MDD Minds Final Report

World Organization of Family Doctors

MDD Minds for Primary Care Project Report

March 2025 www.mddminds.org

MDD MINDS Project Report Table of Contents Foreword ................................................................................................................................... 3 Executive Summary: The MDD MINDS Initiative ........................................................................ 4 Our Impact ......................................................................................................................... 4 Key Achievements.............................................................................................................. 5 Lessons Learned ................................................................................................................. 5 Future Opportunities ......................................................................................................... 6 Conclusion ......................................................................................................................... 6 MDD MINDS: A High-Level Review of the Initiative ................................................................... 7 Our Goals ........................................................................................................................... 8 Our Objectives ................................................................................................................... 8 Addressing the Importance of Tackling MDD in Family Medicine and Primary Health Care .... 10 Project Implementation: From Planning Through Quality and Practice Improvement ............ 12 Recruitment and Registration .............................................................................................. 15 Project Component Overview .............................................................................................. 16 Master Faculty Training and Support ............................................................................... 16 Phase 2: MDD MINDS 101................................................................................................ 16 Phase 3: Train-the-Trainer ............................................................................................... 17 Phase 4: Performance in Practice ........................................................................................ 18 Measuring Outcomes and Impact: Analyzing the Results of the Phases and the Potential for Future Work............................................................................................................................. 19 Phase 2: MDD MINDS 101 ................................................................................................... 19 Practice Setting ................................................................................................................ 20 Phase 3: Train-the-Trainer ................................................................................................... 23 Phase 4: Performance in Practice ........................................................................................ 27 Results ............................................................................................................................. 27 Discussion ........................................................................................................................ 29 Participant Stories & Themes ........................................................................................... 29 Master Faculty ..................................................................................................................... 38

MDD MINDS | A partnership for mental health care 1

Discussion ............................................................................................................................ 39 Lessons Learned and Opportunities for Improvement ............................................................ 41 Lessons Learned................................................................................................................... 41 Plans for Sustaining the Impact of the Project: Where Do We Go Next? ................................. 43 Sustainability and Spread..................................................................................................... 43 Next Steps ............................................................................................................................ 43 Final Statement.................................................................................................................... 45 Thank You ................................................................................................................................ 46 Citations................................................................................................................................... 47

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Foreword Depression is the most common cause of disability worldwide. Rates of detection and treatment of depression remain low, especially in low- and middle-income countries.

WONCA, via our Working Party on Mental Health, has a longstanding commitment to the integration of mental health care into primary care.

The MDD MINDS initiative has significantly enhanced the quality of care for patients with major depressive disorder. It involved almost 3000 Family Doctors and practice teams, across nine countries in Africa, Asia, Middle East, and Latin America.

We know that Family doctors are in a unique position to offer effective, evidence-based care for people who experience depression. The MDD MINDS initiative, has strengthened the capability of family doctors and primary care teams to diagnose, treat, and manage depression. This is so important for what many of us believe is one of the commonest problems in our family medicine clinics. MDD MINDS also highlighted the critical need for healthcare provider self-care.

The project has been highly successful with all objectives set out in the proposal having been met, including: • diagnosing depression in culturally diverse settings • selecting appropriate treatment • managing co-morbidities and • developing team-based care.

The MDD MINDS model provides a framework that can continue to be used for sustainable impact in mental health care.

The success of the project is a testament to the hard work, dedication, and collaboration of everyone involved. WONCA acknowledges the work and dedication of the Steering Committee, in particular, Drs Chris Dowrick, Christos Lionis, Harris Lygidakis, and Roberto Muñoz Sierra, as well as project partner, Mosaica Solutions.

There will be many family doctors and even more patients who will benefit from this initiative. My congratulations on behalf of WONCA, the family doctors who participated and the many patients who will benefit. WONCA is incredibly proud of what has been accomplished in just over two years.

Assoc Professor Karen Flegg WONCA President

MDD MINDS | A partnership for mental health care 3

Executive Summary: The MDD MINDS Initiative The MDD MINDS initiative has successfully enhanced the quality of care for patients with major depressive disorder (MDD) across nine countries in three global regions. This multi-phase project, implemented by the World Organization of Family Doctors (WONCA) and Mosaica Solutions, supported by an independent grant from Pfizer Global Medical Relations, has strengthened the capability of family doctors and primary care teams to diagnose, treat, and manage depression within their communities.

