{"id":5053,"date":"2025-07-09T03:41:56","date_gmt":"2025-07-09T00:41:56","guid":{"rendered":"https:\/\/interfamily.com.ua\/?p=5053"},"modified":"2025-07-14T02:30:27","modified_gmt":"2025-07-13T23:30:27","slug":"best-and-promising-practices-abstracts-depression-screening-good-practices","status":"publish","type":"post","link":"https:\/\/interfamily.com.ua\/en\/best-and-promising-practices-abstracts-depression-screening-good-practices\/","title":{"rendered":"Best and promising practices: depression screening and management in primary care"},"content":{"rendered":"<h3>Routine Depression Screening in Primary Care Using PHQ-2 and PHQ-9<\/h3>\n<h3><b>Target Group:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Adults visiting primary care facilities, including patients with somatic complaints<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Internally displaced persons (IDPs) and other populations affected by war-related stress<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Primary care physicians and nurses responsible for first-line screening<\/span><\/li>\n<\/ul>\n<h3><b>Target Aims:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To ensure <\/span><b>early identification of depressive symptoms<\/b><span style=\"font-weight: 400;\">, including major depression, among the general and high-risk adult populations<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To improve <\/span><b>timely referral and treatment<\/b><span style=\"font-weight: 400;\">, including psychological support or pharmacotherapy, for individuals with depressive symptoms<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To reduce the <\/span><b>burden of undiagnosed depression<\/b><span style=\"font-weight: 400;\">, which has significantly increased during the ongoing war in Ukraine<\/span><\/li>\n<\/ul>\n<h3><b>Details of the Implementation:<\/b><\/h3>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Implementation Details:<\/i><\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">This practice is based on <\/span><b>international evidence-based guidelines<\/b><span style=\"font-weight: 400;\">, particularly the <\/span><b>U.S. Preventive Services Task Force (USPSTF)<\/b><span style=\"font-weight: 400;\"> recommendations, which endorse depression screening for all adults, including pregnant and postpartum women, when appropriate systems for diagnosis and follow-up are in place. In Ukraine, this practice is adapted for wartime context through integration into routine primary care workflows and NGO-led psychosocial support programs.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Duration:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">Screening is <\/span><b>ongoing and integrated<\/b><span style=\"font-weight: 400;\"> into every clinical encounter with adults, particularly those with non-specific somatic symptoms or known psychosocial stressors.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>How long has the practice been implemented?<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">Depression screening tools (PHQ-2 and PHQ-9) have been used internationally for over 20 years. In Ukraine, their use has increased since 2014 and was significantly scaled up in 2022\u20132024 due to war-related needs.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>How often is it carried out?<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">Screening is <\/span><b>continuous and routine<\/b><span style=\"font-weight: 400;\">, especially during first contact and periodic check-ups. Some practices repeat screening at intervals (e.g., every 3\u20136 months), especially for high-risk patients.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Main Activities:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Administering PHQ-2 as an initial screen<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">If PHQ-2 is positive (\u22653), administering the full PHQ-9<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Providing immediate psychological first aid or referrals based on severity<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Documenting results and monitoring follow-up<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>What are the key steps of the practice?<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Train healthcare providers in use and interpretation of PHQ-2\/9<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Integrate tools into standard patient intake forms or digital records<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Screen adults during primary care visits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Offer brief intervention or referral based on score thresholds<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Track patient outcomes<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>What methods are used?<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Structured screening questionnaires<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Brief motivational interviewing or problem-solving interventions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Referral pathways to psychologists or psychiatrists<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Capacity building for providers (e.g., trainings, supervision)<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>What tools, materials, or resources are used during implementation?