, instead describing worries about family and finance

  including affordability of NCD services. Health worker and policy maker

  accounts suggested these NCD centres lacked preparedness for treating

  depression in the absence of specific guidelines, standard screening

  tools, recording systems or training. Barriers and drivers to

  integrating a brief depression intervention reflected capability,

  opportunity and motivation factors for all participant groups. While

  generally valuing the purpose, significant challenges included the busy

  hospital environment, skill deficits and different conceptions of

  depression. Conclusions Given current resource constraints and

  priorities, integrating a brief psychological intervention at these NCD

  centres appears premature. An opportune first step calls for responding

  to patients'' expressed concerns on service gaps in provisioning steady

  and affordable NCD care. Acknowledging differences of conceptions of

  depression and strengthening psychologically informed NCD care will in

  turn be required before the introduction of a specific psychological

  intervention such as BA.'
affiliation: 'Wright, J (Corresponding Author), Univ York, Dept Hlth Sci, York YO10
  5DD, N Yorkshire, England.

  Wright, Jerome; Mazumdar, Papiya; Jennings, Hannah, Univ York, Dept Hlth Sci, York
  YO10 5DD, N Yorkshire, England.

  Barua, Deepa; Lina, Silwa; Huque, Rumana, Ark Fdn, House 6,Rd 109,Gulshan 2, Dhaka,
  Bangladesh.

  Bibi, Humaira; Kanwal, Ateeqa; Mujeeb, Faiza; Naz, Qirat; Safi, Rahim; Ul Haq, Baha;
  Rana, Rusham Zahra; Nizami, Asad, Rawalpindi Med Univ, Inst Psychiat, Rawalpindi
  46000, Pakistan.

  Nahar, Papreen, Univ Sussex, Brighton \& Sussex Med Sch, Med Res Bldg, Brighton
  BN1 9PX, E Sussex, England.

  Sikander, Siham, Hlth Serv Acad, PM Hlth Complex, Chak Shahzad 44000, Pakistan.

  Jackson, Cath, Valid Res Ltd, Suite 19,Sandown House,Sandbeck Way, Wetherby LS22
  7DN, England.'
article-number: '63'
author: 'Wright, Jerome and Mazumdar, Papiya and Barua, Deepa and Lina, Silwa and
  Bibi, Humaira and Kanwal, Ateeqa and Mujeeb, Faiza and Naz, Qirat and Safi, Rahim
  and Ul Haq, Baha and Rana, Rusham Zahra and Nahar, Papreen and Jennings, Hannah
  and Sikander, Siham and Huque, Rumana and Nizami, Asad and Jackson, Cath and Grp,
  NIHR Global Hlth Res and IMPACT, '
author-email: jerome.wright@york.ac.uk
author_list:
- family: Wright
  given: Jerome
- family: Mazumdar
  given: Papiya
- family: Barua
  given: Deepa
- family: Lina
  given: Silwa
- family: Bibi
  given: Humaira
- family: Kanwal
  given: Ateeqa
- family: Mujeeb
  given: Faiza
- family: Naz
  given: Qirat
- family: Safi
  given: Rahim
- family: Ul Haq
  given: Baha
- family: Rana
  given: Rusham Zahra
- family: Nahar
  given: Papreen
- family: Jennings
  given: Hannah
- family: Sikander
  given: Siham
- family: Huque
  given: Rumana
- family: Nizami
  given: Asad
- family: Jackson
  given: Cath
- family: Grp
  given: NIHR Global Hlth Res
- family: IMPACT
  given: ''
da: '2023-09-28'
doi: 10.1186/s13033-020-00399-y
files: []
issn: 1752-4458
journal: INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS
keywords: 'Non-communicable disease; Depression; Behavioural activation; South

  Asia; NCD facilities; Mental health policy; Mental-physical

  co-morbidity; Depression care integration'
keywords-plus: 'NONCOMMUNICABLE DISEASES; HEALTH; PROGRAM; INCOME; DISORDERS; COUNTRIES;

  INDIA'
language: English
month: AUG 11
number: '1'
number-of-cited-references: '47'
orcid-numbers: 'Jennings, Hannah Maria/0000-0002-8580-0327

  Nahar, Papreen/0000-0002-5817-8093

  Haq, Baha Ul/0000-0002-9665-3609

  Barua, Deepa/0000-0002-0122-9048

  Wright, Jerome/0000-0001-9740-0534

  Aslam, Faiza/0000-0002-7847-7250'
papis_id: f21a10fc2022eb5fba7e65c78c242eda
ref: Wright2020integratingdepressio
researcherid-numbers: 'Rana, Rusham/AAD-5432-2021

  '
times-cited: '4'
title: 'Integrating depression care within NCD provision in Bangladesh and Pakistan:
  a qualitative study'
type: Article
unique-id: WOS:000562256300001
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '14'
web-of-science-categories: Psychiatry
year: '2020'