Our Impact The MDD MINDS initiative exceeded its targets, engaging more than 2,500 clinicians and practice teams through a comprehensive educational approach: ● Phase 2: MDD MINDS 101 –2,892 family doctors and primary care professionals (“learners”) enrolled, with 581 participants completing the course (20% completion rate among “completers”), surpassing typical online course completion rates of 12.6%. The curriculum significantly increased clinician confidence in managing depression, with average confidence scores among completers rising from 3.0 to 4.11 on a 5-point scale (p-value 1.7631E-118). ● Phase 3: Train-the-Trainer – 226 family doctors and primary care professionals (“scholars”) across nine countries completed MDD MINDS 101 and enrolled in our advanced program, with at least 126 participants (over 50% completion rate) successfully completing it. Following completion of the advanced program, these regional faculty demonstrated remarkable commitment by disseminating this knowledge through 142 educational sessions to 1,697 additional healthcare professionals in their communities. ● Phase 4: Performance in Practice – Seven practices across Brazil, Japan, and Nigeria implemented a quality improvement program for screening depression among diabetes patients. Through this quality improvement initiative, 1,011 diabetic patients were evaluated, with 22.4% identified as having depression.

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Key Achievements The initiative met all objectives set out in our proposal, addressing critical gaps in depression care. Participating clinicians reported substantial improvements in their ability to: ● ● ● ● ● ● ● ● ●

Diagnose MDD in culturally diverse contexts Educate patients on health promotion and lifestyle changes Apply shared decision-making principles Select appropriate pharmacological and non-pharmacological treatments Manage comorbidities Develop team approaches to care Communicate effectively with specialists Implement activities to drive practice change Follow up with patients to reevaluate care

The project equipped family doctors across nine countries with essential knowledge and skills to address depression, a leading cause of global disability, while also enabling them to share this expertise with other practitioners. Beyond clinical training, the project addressed the importance of self-care, providing resources that strengthened participants' resilience and emphasized the importance of teamwork. This focus on well-being not only improved their ability to serve patients but also reinforced the necessity of maintaining their own wellness, ultimately contributing to improvements in both their professional and personal lives.

Lessons Learned The initiative yielded valuable insights for future planning: ● ● ● ● ●

Language and cultural adaptation significantly enhance engagement and outcomes.

Multiple in-country leaders are essential for successful implementation.

Alignment with existing working groups amplifies the impact and reach.

Faculty leadership by content experts ensures clinical relevance.

Local organizational partnerships facilitate the recruitment of healthcare providers and ensure the sustainability of the program. ● There is a critical need for healthcare provider self-care to strengthen resilience among participating clinicians, enabling them to better serve their patients while maintaining their own well-being. Participants reported the self-care content provided in the modules was as valuable to clinicians as clinical education.

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Future Opportunities The MDD MINDS model provides a framework for sustainable impact in mental health care and beyond: 1. Expanded Content in Mental Health: This project, particularly the Performance in Practice phase, focused on screening patients. New more in-depth curricula could be developed to address the treatment and management of MDD. Furthermore, expanded guidance on self-care strategies would be welcomed by clinicians, who identified it as the third highest area of need for them.

2. Expanded Access: The MDD MINDS 101 curriculum can be translated into additional languages, for example, Chinese, Hindi, and Urdu, and offered globally.

3. Research Initiatives: The impact on patient outcomes offers rich opportunities for further study.

4. Publication: Findings will be presented at the WONCA conference in Lisbon (September 2025) as well as at other regional conferences and prepared for publication.

5. Broader Application: The three-phase model can be adapted for other clinical priorities and public health challenges.

6. Working Party Synergy: Collaboration with WONCA working parties and other professional bodies within the primary care and medical specialties can promote synergy and interdisciplinary collaboration.

Conclusion The MDD MINDS initiative demonstrates WONCA’s capacity to deliver high-quality educational programming at scale and work in partnership with other international organizations, all while meeting defined objectives and producing meaningful outcomes.

Most importantly, the patients of participating doctors have benefited from improved recognition, understanding, and treatment of their condition, with positive impacts on their mental health and well-being. As depression continues to affect hundreds of millions globally, the MDD MINDS initiative offers a replicable, sustainable approach to enhancing mental healthcare in diverse primary care settings.

We thank the Pfizer Global Medical Relations team for its independent educational grant in support of this important work.

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MDD MINDS: A High-Level Review of the Initiative “My experience in the MDD MINDS-WONCA Project was extremely enriching. The course provided a collaborative environment where I was able to learn from the leadership of a psychiatry specialist and family health colleagues. The discussions about mental health practices and the focus on the person-centered approach with MDD broadened my view of comprehensive care.

Furthermore, the practical activities and exchange of experiences contributed to my professional development as a trainer for other colleagues, allowing me to apply new knowledge directly into my daily practice. I believe that this experience made me a more prepared professional and sensitive to the needs of my patients and my coworkers.”