<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">PHQ-2 and PHQ-9 screening forms (paper or electronic)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">WHO and USPSTF guidelines<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">National mental health protocols<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Referral directories and digital case registries<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><b>Involved Stakeholders:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Organizations or Institutions Involved:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Ministry of Health of Ukraine<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">WHO Country Office in Ukraine<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Ukrainian-Swiss Mental Health for Ukraine (MH4U) Project<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">NGOs providing mental health support (e.g., M\u00e9decins Sans Fronti\u00e8res, Red Cross, local NGOs)<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Key Actors:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Family doctors and nurses<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Mental health professionals<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">NGO case managers and outreach workers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Ministry of Health policy makers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Community leaders supporting trust-building<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>How do stakeholders collaborate?<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">National policy sets the screening standard<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Healthcare providers conduct screening and provide initial support<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">NGOs assist with capacity building and referrals<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Psychologists\/psychiatrists provide follow-up care and supervision<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><b>Where was the good practice implemented?<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Implemented in <\/span><b>multiple regions of Ukraine<\/b><span style=\"font-weight: 400;\">, including conflict-affected areas and temporary accommodation centers for IDPs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Also used by mobile health units and in NGO-supported clinics<\/span><\/li>\n<\/ul>\n<p><b><i>Can it be transferred or adapted to other locations?<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">Yes. PHQ-2 and PHQ-9 are <\/span><b>open-access, validated instruments<\/b><span style=\"font-weight: 400;\"> that can be adapted for <\/span><b>other countries, crises, or vulnerable groups<\/b><span style=\"font-weight: 400;\">, provided that follow-up systems are in place.<\/span><\/p>\n<h3><b>What has been achieved through the practice?<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Increased identification<\/b><span style=\"font-weight: 400;\"> of depressive symptoms in primary care settings<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Earlier access to care<\/b><span style=\"font-weight: 400;\"> for vulnerable groups<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reduction of stigma around mental health through routine integration into somatic consultations<\/span><\/li>\n<\/ul>\n<h3><b>What types of feedback have been received?<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Providers report that the tools are <\/span><b>quick, easy to use, and clinically helpful<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patients feel <\/span><b>heard and validated<\/b><span style=\"font-weight: 400;\"> when mental health is addressed during routine care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NGOs note improved <\/span><b>case detection and referral quality<\/b><\/li>\n<\/ul>\n<h3><b>Are there any measurable outcomes or observable changes?<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>PHQ-9 <\/b><span style=\"font-weight: 400;\">scores allow for measurable tracking of depressive symptom severity<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Increased referrals to mental health services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Improved provider confidence and screening rates (based on internal audits)<\/span><\/li>\n<\/ul>\n<h3><b>To what extent is the practice sustainable in the long term?<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Adoptability:<\/b><span style=\"font-weight: 400;\"> Yes, it is low-cost, scalable, and endorsed by WHO and USPSTF<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Conditions for successful replication:<\/b>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Training of primary care staff<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Clear referral mechanisms<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Availability of follow-up care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Leadership support for integration into routine care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Digital or paper-based documentation systems<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Link or Source:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.apa.org\/pi\/about\/publications\/caregivers\/practice-settings\/assessment\/tools\/patient-health\"><span style=\"font-weight: 400;\">https:\/\/www.apa.org\/pi\/about\/publications\/caregivers\/practice-settings\/assessment\/tools\/patient-health<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2806144\"><span style=\"font-weight: 400;\">https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2806144<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0165032720328287?via%3Dihub\"><span style=\"font-weight: 400;\">https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0165032720328287?via%3Dihub<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/journals.sagepub.com\/doi\/full\/10.1177\/2150132720931261\"><span style=\"font-weight: 400;\">https:\/\/journals.sagepub.com\/doi\/full\/10.1177\/2150132720931261<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10157790\/\"><span style=\"font-weight: 400;\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10157790\/<\/span><\/a><\/li>\n<\/ul>\n<p><b>How it could support the pilot implementation in your country:<\/b><\/p>\n<p><b><\/b><span style=\"font-weight: 400;\">This good practice enables <\/span><b>non-specialist providers to detect depression early<\/b><span style=\"font-weight: 400;\">, especially under conditions of high stress and displacement. During war or displacement, psychological distress is common, and many patients present with <\/span><b>somatic symptoms masking mental illness<\/b><span style=\"font-weight: 400;\">. Systematic use of PHQ-2\/9 in Ukraine has shown that brief tools can uncover hidden distress, guide interventions, and improve care without burdening clinicians. For pilot sites, this approach offers <\/span><b>evidence-based, scalable mental health support<\/b><span style=\"font-weight: 400;\"> with measurable outcomes and high provider acceptability.