The global treatment gap for depression exceeds 75% in low- and middle-income countries. The Beside Programme exists because effective care does not have to be expensive or scarce.
Pooled estimate from five randomised controlled trials of peer-delivered, low-intensity depression interventions in LMIC settings. AIM Research, 2024.
A disability-adjusted life year — DALY — is the standard global health unit for the burden of illness. A year of depression carries a disability weight of roughly 0.4; severe depression more.
Comparable mental health programmes typically cost between $500 and $3,000 per DALY averted. The figures below sit alongside the strongest cost-effectiveness data in global health.
Cost figures include training, supervision, delivery, and monitoring. They exclude founding overhead.
The programme draws on a body of randomised evidence built up over the last decade. The trials test variants of a brief, peer-delivered, behavioural-activation-based protocol against waitlist or treatment-as-usual controls.
Effect sizes have been measured using the PHQ-9, a nine-item depression screening tool widely validated for use in primary care.
Across the five trials, the average post-intervention PHQ-9 reduction has been around five points greater than control — a clinically meaningful change. The two Lebanon trials, the largest, also show sustained benefit at three months.
We summarise each trial below. The full appraisal is in the AIM research report linked at the foot of this page.
| Country | Population | n | Effect (Δ PHQ-9) |
|---|---|---|---|
| Lebanon | Adults, primary care | 412 | −5.8 |
| Lebanon | Refugee adults | 589 | −6.2 |
| Egypt | Women, urban | 288 | −4.9 |
| China | Older adults, rural | 341 | −3.4 |
| Zambia | Adults, peri-urban | 204 | −5.1 |
Self-Help Plus (SH+) is a WHO-developed, five-session group intervention designed for people living in adversity. The trials below are randomised controlled studies of SH+ in refugee and displaced populations. All compare SH+ against enhanced care as usual (ECAU) or standard care, delivered in person.
| Study | Country / Setting | Population | Primary outcome | Follow-up | Key finding | Comparator |
|---|---|---|---|---|---|---|
| Karyotaki et al.2021 · IPDMA | South Sudan, Türkiye, multiple European countries | Refugees & asylum seekers, adults | Depression symptoms | 6 months | SH+ significantly reduced depression symptoms vs ECAU. Improved mental well-being (95% CI 1.88–12.96, p=0.009) and self-identified problems (p=0.001) at post-test. | ECAU |
| Acarturk et al.2022 · RCT | Türkiye | Syrian refugees, adults | Mental disorder presence at 6 months (MINI) | 6 months | 21% vs 38% met criteria for a current mental disorder at 6 months. OR 0.32 (95% CI 0.42–0.69, p<0.001). Significant improvements across all secondary outcomes. | ECAU |
| Purgato et al.2021 · RCT | Multiple W. European countries | Refugees & asylum seekers from Syria, Afghanistan, Iraq, Pakistan & Nigeria, adults | Mental disorder presence (MINI) | 6 months | Significant reduction in mental disorder post-intervention (p=0.011). At 6 months: improved psychological distress (GHQ-12, p=0.001) and functioning (WHODAS, p=0.007). | ECAU |
| Tel et al.2020 · Cluster RCT | Uganda | South Sudanese female refugees, adults | Psychological distress (Kessler-6) | 3 months | Significantly greater reductions in psychological distress 3 months after the intervention relative to control (p=0.0007). | ECAU |
| Purgato et al.2023 · RCT (RESPOND) | Italy | Migrants & refugees, adults (PHQ-9 ≥10) | Depression (PHQ-9) & anxiety (GAD-7) | 21 weeks | Significant reductions in depression (PHQ-9 −3.5, p=0.007) and anxiety (GAD-7 −3.5, p=0.007) vs care as usual. Consistent across all follow-up timepoints. | Care as usual |
Trial evidence is encouraging but it is not the whole story. Three uncertainties shape how we deliver and what we report.
Two of the five trials followed participants for twelve weeks. Only one extended to six months. Depression recurs, and we cannot yet say how durable these gains are in the conditions we operate in.
Trial conditions tend to produce higher completion rates than real-world delivery. We expect a meaningful share of participants to drop off before session five, and we are tracking that openly.
The trial populations are not all populations. The effect in a refugee setting may differ from the effect in a stable urban one. We are running a fresh evaluation in each country we enter.
The Ambitious Impact (AIM) research report walks through the trials, the cost model, and the assumptions in detail. It is roughly thirty pages.
Open the AIM report (PDF) ↗