– MDD MINDS learner Mental health is a fundamental pillar of global health, yet depression remains the leading cause of disability worldwide. Too many people—up to 90%—struggle without a diagnosis or access to appropriate care. In 2015, the number of people globally living with depression reached 322 million, an increase of 18.4% since 2005.1 Rates are higher among older people, and the burden of illness is greatest for women in low-resource settings.2 The decrease in productivity and the other medical conditions often linked to depression come with a financial toll, with the global cost estimated at $1 trillion annually. Even in high-income countries, approximately half of people suffering from depression are not diagnosed or treated appropriately, and the percentage increases to between 80 and 90 percent in low-resource settings.3 To address these disparities, the integration of mental health screening into primary care, particularly in family medicine, is recognized as a priority by international agencies (WHO/WONCA, 2008). Empowering family medicine and primary care clinicians to put clear evidence and practical guidelines into practice is critical. Doing so will empower patients to access care from physicians who are informed and confident about the management of mental health problems.

The MDD MINDS initiative was born of this need to translate evidence into active practice.

The overall project goal was to enhance the quality of family medicine and primary health care for patients with major depressive disorder (MDD) in nine targeted countries in three regions: Africa/Middle East, Asia, and Latin America. Curriculum customization focused on the diverse policies, cultures, and healthcare systems in which family doctors and their teams practice.

MDD MINDS | A partnership for mental health care 7

“The opportunity to collaborate with healthcare professionals worldwide broadened my understanding of mental health care beyond my local setting.” – MDD MINDS learner The WONCA MDD MINDS Project has had a profound impact on participants, strengthening their ability to both manage mental health conditions in primary care and work with colleagues, peers, and patients to improve health status. The project enhanced clinical confidence, improved patient outcomes, and promoted a sense of collaboration and advocacy. The project also encouraged self-care and inspired many clinicians to take proactive steps to expand mental health initiatives in their communities.

Our Goals The goals of this multi-phase project were to build content with master faculty, educate physicians through an online curriculum, engage regional faculty via a train-the-trainer program that supported training on clinical issues and delivery of community-based education, and complete a pilot performance/quality improvement activity with two practices in each of three geographic locations.

In Phase 1 of the project, we formed our leadership team, identified the Master Faculty, and solidified the educational design. Our three-phased educational approach met every objective set out for the project; from design and delivery to changes in practice and community-based learning, the project engaged more than 2,500 clinicians and practice teams. Phases 3 and 4 ran concurrently.

Our Objectives In our proposal, we set out a series of objectives for this project, including increasing physician competence to: ● Diagnose major depressive disorder (MDD) in the context of cultural variations in presentation; ● Employ shared decision-making; ● Select appropriate pharmacologic and non-pharmacologic therapy, including group interventions;

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● ● ● ● ● ● ●

Manage comorbidities of MDD, with a focus on cardiovascular disease; Develop team approaches, including family and community support; Communicate with specialists in making referrals; Follow-up with patients to reevaluate care; Educate patients in health promotion and lifestyle change; Implement activities to support practice change; and Train other primary care and family medicine physicians in the diagnosis and management of MDD.

We met the metrics set out in the original proposal, as illustrated in the graphic summary below, and are pleased to submit this report detailing the work and results.

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Addressing the Importance of Tackling MDD in Family Medicine and Primary Health Care The MDD MINDS project was created to provide family doctors and their practice teams with education, tools, and resources, with the goal of improving the care provided to patients with major depressive disorder. The participating clinicians gained knowledge, skills, improved confidence, and comfort in providing mental health care to patients. The resulting outcome was that patients benefitted from improved communication and understanding of their condition, which had subsequent positive effects on their mental health.

The project targeted family doctors, and primary care professionals in nine countries across three regions.

The MDD MINDS project aligned with four major initiatives undertaken by the WONCA Working Party on Mental Health and Mosaica Solutions, with additional external partners.

2018-2019: The California Academy of Family Physicians, Healthcare Performance Consulting, and WONCA, with funding from Pfizer, delivered a train-the-trainer program focused on the assessment and management of depression and anxiety in primary care to family doctors in the Asia-Pacific Region (APR). Two cohorts participated, one in Seoul (October 2018) and one in Kyoto (May 2019), and both in conjunction with WONCA Asia Pacific regional meetings.

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2020-2021: Members of the WONCA Working Party for Mental Health collaborated with behavioral scientists at the Eugene S. Farley, Jr. Health Policy Center in Colorado in an innovative pilot advocacy project funded by WONCA, bringing 12 family doctors from all global regions to learn the steps to integrate mental/behavioral health care into primary care delivery, to develop skills for practice transformation, and to become advocates for local system change.