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">II Name of the Good Practice:<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><b>Need in\u00a0 Assessment Questionnaire for Healthcare Professionals to Support the Implementation of Depression Screening<\/b><\/p>\n<p><b>Target Group:<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Primary care physicians (family doctors) and other healthcare professionals involved in mental health service delivery at the primary care level.<\/span><\/p>\n<p><b>Target Aims:<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">To identify and evaluate the specific needs of healthcare professionals for effectively implementing depression screening using PHQ-2 and PHQ-9, as recommended by the USPSTF.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">Rather than measuring behavioral determinants per se, the goal is to assess the <\/span><b>importance<\/b><span style=\"font-weight: 400;\"> of needs and gather insights on how to support implementation efforts.<\/span><\/p>\n<p><b>Details of the Implementation<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Implementation Status:<\/i><\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Currently in the final development phase; implementation is planned for <\/span><b>June 2025<\/b><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Duration:<\/i><\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">The questionnaire is administered <\/span><b>before each new implementation<\/b><span style=\"font-weight: 400;\"> of evidence-based mental health interventions, particularly depression screening.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Frequency:<\/i><\/b><b><br \/>\n<\/b><b>Periodic<\/b><span style=\"font-weight: 400;\">, depending on the implementation cycle; typically used before new projects or process changes in primary care practices.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Main Activities:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Literature analysis of relevant implementation frameworks (DIBQ, PMA).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Selection and adaptation of relevant items to design the new questionnaire focused on needs.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Iterative formulation of items tailored to the Ukrainian healthcare context.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Expert consultations to refine and validate questionnaire content.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Content validity assessment (using CVI and CVR) by 12 Ukrainian academic experts.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Face\/external validity testing among 25 practicing family physicians (IIS score).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Final piloting with clinicians for additional improvements and insights on importance and satisfa<\/span><span style=\"font-weight: 400;\">ction of identified needs.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Key Steps of the Practice:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Needs item extraction from validated implementation questionnaires.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Reformulation to align with needs-based evaluation.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Two-step validation (content + external).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Final piloting and revisions based on user feedback.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Implementation through clinical leadership in selected facilities.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Methods Used:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Literature analysis and synthesis.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Expert consultation and validation (quantitative and qualitative).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Online surveys and structured feedback collection.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Statistical analysis (CVI, CVR, IIS).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Tools, Materials, or Resources Used:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Adapted items from DIBQ and PMA.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Google Forms for data collection.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Google Sheets and Excel for statistical validation analysis.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Final version of the Needs Assessment Questionnaire.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Involved Stakeholders:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Organizations\/Institutions Involved:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Research team from the pilot group.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Ukrainian academic family medicine institutions.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Primary healthcare facilities in Uzhhorod and Zakarpattia region.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Key Actors:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">International expert (Michael Harris).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Ukrainian clinical educators and practicing family doctors (as expert validators).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Clinical leadership teams (as users of data for implementation planning).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Practicing physicians participating in the pilot.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Collaboration:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Researchers lead the design and analysis.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">International and local experts review and refine content.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Practitioners validate relevance and clarity.