Adaptation of problem-solving therapy for primary care to prevent late-life depression in Goa, India: the ‘DIL’ intervention

Figures & data

Table 1. In-depth interviews.

Participants	No. of IDI
Elderly participants	20	(m = 10; f = 10)
Depressed participants	5	(m = 0; f = 5)
Caregivers	5	(m = 2; f = 3)
Experts	2	(m = 1; f = 1)
Total	32	(m = 13; f = 19)

Figure 1. Theory-of-change pathway.

Figure 2. Consort – case series.

Figure 3. Use of illustration as a visual aid to teach PST in three steps.

Figure 4. Sleep-monitoring chart.

Figure 5. Sleep hygiene (dos and don’ts).

Table 2. Challenges and strategies used during open-case series.

Challenges faced	How they were handled
Elder would not generate solutions on his own during the session and wanted the counselor to give him advice	Elder was reminded that solutions that work for one person may not work for another, and that it is best for each person to come up with their own solutions
Elders had difficulty recalling the content of the previous session	Counselor summarized and gave the elder probes to recall the action plan
Family did not think that their elder needed counseling	Benefits of the program, such as chronic illness management, better sleep, and improved pleasurable activities, were explained to the family. Did not use the term ‘depression’ while talking to the family and the participants.
Interruptions from family members and neighbors during the home-based sessions	Session was resumed with a brief summary after informing the interrupter about the need for privacy
challenges related to scheduling sessions: missed appointments not reachable on the telephone busy with house work renovation of house – too much noise	Appointment was confirmed via telephone (when available) in the morning and only then visit the elder. When no telephone, multiple visits to the elder’s house were carried out. Flexible gaps between sessions provided.
Challenges related to duration of sessions – elders vent out and session goes beyond 60 minutes	give space to the elder to cry use reflection begin the next session by retelling the elder his/her story

Table 3. Competency assessment final scoring.

For section 1, a counselor should demonstrate:	(i) A minimum of four of the skills to acquire and maintain competency(ii) Among the skills that should not be present in a session, at least two of them should not be demonstrated
For section 2, a counselor should demonstrate:	(iii) A minimum of five of the core skills