A beta version was undertaken in 2024.

2020 and 2021: Members of the WONCA Working Party for Mental Health undertook preparatory work with Pfizer in setting the parameters for the MDD MINDS program for primary care, including preparation for and participation in three expert panel meetings for Asia, Latin America, and Africa/Middle East.

2022-2023: Mosaica Solutions, working with WONCA and incountry leaders, completed an extensive Latin America needs assessment on issues related to mental health care provided by family doctors in 2022. The assessment, completed in Mexico, Peru, Chile, Brazil, and Colombia, provided clinical and gap data to support training for family and primary care physicians, as well as an educational construct to support learning. Presentations of the results were made at the WONCA annual conference in Sydney in October 2023.

MDD MINDS | A partnership for mental health care11

Project Implementation: From Planning Through Quality and Practice Improvement The extensive work done previously by WONCA, Mosaica Solutions, and the WONCA Working Party on Mental Health (as outlined above) provided the groundwork for this project, informing our clinical considerations, educational framework, and practice needs and gaps to be addressed.

We began our work in earnest with a Steering Committee workshop in January 2023 and launched the seven Phase 2 MDD MINDS 101 online learning modules in October 2023 (English version), with the Portuguese, Japanese, and Spanish versions following closely behind. Phase 3 Train-the-Trainer was launched in parallel with Phase 4 Performance in Practice in August 2024, and both were completed in December 2024. Several scholars from Phase 3 are still presenting community sessions. A conference with the Steering Committee, Master Faculty, WONCA officers, members of external organizations, governmental agencies, and journal editors will be held March 24-25, 2025, in Brussels.

The project benefited from a multi-level structure as well, with the work needed to implement the MDD MINDS project being led by three working teams, plus the internal project management coordinated by WONCA staff leadership and staff teams. ● Steering Committee: The Steering Committee for this project, which met monthly throughout the life of the project, was responsible for project oversight, support of the WONCA staff, input on the curriculum and content, and communications with the Master Faculty and participants. The Steering Committee team included Chair Professor Chris Dowrick; Immediate Past Chair of the WONCA Working Party on Mental Health, Professor Christos Lionis; Chair of the WONCA Working Party on Mental Health, Mary

12 MDD MINDS | A partnership for mental health care

Ales; Mosaica Solutions Partner Shelly Rodrigues; WONCA Chief Executive Officer Dr. Harris Lygidakis; and WONCA Project Manager Roberto Munoz Sierra. ● Design and Measurement Group: The Design and Measurement group was responsible for the overall content design, development, and outcome strategies for the project.

Their responsibilities included guiding the phasing, clinical modifications, recruitment, and communications; designing the dissemination plan; and analyzing the outcomes data. Chris Dowrick, Mary Ales, and Shelly Rodrigues served as the leaders of this group. ● Master Faculty: The Master Faculty team consisted of professionals in family medicine, psychiatry, and psychology, all of whom had experience in mental health and education across diverse settings and locations. Several faculty members were also part of the WONCA Working Group on Mental Health, and all were from countries selected for this project. Throughout the project, the Master Faculty was engaged in addressing clinical questions, assisting with country selection, recommending partner organizations, serving as faculty for the Train-the-Trainer program, piloting the Quality Improvement phase in medical practices, and providing feedback on the outcomes process.

Members of the MDD MINDS team: Adekunle Ariba, Shelly Rodrigues, Christos Lionis, Sankha Randenikumara, Ryuki Kassai, Chris Dowrick, and Mary Ales met at the WONCA conference in Sydney in October 2023.

Master Faculty Member and Country André Luís Bezerra Tavares Ana B. Perez Villalva Yazmin Cordova Rios Adekunle Joseph Ariba Joy Mugambi

Brazil Mexico Peru Nigeria Kenya

Abdullah AlKhathami Ryuki Kassai Sankha Randenikumara Darien Cipta Cindy Lam

Saudi Arabia Japan Sri Lanka Indonesia Hong Kong advisor

Project Management: Dr. Harris Lygidakis, WONCA CEO, assumed ultimate responsibility for the project, with the Project Manager, Roberto Muñoz Sierra, reporting directly to him. The

MDD MINDS | A partnership for mental health care13

Project Manager had oversight for the day-to-day management of this project, collaborating with the Steering Committee and the Design and Measurement Group and working with the content developers, web designers, Master Faculty, WONCA members, registered learners, and others to ensure the successful completion of the work of the project.

The four working groups plotted the course for this initiative—from recruitment to evaluation.