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Clinic managers use findings to support tailored implementation of screening protocols.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Implementation Site:<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Initial implementation in <\/span><b>Uzhhorod, Ukraine<\/b><span style=\"font-weight: 400;\">. Further rollout is planned in the <\/span><b>Zakarpattia region<\/b><span style=\"font-weight: 400;\"> and potentially across other regions of Ukraine.<\/span><\/p>\n<p><b>Transferability and Adaptability:<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Yes, the practice is highly transferable. The questionnaire structure and methodology can be adapted for other healthcare settings, countries, or thematic areas (e.g., anxiety, trauma, chronic disease management). It can also be applied before other mental health innovations.<\/span><\/p>\n<p><b>Achievements:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">High perceived relevance and usefulness by clinical and academic experts.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Final validated version reflects actual needs and challenges identified by frontline practitioners.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Enables management teams to make informed decisions about support mechanisms (training, time, materials, supervision).<\/span><\/li>\n<\/ul>\n<p><b>Feedback from Participants and Stakeholders:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Experts and clinicians described the tool as <\/span><b>timely and highly practical<\/b><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Considered helpful for <\/span><b>diagnosing implementation gaps<\/b><span style=\"font-weight: 400;\"> before rolling out new processes.<\/span><\/li>\n<\/ul>\n<p><b>Measurable Outcomes:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">High CVI and CVR scores demonstrate <\/span><b>strong content validity<\/b><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">IIS results from practicing doctors confirm <\/span><b>strong face validity<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Final version includes only items deemed relevant, clear, and aligned with intended purpose.<\/span><\/li>\n<\/ul>\n<p><b>Sustainability:<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Long-Term Use:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">Yes, the tool is sustainable and scalable. It can be integrated into quality improvement cycles.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Adoption by Others:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">Yes, with minimal contextual adaptation, it can be used by other healthcare institutions or in other countries.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Required Conditions\/Resources:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Research\/expert team to conduct contextual adaptation and validation.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Buy-in from clinical management to use findings for decision-making.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Simple digital tools (Google Forms, Sheets) for data collection and analysis.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Link or Source:<\/b><b><br \/>\n<\/b><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28407994\/\"><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/28407994\/<\/span><\/a><\/p>\n<p><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4000005\/\"><span style=\"font-weight: 400;\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4000005\/<\/span><\/a><\/p>\n<p><a href=\"https:\/\/docs.google.com\/forms\/d\/1GNZEgr0V8vXZM6w0wgOdCPXB_3fd01CGzACojGOo2Ec\/edit\"><span style=\"font-weight: 400;\">https:\/\/docs.google.com\/forms\/d\/1GNZEgr0V8vXZM6w0wgOdCPXB_3fd01CGzACojGOo2Ec\/edit<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">(Currently in internal project documentation).\u00a0<\/span><\/p>\n<p><b>How It Supports the Pilot Implementation in Ukraine:<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">This good practice is critical for ensuring <\/span><b>contextually grounded, needs-responsive implementation<\/b><span style=\"font-weight: 400;\"> of depression screening at the primary care level. It helps identify <\/span><b>barriers and support needs<\/b><span style=\"font-weight: 400;\"> ahead of rollout, increasing the likelihood of sustainable integration of PHQ-2 and PHQ-9 into clinical routines.<\/span><\/p>\n<p><b>Depression management and promotion good practices<\/b><\/p>\n<p><span style=\"font-weight: 400;\">III Name of the good practice:<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><b>Implementation of WHO mhGAP Intervention Guide (mhGAP-IG) with the Planned Innovation of Post-Training Peer Case Discussion Clubs<\/b><\/p>\n<p><b>Target Group:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family doctors and other primary healthcare professionals working with internally displaced persons (IDPs)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Young professionals and medical interns involved in psychosocial support<\/span><\/li>\n<\/ul>\n<p><b>Target Aims:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To enhance the capacity of non-specialist health workers in recognizing, managing, and treating priority mental health conditions using evidence-based psychosocial support strategies and promoting help-seeking in the field of mental health.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To ensure early identification of anxiety, depression, and stress-related disorders, especially among vulnerable populations such as IDPs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To foster practical skills and peer support through innovative case discussion clubs after formal training<\/span><\/li>\n<\/ul>\n<p><b>Details of the Implementation:<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Implementation Details:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">The core of the practice is based on WHO\u2019s mhGAP-IG, implemented through in-person or blended training programs. As an <\/span><b>innovative addition<\/b><span style=\"font-weight: 400;\">, we plan to launch <\/span><b>Peer Case Discussion Clubs<\/b><span style=\"font-weight: 400;\"> for those who have completed the training, enabling practical case-based learning and peer reflection in a safe, structured environment.