Happier and Wiser in Developing Countries

Brief, inexpensive, and easily deliverable forms of psychotherapy can effectively improve mental health and other individual outcomes for a long time also in the developing world.
 
These therapies, said Gautam Rao (Harvard University) presenting a new study at the first LEAP (Laboratory for Effective Antipovery Policies) – Cattolica University joint seminar of the academic year 2021-2022, “represent a powerful tool for filling the huge treatment gap particularly occurring in developing countries.”
 
Professor Rao presented his new fascinating paper on the long-run effects of brief psychotherapy (inexpensive and easily deliverable) on depression and on other several outcomes. The study, focusing on two psychotherapy trials in Goa (India), documents three important results: “light” therapy alleviated major depressive disorders for 5 years, influenced people’s self-confidence by making both happier and wiser, increased participants’ patience and altruism and improved people’s expectations about the treatment effectiveness.
 
Professor Rao introduced the seminar illustrating the motivations that drove this study. Depression is very common: according to recent estimates there is about a 20% lifetime prevalence of depression, meaning that 20% of all of us will probably suffer from depression at some point in our lives. Moreover, since depression tends to be a more chronic condition rather than episodic (people who had depression once will probably be affected again), it also accounts for 5.6% of years lived with disability globally. Finally, it entails consistent costs, both in terms of human capital loss and welfare expenditures. Despite such ubiquity, depression is something for which huge treatment gaps exist and, especially in developing countries, there still is a large share of people that does not receive any treatment at all. This is a consequence of two joint barriers: those on the demand side and on the supply side. Indeed, from one hand, people living in developing countries are not familiar with Western psychiatry practices and are usually reluctant to receive treatment because of suspicion and stigma issues. From the other, there is also a consistent lack of mental health professionals. For example, even if India hosts nearly 1.4 billion of people, there are only 3 thousand psychiatrists and some of them are not even practicing. Therefore, about 85% of Indians suffering from major depressive disorders go completely untreated.
 
In response to this huge treatment gap, researchers have in recent years developed inexpensive (66$ per patient) forms of psychotherapy that can be delivered by non-specialist counselors after few-weeks trainings. Brief forms of therapy essentially consist of a particular treatment for depression that has been found to be very effective, behavioral activation. This treatment shifts the attention away from cognitions and feelings to focus on patients’ behavior and environment. In few words, it is about explaining to people the positive relation between pleasurable activities they engage in and the mood that results from them and, although apparently very simple, this is enough to ease depression conditions. Indeed, multiple clinical trials have already documented their effectiveness in reducing depression in the short run. With the present study, instead, Gautam Rao and co-authors ask whether this positive impact persist in the long run too. In addition, they try to develop a sort of economic model of depression by studying the effects of brief psychotherapy on patients’ economic decision-making and behaviors.
 
The study looks at two different clinical trials up to 5 years after their completion and compares treatment and control groups. As first finding, Rao’s team documents a 14 percent points depression reduction resulting from one of the trials showing, instead, no long-run effects from the other (despite the significance of the short-term ones). Concerning the impact on self-confidence, measured through the performance of an ego-relevant work task subject to repeated feedbacks, authors find that treatments made participants “happier and wiser”. Indeed, treated participants updated their beliefs less optimistically (i.e. reacted less to positive signals), suggesting a more rational approach to reality. Self-evaluations regarding patience and altruism were also found to be improved. Finally, brief psychotherapy increased participants’ beliefs about its efficacy.
 
To conclude, these important results suggest that brief forms of psychotherapy can effectively improve mental health and other individual outcomes for a long time. Therefore, given their affordability and immediacy, these therapies represent a powerful tool for filling the huge treatment gap particularly occurring in developing countries.
 
Gautam Rao is Associated Professor at the Department of Economics at Harvard University, research fellow at the National Bureau of Economic Research (NBER), faculty affiliate at the Abdul Latif Jameel Poverty Action Lab (JPAL) and also served as associate editor at the Journal of Political Economy. His research tries to apply insights from psychology to topics in economics, with a particular focus on developing countries.

by Giorgia Cascone