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Recruitment and Registration Family doctors from the nine participating countries across three regions were recruited via email, web notices, social media (including WhatsApp), and organizational invitations. These local WONCA membership organizations assisted with the recruitment process: Brazil: Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC) Indonesia: Indonesian Association of Family Physicians (IAFP) Japan: Japan Primary Care Association (JPCA) Kenya: Kenya Association of Family Physicians (KAFP) Mexico: Federación Mexicana de Especialistas y Residentes en Medicina Familiar (FEMERMEF) Nigeria: Society of Family Physicians of Nigeria (SOFPON) Peru: Sociedad Peruana de Medicina Familiar y Comunitaria Saudi Arabia: Saudi Society of Family and Community Medicine (SSFCM) Sri Lanka: College of General Practitioners of Sri Lanka (CGPSL) Interested participants then completed a registration process that included a pre-assessment for demographics, practice settings, and clinical knowledge. Once the assessment was completed, learners were logged into the online platform to begin MDD MINDS 101.

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Project Component Overview MDD MINDS was designed to deliver education in three phases, beginning with a wide audience of online learners, moving to a Trainer-the-Trainer program with participants from each of the nine countries, and culminating in a Performance in Practice (PIP) project with seven practices from three countries.

Master Faculty Training and Support Prior to the launch of each phase of the project, a series of training sessions for the Master Faculty were held, ensuring they had a full understanding of the materials and implementation plans and the opportunity to engage in conversations with each other. The Master Faculty members were encouraged to adapt the content to meet the needs of the family doctors in their regions. Support for the Master Faculty was also provided by Mosaica Solutions in Phases 3 and 4—with participation in Zoom sessions and one-on-one guidance as needed.

Phase 2: MDD MINDS 101 Phase 2: MDD MINDS 101 was a series of seven modules (see right) available online, 24/7. The modules were designed to provide learners with clinical information and practice tools to enhance their care of patients with MDD. The case-based content was developed by Mosaica Solutions and built on the curriculum developed in the APR project (referenced above), with review provided by Chair Chris Dowrick and Working Party on Mental Health Chair Christos Lionis and oversight by the full Steering Committee. The modules were presented in video format, each averaging 15-20 minutes, with resources for further learning provided to augment the sessions. Postsession reflection questions were asked as learners moved through the modules, and each module included a quick review of the previous session. The modules were developed and presented in English.

Portuguese, Japanese, and Spanish versions were subsequently developed with the assistance of local faculty.

“The self-care and wellness module was vital. It not only improved my professional skills but also helped me maintain my own mental health.” – MDD 101 learner Those completing the MDD MINDS 101 curriculum received a bonus module that included resources from WHO.

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Phase 3: Train-the-Trainer Learners who completed Phase 2 were eligible to enter Phase 3: Train-the-Trainer as scholars ready to work with a Master Faculty member and cohort of their peers to expand their competence and confidence. The Train-the-Trainer course combined both online content and real-time sessions with a member of the Master Faculty. The course covered the same content areas as Phase 2, but in greater depth, with additional modules on motivational interviewing, communication skills, and presentation training. The Train-the-Trainer course used the Trello platform, Zoom, and WhatsApp for engagement, and Master Faculty members were encouraged to add and translate content as needed.

The scholars participated in four sessions with a Master Faculty member and their cohort and then delivered at least one local training activity.

The Scholars’ Choice sessions were designed to meet localized needs expressed by the cohorts; for example, one group asked to spend more time role-playing shared decisionmaking and mindfulness exercises with patients, and another focused its work on team engagement in care.

“I was able to understand how to provide non-pharmacological interventions for mental health patients encountered in primary care. The sessions were practical and rich, so I was able to immediately apply them to my daily clinical practice. I would like to continue brushing up on my own skills and sharing them with the staff.” – Train-the-Trainer Scholar

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Evaluation of the Train-the-Trainer phase included each scholar’s evaluation of the overall experience, community meeting feedback, and evaluations from the community learners about the experience and content.

Phase 4: Performance in Practice The final phase, Performance in Practice, focused on implementing systematic screening for depression in adult patients with diabetes. The Master Faculty recruited two practices each from Brazil, Japan, and Nigeria to participate in this pilot project.

Patients with chronic disease are at increased risk for depression.4 The metrics for this project were changed from cardiovascular disease to a systematic approach for screening adult patients with diabetes for depression. This shift was made because diabetes is more consistently diagnosed in primary care settings internationally. Focusing on patients previously diagnosed with diabetes allowed practices to target a population commonly seen in family medicine. Practices reviewed patients’ records for any history of depression and then implemented a screening process tailored to their specific needs.