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Duration:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">Core mhGAP training lasts 3\u20134 days; follow-up peer discussion sessions are planned monthly for at least 6 months after training.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>How long has the practice been implemented?<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">mhGAP-IG has been implemented globally since 2010 and in Ukraine since 2014 in various regions.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">The planned innovation (Discussion Clubs) is scheduled for pilot testing starting in 2025.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>How often is it carried out?<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">The mhGAP training is typically project-based. The Peer Case Discussion Clubs will be held <\/span><b>monthly<\/b><span style=\"font-weight: 400;\"> to ensure continuous development and retention of practical skills.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Main Activities:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Training healthcare workers using the mhGAP-IG modules<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Practical exercises with clinical scenarios<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Post-training peer case discussion clubs (planned innovation)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Mentorship and optional supervision support<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Key Steps of the Practice:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Identification of target participants<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Delivery of mhGAP-based training<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Distribution of practical tools and job aids<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Formation of small discussion groups<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Facilitation of monthly peer case discussions with expert support<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Evaluation of knowledge, confidence, and skill application<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Methods Used:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Group work and simulation<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Facilitated training sessions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Peer mentoring and supervision<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Case-based learning and reflection sessions<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Tools, Materials, or Resources Used:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">WHO mhGAP-IG (paper and digital versions)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Clinical case scenarios and job aids<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">PHQ-9 and other validated screening tools<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Facilitation guides for discussion clubs<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Involved Stakeholders:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Organizations Involved:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">World Health Organization (WHO)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Ministry of Health of Ukraine<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Primary Health Care Centers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">NGOs supporting IDPs and mental health response<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Key Actors:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Primary care physicians<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Medical managers and mentors<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">NGO coordinators and trainers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Psychiatrists and psychologists providing expert support<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Stakeholder Collaboration:<\/i><\/b><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">National health authorities validate content and provide endorsement<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">NGOs facilitate the training and peer sessions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Mentors and peers co-lead the case discussions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Community feedback informs ongoing improvements<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Where was the good practice implemented?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Locally in several Ukrainian regions (e.g., Kyiv, Lviv), as well as through national online formats during wartime.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Globally used in over 100 countries.<\/span><\/li>\n<\/ul>\n<p><b>Can it be transferred or adapted to other locations?<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Yes. The mhGAP framework is designed for global adaptation.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">Our <\/span><b>planned innovation \u2014 the Peer Case Discussion Clubs \u2014<\/b><span style=\"font-weight: 400;\"> can be tailored and replicated in other settings as a sustainable support mechanism for trained professionals.<\/span><\/p>\n<p><b>What has been achieved through the practice?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Increased detection and treatment of mental health conditions at primary care level<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reduction of stigma among healthcare workers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stronger peer support networks among trained professionals<\/span><\/li>\n<\/ul>\n<p><b>What types of feedback have been received?