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Effectiveness and cost-effectiveness of digital approaches for training frontline health workers in depression care: a randomized controlled trial – Nature Mental Health

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John A. Naslund
effectiveness-and-cost-effectiveness-of-digital-approaches-for-training-frontline-health-workers-in-depression-care:-a-randomized-controlled-trial-–-nature-mental-health

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Data availability

All de-identified data reported in this study were submitted to the National Data Archive (NDA) housed at the National Institute of Mental Health (NIMH), USA. Other researchers may access the data by submitting a data application to the NDA. At 2 years after publication, all individual participant de-identified data will be shared with researchers who submit a written proposal to John_Naslund@hms.harvard.edu. The data will be available indefinitely. This timeline allows the study team to analyze and potentially publish the results of the exploratory measures as indicated in our study protocol. Researchers requesting data will receive a response from the study team within three business days.

Code availability

At 2 years after publication, the analytic code will be shared with researchers who submit a formal written proposal to John_Naslund@hms.harvard.edu. The code will be available indefinitely. This timeline allows the study team to analyze and potentially publish the results of the exploratory measures as indicated in our study protocol. Researchers requesting the code will receive a response from the study team within three business days.

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Acknowledgements

We thank the Accredited Social Health Activists (ASHAs) and ASHA Facilitators who participated in this trial, members of the independent data and safety monitoring board and research staff involved in the trial. We also thank our collaborators from the National Health Mission, Ministry of Health and Family Welfare, Government of Madhya Pradesh and the National Health Systems Resource Center, Government of India, New Delhi, for their support of this project. We also thank the National Institute of Mental Health (NIMH) who funded the ESSENCE program. The NIMH had no role in the writing of this paper or the decision to submit it for publication.

Funding

This study was supported by a grant from the National Institute of Mental Health (grant no. U19MH113211), USA. The funder played no role in the study design; collection, analysis or interpretation of data; writing of the paper; or submission of the paper for publication.

Author information

Author notes

  1. These authors jointly supervised this work: Anant Bhan, Vikram Patel.

Authors and Affiliations

  1. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    John A. Naslund, Chunling Lu, Carina Akemi Nakamura & Vikram Patel

  2. Sangath, Bhopal, India

    Deepak Tugnawat, Aditya Anand, Udita Joshi, Azaz Khan, Shital Muke, Ritu Shrivastava, Abhishek Singh, G. Sai Teja & Anant Bhan

  3. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Zafra Cooper

  4. Department of Psychology and Neuroscience, Crown Institute, University of Colorado Boulder, Boulder, CO, USA

    Sona Dimidjian

  5. Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK

    Christopher G. Fairburn

  6. Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Bethany Hedt-Gauthier & Rohit Ramaswamy

  7. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Bethany Hedt-Gauthier

  8. Department of Psychology, Vanderbilt University, Nashville, TN, USA

    Steven D. Hollon

  9. Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA

    Chunling Lu

  10. Department of Medicine, The University of Chicago, Chicago, IL, USA

    Lauren M. Mitchell

  11. Center for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

    Abhijit Nadkarni

  12. Sangath, Alto Porvorim, Goa, India

    Abhijit Nadkarni

  13. Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV, USA

    Juliana L. Restivo Haney

  14. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

    Daisy R. Singla

  15. Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada

    Daisy R. Singla

  16. Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Daisy R. Singla

  17. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Vikram Patel

Authors

  1. John A. Naslund
  2. Deepak Tugnawat
  3. Aditya Anand
  4. Zafra Cooper
  5. Sona Dimidjian
  6. Christopher G. Fairburn
  7. Bethany Hedt-Gauthier
  8. Steven D. Hollon
  9. Udita Joshi
  10. Azaz Khan
  11. Chunling Lu
  12. Lauren M. Mitchell
  13. Shital Muke
  14. Abhijit Nadkarni
  15. Carina Akemi Nakamura
  16. Rohit Ramaswamy
  17. Juliana L. Restivo Haney
  18. Ritu Shrivastava
  19. Abhishek Singh
  20. Daisy R. Singla
  21. G. Sai Teja
  22. Anant Bhan
  23. Vikram Patel

Contributions

V.P. conceptualized the study and led efforts in funding acquisition. J.A.N. designed the study methodology, with contributions from V.P., S.D., C.G.F., S.D.H., C.L., A.N. and R.R. U.J., L.M.M. and J.L.R.H. led development of the knowledge assessment with guidance from J.A.N., Z.C., C.G.F. and D.R.S. A.K. and D.T. led development of the training programs with contributions from R.S., A.S., S.D., J.A.N. and S.D.H. A.A., U.J. and S.M. performed data curation and A.A., G.S.T. and C.A.N. conducted the formal analysis with oversight from B.-H.G. U.J. supported the economic evaluation with contributions from C.A.N. and oversight by C.L. D.T. and A.B. managed and coordinated responsibility for the research planning and execution. J.A.N. and D.T. provided oversight and leadership for the research activity planning and execution, with oversight from A.B. and V.P. J.A.N. wrote the original draft of this paper with significant inputs from Z.C., B.H.G., S.D.H., A.K., C.L., L.M.M., C.A.N., D.R.S. and V.P. All authors reviewed and edited subsequent drafts. All authors had full access to all the data in the study, read the final paper and had final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to John A. Naslund.

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Competing interests

The authors declare no competing interests.

Peer review

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Nature Mental Health thanks Carly Brantner, Kaaren Mathias and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Naslund, J.A., Tugnawat, D., Anand, A. et al. Effectiveness and cost-effectiveness of digital approaches for training frontline health workers in depression care: a randomized controlled trial. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00693-7

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  • DOI: https://doi.org/10.1038/s44220-026-00693-7

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