Projects included a two-cycle improvement process with baseline measurement and final process cycles. Coaching by the Master Faculty and education on elements of performance improvement/quality improvement (PI/QI) were held through four virtual calls scheduled to align with the data collection and reflection process. Learners were encouraged to interact using the Trello platform, which housed the resources and shared data and ideas from the project participants. The 12-week project was designed in a model with four phases, as illustrated in the graphic to the right. The practices completed swim lane analysis and Plan-Do-Study-Act planning prior to beginning their improvement cycles.

“We live in a primary care reality in Brazil where the volume of care and the complexity of clinical situations demand exceptional dedication from professionals. Often, screening routines such as those for depression are set aside, even though we know their positive impacts on population health. The project was valuable in highlighting this issue within the team’s dynamic.” – PIP participant

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Measuring Outcomes and Impact: Analyzing the Results of the Phases and the Potential for Future Work Each phase of the project included a comprehensive evaluation component. The Design and Measurement group used a variety of evaluation tools, including pre-assessment questionnaires, pre-post testing, and a series of surveys to measure the results and outcomes for the individual phases as well as the overall project. Additionally, the Master Faculty completed an evaluation of their involvement in the overall project.

Phase 2: MDD MINDS 101 The MDD MINDS core curriculum was hosted on the MDD MINDS website. Initial enrollment totaled 2,892 family doctors and primary care professionals (“learners”), with 581 completing the course. Most of the participants who completed the course (96.0%) were from the targeted countries. Twenty percent (20%) of those enrolling in the online project completed the modules. Of those completing the course, 39% enrolled in the Train-the-Trainer program.

Enrolled by Country

Completed by Country

% Completed by Country

891 125 172

155 17 33

17.4% 13.6% 19.2%

77 279 349

19 52 47

24.5% 18.6% 13.5%

77 112 419

19 42 108

24.7% 37.5% 25.8%

Other countries

121

23

19.0%

Totals

2,892

581

20.0%

Countries South/Central America Brazil Mexico Peru Asia Pacific Indonesia Japan Sri Lanka Africa/Middle East Kenya Nigeria Saudi Arabia

The content of the MDD 101 program included a number of modules on topics ranging from culturally sensitive screening strategies to self-care approaches for clinicians. To achieve an understanding of the learners’ demographics and a baseline of their knowledge and clinical approach, they had to answer demographic, knowledge, and self-care questions at enrollment.

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Upon completion of the online course, learners completed a post-test and identified practice changes they would implement. The responses below are from 554 MDD 101 completers.

Practice Setting Of our respondents: ● 12.8% practice in rural settings ● 17.5% practice in suburban settings ● 69.7% practice in urban settings Practice Setting

Number

Community Clinics Hospitals Private Practices Academic Medical Centers Other Totals

Percentage 179 167 77 66 92 581

30.8% 28.4% 13.2% 11.4% 15.8%

45.5% of the respondents were men, and 54.5% were women.

Learners treat patients across the life span, including geriatric patients, adults, and adolescents, with fewer treating children, providing maternity care, or providing gender-affirming care.

PRACTICE PROFILE % Adults

% Geriatric

% Adolescent % Children

% treating pregnant women

% providing Gender Affirming Care

SOUTH/CENTRAL AMERICA Brazil 100% Mexico 100% Peru 97%

98% 100% 94%

99% 100% 91%

88% 94% 85%

98% 94% 67%

85% 53% 48%

ASIA PACIFIC Indonesia Japan Sri Lanka

100% 88% 100%

95% 88% 96%

95% 87% 100%

84% 62% 94%

66% 60% 89%

39% 37% 51%

AFRICA MIDDLE EAST Kenya 100% Nigeria 100% Saudi Arabia 100%

95% 100% 98%

100% 100% 97%

79% 88% 88%

79% 86% 89%

37% 19% 32%

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Learners also provided an assessment of their personal mental wellness and indicated the self-care tools that they use. The table below summarizes their responses.

SELF MANAGEMENT Assess and Maintain improve healthy selflifestyles? compassio n?

SOUTH/CENTRAL AMERICA Brazil 87.7% Mexico 64.7% Peru 78.8% ASIA PACIFIC Indonesia 85.9% Japan 17.3% Kenya 68.4%

Increase Keep a Watch for Seek Reach Practice activities daily signs of mental out to Mindful that bring gratitude burnout in health care others Meditati the most diary? yourself and for for help? on? joy in your your team? yourself? life?