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Participants praise the mhGAP guide for its practical relevance<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Health centers report greater confidence in managing mental health cases<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Anticipated feedback for the discussion clubs includes improved peer learning and reduced professional isolation<\/span><\/li>\n<\/ul>\n<p><b>Are there any measurable outcomes or observable changes?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Improved knowledge and confidence (based on pre\/post evaluations)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Increased identification and referral rates<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Better adherence to evidence-based care protocols<\/span><\/li>\n<\/ul>\n<p><b>To what extent is the practice sustainable in the long term?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Adoptability:<\/b><span style=\"font-weight: 400;\"> Yes. It can be scaled to other clinics.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Conditions for successful replication include:<\/b>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Trained facilitators and mentors<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Institutional support for monthly meetings<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Structured materials and ongoing monitoring<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Link or Source:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.who.int\/teams\/mental-health-and-substance-use\/treatment-care\/mental-health-gap-action-programme\"><span style=\"font-weight: 400;\">https:\/\/www.who.int\/teams\/mental-health-and-substance-use\/treatment-care\/mental-health-gap-action-programme<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pinchuk, I., Yachnik, Y., Kopchak, O., Avetisyan, K., Gasparyan, K., Ghazaryan, G., Chkonia, E., Panteleeva, L., Guerrero, A., &amp; Skokauskas, N. (2021). The Implementation of the WHO Mental Health Gap Intervention Guide (mhGAP-IG) in Ukraine, Armenia, Georgia and Kyrgyz Republic. <\/span><i><span style=\"font-weight: 400;\">International journal of environmental research and public health<\/span><\/i><span style=\"font-weight: 400;\">, <\/span><i><span style=\"font-weight: 400;\">18<\/span><\/i><span style=\"font-weight: 400;\">(9), 4391. <\/span><a href=\"https:\/\/doi.org\/10.3390\/ijerph18094391\"><span style=\"font-weight: 400;\">https:\/\/doi.org\/10.3390\/ijerph18094391<\/span><\/a><\/li>\n<\/ul>\n<p><b>How it could support the pilot implementation in your country:<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">The <\/span><b>mhGAP-IG framework provides a globally validated training foundation<\/b><span style=\"font-weight: 400;\"> for non-specialist mental health service delivery.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><b>Our planned innovation\u2014Peer Case Discussion Clubs\u2014adds a unique, low-cost, high-impact layer of support<\/b><span style=\"font-weight: 400;\">, allowing trained professionals to apply their skills, consult peers on complex cases, and build confidence through experiential learning. This model strengthens long-term implementation by building sustainable communities of practice.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">IV Name of the Good Practice:<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><b>Open-label Placebo (OLP) as a Potential First-Line Intervention for<\/b><b> Mild to Moderate Depression in Primary Care. Research Projects.<\/b><\/p>\n<p><b>Target Group<\/b><b>:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patients with mild to moderate depression seeking care at primary health care facilities<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family doctors trained under the WHO mhGAP program<\/span><\/li>\n<\/ul>\n<p><b>Target Aims:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To examine the effectiveness of open-label placebo (OLP) in combination with psychosocial interventions in primary care settings<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To enhance the accessibility and safety of depression treatment while minimizing the use of pharmacotherapy associated with potential adverse effects<\/span><\/li>\n<\/ul>\n<p><b>Details of the Implementation:<\/b><\/p>\n<p><b><i>Implementation Details:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">This practice has been investigated by the <\/span><b>Depression Clinic at Massachusetts General Hospital<\/b><span style=\"font-weight: 400;\"> and <\/span><b>Shalvata Mental Health Center, P.O.B 94, Hod-Hasharon, Israel<\/b><span style=\"font-weight: 400;\">.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">It has <\/span><i><span style=\"font-weight: 400;\">not yet been conducted in Ukraine<\/span><\/i><span style=\"font-weight: 400;\">, and is currently under consideration for a pilot study.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A randomized controlled trial (RCT) design is used, where participants are allocated to:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Group A: open-label placebo (OLP) capsules + psychosocial support<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Group B: psychosocial support only<\/span><\/li>\n<\/ul>\n<p><b><i>Duration:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">28-day core intervention period, followed by a 14-day follow-up<\/span><\/li>\n<\/ul>\n<p><b><i>How long has the practice been implemented?<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Still at the experimental pilot stage<\/span><\/li>\n<\/ul>\n<p><b><i>How often is it carried out?