Background: The rising burden of depression and non-communicable disease multimorbidity is an increasing global challenge, largely neglected by healthcare services, particularly in low- and middle-income countries (LMIC). Coexistence of depression and chronic physical disease is common and worsens outcomes for both mental and physical disorder. Depression is amenable to treatment; effective interventions include a range of pharmacological and psychological therapies. Encouragingly for resource-constrained health systems, brief therapies, such as behavioural activation, have been shown to be as effective as more resource-intensive therapies for the treatment of depression in the general population. Several clinical guidelines recommend the use of these brief therapies, including for depression in people with physical health conditions. However, their feasibility and effectiveness for depression in patients with non-communicable diseases is not known

Aims: We aim to adapt and test the feasibility of brief psychological therapy, behavioural activation, delivered by non-specialist health workers for people with depression in non-communicable diseases in LMIC in South Asia. 

Methods: Following the MRC framework for design and evaluation of complex interventions, we will first adopt the behavioural activation intervention to take account of contextual factors such as language and culture, resource constraints, infrastructure, staff capacity and training needs, scalability, and feasibility of integration within non-communicable disease services in Bangladesh, India and Pakistan.

An expert panel will first identify how behavioural activation needs to be modified for delivery as part of current models of non-communicable disease care, informed by an assessment of the organisational capacity of healthcare services and focus groups and interviews with patients and healthcare providers. Co-design workshops and prototyping will then be used to iteratively adapt and refine the intervention content and materials