79.9% 64.7% 81.8%

80.5% 82.4% 97.0%

22.7% 17.6% 21.2%

87.7% 88.2% 81.8%

52.6% 76.5% 57.6%

79.9% 82.4% 78.8%

27.3% 47.1% 45.5%

88.2% 67.3% 94.7%

94.1% 71.2% 89.5%

60.0% 7.7% 10.5%

88.2% 76.9% 89.5%

67.1% 30.8% 36.8%

83.5% 46.2% 52.6%

62.4% 28.8% 52.6%

95.2%

45.2%

85.7%

57.1%

90.5%

83.3%

90.1% 93.6%

57.7% 29.8%

81.1% 89.4%

58.6% 44.7%

85.6% 85.1%

59.5% 61.7%

87.1%

35.5%

85.2%

54.1%

78.8%

48.8%

AFRICA/MIDDLE EAST Nigeria 85.7% 95.2% Saudi Arabia 79.3% 86.5% Sri Lanka 93.6% 89.4% Grand Total 77.7% 83.4%

Learners assessed their confidence before beginning the activity and then following the completion of the curriculum. The pre-learning average confidence was 3.0 (Likert scale 1-5).

Post-activity learner confidence was 4.11. The change of 1.11 reflects the need for family medicine education in diagnosing and treating mental health in the community. Of note is the difference in confidence gained by gender. We noted that the gap between pre- and postlearning confidence ratings was higher for female learners. The average age of the learners was 38 (median 36, std dev 9.33).

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POST Average Confidence

Difference

3.00 2.88 3.17 3.24 3.17 3.40 3.33 3.11 3.64

4.07 3.97 4.23 4.38 4.38 4.38 4.44 4.32 4.62

1.07 1.09 1.06 1.14 1.21 0.98 1.10 1.21 0.97

31 32 31

2.69 2.59 2.92

3.89 3.74 4.24

1.20 1.14 1.32

21 43 41 43

3.00 2.16 1.87 2.33

3.00 2.87 2.69 2.94

0.00 0.70 0.82 0.61

47 40 38 41

1.00 2.98 2.96 3.00

3.00 4.17 4.00 4.33

2.00 1.20 1.04 1.33

AFRICA/MIDDLE EAST – 172 Completers Kenya 19 40 Female 63% 39 Male 37% 41 Nigeria 42 44 Female 52% 40 Male 48% 48 Saudi Arabia 111 37 Female 47% 38 Male 53% 36

2.74 2.67 2.86 3.07 3.00 3.15 3.50 3.35 3.64

4.53 4.50 4.57 4.58 4.67 4.47 4.50 4.53 4.46

1.79 1.83 1.71 1.51 1.67 1.32 0.99 1.18 0.82

All Region Completers

3.00

4.11

1.11

PRE Average Value/Percentage Average Age Confidence SOUTH/CENTRAL AMERICA – 204 Completers Brazil 154 36 Female 58% 37 Male 42% 36 Mexico 17 35 Female 71% 36 Male 29% 33 Peru 33 40 Female 58% 42 Male 42% 37 ASIA PACIFIC – 184 Completers Indonesia 85 Female 69% Male 29% Prefer not to say 1% Japan 52 Female 31% Male 67% Prefer not to say 2% Sri Lanka 47 Female 49% Male 51%

The knowledge assessment pre-questions covering core symptoms of depression were answered correctly by 97% of learners, and the question on the best psychosocial interventions

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for someone with depression was answered correctly by 88%. Upon completion of the learning modules, the knowledge assessment questions were answered correctly by over 93% of learners.

At the completion of the modules, learners were asked to identify two changes in practice they would make. The 1,106 responses from 561 individuals captured a variety of changes, with most focusing on diagnosis and screening.

Phase 3: Train-the-Trainer Evaluation of the Train-the-Trainer program included scholar evaluation of the program as well as evaluation of the learners in the educational programs the scholars delivered. Approximately 226 scholars initially enrolled in the Train-the-Trainer program, with at least 126 completing the program. Several scholars are still delivering their in-country learning sessions. Sixty-one percent (61%) of the scholars were from either Saudi Arabia or Brazil. Collectively, the scholars delivered 142 sessions to 1,697 clinicians within their home communities. The audiences included physicians, nurses, public health staff, community health workers, and administrators.

“Participation meant a lot to me; I was in a phase of mental fatigue that was affecting my behavior and interactions with patients. Learning about tools and realizing how multidisciplinary support makes a difference in treating mental health opened my eyes and brought back my enthusiasm for treating mental health.” – Train-the-Trainer Scholar

MDD MINDS | A partnership for mental health care23

The Training Sessions Scholars found the Train-the-Trainer sessions to be very valuable (n=107, 4.72 on a scale of 1 (not valuable) to 5 (highly valuable)). These sessions had a high impact on their clinical skills (4.44), and they emerged feeling confident in their ability to teach this content in their communities (4.42). They felt the meeting format was effective (4.48) and that they had adequate resources throughout the program (4.48).