<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Currently designed as a one-time intervention pilot, with the potential for routine integration based on outcomes<\/span><\/li>\n<\/ul>\n<h3><b>Main Activities and Key Steps Across All Countries (USA, Israel, Ukraine \u2013 planned):<\/b><\/h3>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Provision of a rationale for open-label placebo (OLP):<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">In all studies, participants were provided with a standardized rationale explaining why OLP might be effective. The rationale included:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Placebos in RCTs are often about 80% as effective as antidepressants<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Classical conditioning can support automatic self-healing<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Higher adherence to placebo intake is associated with better outcomes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Positive expectations may help, though skepticism is acceptable<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">In the <\/span><b>planned Ukrainian study<\/b><span style=\"font-weight: 400;\">, the rationale will be delivered in a non-suggestive, autonomy-supportive tone, with sensitivity to war-related trauma and mistrust, particularly among internally displaced persons (IDPs).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Assessment of depressive symptoms:<\/i><\/b><\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">In the <\/span><b>USA<\/b><span style=\"font-weight: 400;\">, assessments included the clinician-rated HAM-D-17 and self-report tools (QIDS, SDQ)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">In <\/span><b>Israel<\/b><span style=\"font-weight: 400;\">, self-report QIDS-SR-16 was used<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">In the <\/span><b>planned Ukrainian study<\/b><span style=\"font-weight: 400;\">, clinicians will use the <\/span><b>Montgomery\u2013\u00c5sberg Depression Rating Scale (MADRS)<\/b><span style=\"font-weight: 400;\">, with validated Ukrainian-language instruments. This approach addresses the limitations of self-report tools and enhances clinical precision.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Randomization and group conditions:<\/i><\/b><\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">In the <\/span><b>USA<\/b><span style=\"font-weight: 400;\"> and <\/span><b>Israel<\/b><span style=\"font-weight: 400;\">, participants were randomized to receive either OLP or waitlist\/TAU (treatment as usual)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">In the <\/span><b>planned Ukrainian study<\/b><span style=\"font-weight: 400;\">, both randomized groups will receive <\/span><b>active psychosocial interventions<\/b><span style=\"font-weight: 400;\">; there will be <\/span><b>no passive waitlist group<\/b><span style=\"font-weight: 400;\">. This decision was made to ensure ethical support and to reflect the realities of delivering care in a humanitarian context.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>OLP treatment duration and follow-up schedule:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">OLP treatment was given for 2\u20134 weeks in both the USA and Israel, with follow-ups at 2- or 4-week intervals.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">In the <\/span><b>planned Ukrainian protocol<\/b><span style=\"font-weight: 400;\">, a longer observation period is included to assess the <\/span><b>sustainability of OLP effects<\/b><span style=\"font-weight: 400;\"> in real-world primary care and displacement-affected settings.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Informed consent and participant engagement:<\/i><\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">All completed studies ensured informed consent. In the USA, participants received financial compensation and post-trial psychiatric care.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">In the <\/span><b>planned Ukrainian study<\/b><span style=\"font-weight: 400;\">, participants will be invited to post-intervention debriefing sessions to reduce stigma, foster trust, and encourage further engagement with mental health services, especially within primary care.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b><i>Feasibility and recruitment focus:<\/i><\/b><b><i><br \/>\n<\/i><\/b><span style=\"font-weight: 400;\">The USA study (Massachusetts General Hospital) demonstrated fast recruitment and high retention (75%).<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">In the <\/span><b>planned Ukrainian study<\/b><span style=\"font-weight: 400;\">, a <\/span><b>larger sample<\/b><span style=\"font-weight: 400;\"> is anticipated, and structured feedback will be collected from both patients and providers to assess feasibility, acceptability, and contextual adaptation for conflict-affected populations<\/span><\/li>\n<\/ol>\n<p><b><i>Methods Used:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family doctor consultations<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Psychoeducation on the mind-body connection and placebo mechanisms<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Use of standardized clinical assessment tools (MADRS or HAM-D)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Use of IBM SPSS for statistical analysis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">One-on-one interactions; group therapy is not used in this intervention<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Supervision and mentorship of clinicians during the study phase<\/span><\/li>\n<\/ul>\n<p><b>Tools, Materials, or Resources Used:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Open-label placebo capsules<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">PHQ-9 and MADRS or HAM-D depression scales<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">WHO mhGAP intervention guide<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Randomization tables<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">G*Power 3.1 software for sample size calculation<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">IBM SPSS for data analysis<\/span><\/li>\n<\/ul>\n<p><b>Involved Stakeholders:<\/b><\/p>\n<p><b><i>Organizations or Institutions Involved:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Depression Clinic at Massachusetts General Hospital<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Shalvata Mental Health Center, Hod-Hasharon, Israel<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Uzhhorod