Abstract

Depression is among the leading causes of disability worldwide and contributes substantially to the burden of common mental disorders in India, where the treatment gap for mental illness exceeds eighty per cent. Given the acute shortage of psychiatrists and clinical psychologists, task-shifted models that place nurses and trained lay counsellors at the centre of depression care have attracted growing attention. This narrative review synthesises evidence on nurse-led interventions for depression, drawing on collaborative care trials, telephone-based case management studies, and community counsellor-delivered psychological treatments conducted in high-income and low-resource settings, including India. Nurse-delivered collaborative care, in which a nurse care manager coordinates screening, psychoeducation, medication monitoring, and stepped referral under psychiatrist supervision, has been shown in large randomised trials to substantially improve recovery rates compared with usual care and to produce benefits that persist over one to two years. Telephone-delivered case management does not diminish these benefits and extends reach to patients unable to attend frequent clinic visits. In India, lay-counsellor and nurse-delivered brief psychological treatments, and stepped-care programmes such as MANAS, have produced clinically meaningful reductions in depressive symptoms among primary care attenders. Behavioural activation, a core component of several of these programmes, is amenable to delivery by trained nurses with brief instruction and supervision. Barriers to scale-up include limited pre-service training in mental health nursing, absence of defined career pathways for psychiatric nurses, supervision gaps, and stigma. Strengthening the psychiatric nursing workforce through structured training, supervision, and integration into stepped-care pathways is essential to closing India’s depression treatment gap.

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