Use of a digital health solution after percutaneous coronary intervention: a randomised controlled trial.

This research highlights the importance of religious identity to Muslim mental health. We demonstrate that faith-sensitive depression treatment is more effective than standard treatments in this population, which constitutes the second-largest faith group globally. Our three trials introduced inclusive policy and practice approaches within involved mental health services and staff trained in BA-M continue to use the intervention. BA-M training has also been delivered to 10 NHS therapy teams in the UK and to psychology practitioners in the UK, Pakistan, Turkey, Indonesia and the UAE. University modules have been developed to teach future psychologists in the UK, Pakistan and Indonesia and further work is being planned in Qatar and the United Arab Emirates. The UK course for clinical psychologists will be delivered online and globally accessible to therapists wishing to deliver BA-M. BA-M was effectively delivered by non-specialists in the UK, providing evidence that it can increase capacity among healthcare staff to deliver depression treatment. The intervention also provides a model for faith-sensitive treatments in other religious groups, as the systematic review that informed our development of BA-M included faith-sensitive interventions for a wide range of religious populations. A PhD study is currently being conducted at the University of Leeds to adapt the self-help booklet for Hindus with depression in the UK. This contribution to evidence about effective treatments can potentially support the development of governmental policies globally for faith-sensitive interventions delivered at scale to reduce the burden of depression. Such a change in policy and practice should significantly improve the quality of life for those who consider religion a significant aspect of their identity and subsequently impact education, employment and trust in mental health services. Our results are likely to influence thinking about the most appropriate intervention for treating depression in Muslim and other faith groups and we make recommendations for future policy, practice and research development. Depression affects 4.4% of the global population, with a far higher burden in low- and middle-income countries (World Health Organization, ). In England, one in six people lives with moderate to severe depressive symptoms (Office for National Statistics, ). Poor access to therapy and low rates of recovery compared to the general population have been found among Muslims in the UK, the second largest faith group, who make up around 3.4 million of the population (The Lantern Initiative CIC et al., ; Baker and Kirk-Wade, ; Choudhry and Mir, ). The prevalence of depression in Pakistan, the second largest Muslim majority country in the world (Hafeez, ), is estimated at around 10% of the population – approximately 20 million people (Nisar et al., ) – and higher estimates up to 36% have been found among women in the postnatal period (Husain et al., ) and in a large urban settlement in Karachi (Altaf et al., ). In Turkey, a prevalence rate of 4.4% (around 3.3 million people) has been reported for depression (World Health Organization, ). Culturally adapted therapies are more effective for many populations than Western treatment models (Anik et al., ), and there is evidence that people from minority backgrounds living in Western contexts may identify with a cultural or religious background that is not acknowledged in such treatment (Islam et al., ; Wallace et al., ). Western secular norms have been found to influence dominant knowledge in the field of mental health treatment internationally and to routinely undermine religious identity (Hansdak and Paulraj, ). Individuals accessing psychotherapy in the global South may thus be faced with similar issues because psychologists are trained in and use Western therapy models (Altaf et al., ). There is growing recognition that equitable access and outcomes to mental health support involve decolonising global mental health systems, that is, removing systemic oppression and discrimination by challenging dominant norms that reflect Eurocentric systems of knowledge and power and perpetuate inequitable outcomes (Fay, ; Rivera-Segarra et al., ).