National University, Ukraine<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Primary health care centers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">WHO (in relation to mhGAP materials)<\/span><\/li>\n<\/ul>\n<p><b><i>Key Actors:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patients<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family physicians<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Academic researchers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Implementation coordinators<\/span><\/li>\n<\/ul>\n<p><b><i>Collaboration Between Stakeholders:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Joint planning and training of health professionals<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physicians implement the intervention under supervision from the research team<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Use of international protocols and evidence to structure the intervention<\/span><\/li>\n<\/ul>\n<p><b>Where Was the Good Practice Implemented?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The original studies were conducted in the USA and Israel.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">It has <\/span><b>not yet been implemented in Ukraine<\/b><span style=\"font-weight: 400;\">, but is proposed for local pilot testing in several primary care facilities.<\/span><\/li>\n<\/ul>\n<p><b>Can It Be Transferred or Adapted to Other Locations?<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Yes. The practice is low-cost, ethically acceptable, and adaptable for primary care systems in other countries with established PHC networks.<\/span><\/p>\n<p><b><i>Achievements:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Increased awareness of ethical placebo use among clinicians<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Enhanced doctor-patient transparency and trust<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Potential reduction in unnecessary pharmacological prescriptions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Promotion of patient participation in treatment decisions<\/span><\/li>\n<\/ul>\n<p><b><i>Feedback Received:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patients reported appreciation for the honesty and openness of the approach<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physicians expressed interest in safe alternatives to antidepressants<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some clinicians noted the need for additional guidance in explaining the rationale to patients<\/span><\/li>\n<\/ul>\n<p><b><i>Measurable Outcomes or Observable Changes:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reduction in scores after intervention<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Comparison of outcomes between the OLP and control group<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient adherence and follow-up completion rates<\/span><\/li>\n<\/ul>\n<p><b><i>Sustainability in the Long Term:<\/i><\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">High potential for scale-up with minimal cost<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Requires institutional endorsement and integration into clinical guidelines<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Training of family physicians is feasible through existing mhGAP infrastructure<\/span><\/li>\n<\/ul>\n<p><b>Link or Source:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Kirsch I. (2019). <\/span><i><span style=\"font-weight: 400;\">Placebo Effect in the Treatment of Depression and Anxiety<\/span><\/i><span style=\"font-weight: 400;\">. <\/span><i><span style=\"font-weight: 400;\">Frontiers in Psychiatry<\/span><\/i><span style=\"font-weight: 400;\">, 10, 407<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Charlesworth JE et al. (2017). <\/span><i><span style=\"font-weight: 400;\">Effects of placebos without deception compared with no treatment: a systematic review and meta-analysis<\/span><\/i><span style=\"font-weight: 400;\">. <\/span><i><span style=\"font-weight: 400;\">Journal of Evidence-Based Medicine<\/span><\/i><span style=\"font-weight: 400;\">, 10(2)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nitzan U. (2020). <\/span><i><span style=\"font-weight: 400;\">Open-label placebo for major depressive disorder: A pilot study<\/span><\/i><span style=\"font-weight: 400;\">. PubMed<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Kelley JM et al. (2012). PMC article on OLP and depression<\/span><\/li>\n<\/ul>\n<p><b><i>Explanation of How It Could Support the Pilot Implementation in Your Country:<\/i><\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Open-label placebo (OLP) provides an ethically sound, safe, and potentially effective treatment option for mild depression\u2014particularly relevant in Ukraine, where access to psychiatric services is limited, stigma around psychotropic medication is high, and PHC providers are overburdened.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">Results from a local pilot could inform national guidelines and support the scale-up of this approach across the country.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Routine Depression Screening in Primary Care Using PHQ-2 and PHQ-9 Target Group: Adults visiting primary care facilities, including patients with somatic complaints Internally displaced persons (IDPs) and other populations affected by war-related stress Primary care physicians and nurses responsible for first-line screening Target Aims: To ensure early identification of depressive symptoms, including major depression, among [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":3968,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[236],"tags":[],"class_list":["post-5053","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mimind-en"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Best and promising practices: depression screening and management in primary care &#8211; InterFamily<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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