In the open-ended questions, they identified multiple areas of improvement in their own care of their patients, including improved screening and diagnosis skills, enhanced nonpharmacological approaches, and increased confidence in management.

O v e r 5 0 c N=104 l i n i The next table summarizes respondents’ statements about the impact this program had on c itheir ability to provide care for their patients. a n Summary of Participant Responses: Impact of the WONCA MDD MINDS Project Phase 3 s a Increased Confidence in Treating Mental Health Problems t Many participants expressed that the project significantly improved their ability to diagnose and t manage depression. Through structured learning, practical tools like the PHQ-9, and person-centered e n approaches, participants gained confidence in addressing mental health concerns within primary care d settings. e d a “Through this MDD Minds Train-the-Trainer Program, we strengthened our confidence in caring for s patients and recognized the importance of training others.” e Enhanced Professional Growth and Skills s The project was praised for its well-structured modules that provided knowledge beyond standard s i clinical practice. Participants appreciated the evidence-based strategies that they could directly o integrate into their daily work. n i n “The training was one of the most effective programs I have attended. The interactive sessions, Mdiverse perspectives, and structured curriculum added great value to my practice.” e x i c o C 24 MDD MINDS | A partnership for mental health care i t y d

Improved Patient Outcomes and Engagement Participants noted that applying their newly acquired knowledge led to better patient interactions, early detection of depression, and improved treatment plans. Many saw a shift in patient trust and engagement in mental health care.

“Patients became more convinced and accepting of treatment, whether pharmacological or nonpharmacological, leading to visible improvements.”

Integration of Mental Health Care into Primary Care Many family physicians acknowledged that the training helped them see mental health as an integral part of their work. The project demystified mental health care and enabled them to incorporate routine screening and treatment into their existing workflows.

“This project has helped me incorporate routine screening for depression in patients with diabetes mellitus, and I am working on expanding this to more primary care settings.”

Value of Collaborative Learning and Networking A significant number of participants highlighted the value of learning from global peers and mental health experts. The discussions and interactive formats allowed for the exchange of experiences across different healthcare systems.

“The opportunity to collaborate with healthcare professionals worldwide broadened my understanding of mental health care beyond my local setting.”

Use of Practical Tools and Non-Drug Interventions Many respondents appreciated learning about and implementing non-pharmacological approaches such as mindfulness, slow breathing exercises, and progressive muscle relaxation. These tools were effective for both patient care and personal well-being.

“I have started applying psychological interventions such as mindfulness meditation and progressive muscle relaxation with my patients, and the results have been promising.”

Personal Impact and Self-Care Improvement Some responses indicated that the project also had a positive effect on participants’ mental wellbeing. The focus on self-care and resilience was particularly valuable to healthcare workers managing high workloads and stress.

“The self-care and wellness module was vital. It not only improved my professional skills but also helped me maintain my own mental health.”

Training Others and Expanding Mental Health Initiatives Several participants took the knowledge they gained and passed it on to colleagues, trainees, or even implemented it through new mental health initiatives in their communities.

“Following this training, I have established a mental health support group for undergraduates and am working on a peer-education-led psychosocial intervention program.”

Inspiration to Advocate for Mental Health Awareness Many participants noted a newfound passion for mental health advocacy. The training reinforced the importance of reducing stigma and increasing public awareness around mental health issues.

“This training inspired me to advocate for mental health awareness and work towards reducing stigma within my practice and community.”

Contextual Challenges (Natural Disasters, System Issues) Some participants faced additional challenges, such as working in communities affected by natural disasters. Despite these obstacles, they found the training to be a source of support and resilience.

MDD MINDS | A partnership for mental health care25

“The course came at a difficult time when we were dealing with flooding and displacement, yet it provided valuable guidance and support during this crisis.”

Scholar Community Sessions Collectively, the scholars delivered 142 sessions to 1,697 clinicians in their home communities.

The audiences included physicians, nurses, public health staff, community health workers, and administrators. Most sessions were held in-person, with some sessions held virtually.

S o c i a l M e d i a c o n t r i b u t e d t o t Countries Number of Total Sessions h Scholars i s Reporting M 30 60 DBrazil DMexico 2 4 MPeru ** 0 0 i n d s a s MDD MINDS | A partnership for mental health care 26 S c h o

S E Q F i g u r e Pictured: Session presentations in \ Peru, Kenya, and Mexico City. * A R A B I C 1 M e n t a Number of Average l Learners per HLearners e Session a 928 15 l 135 34 t h 0 a w S a E r Q e F n ie gs us r

Indonesia

18

18

129

7

Japan Sri Lanka Kenya Nigeria

5 8 1 5

8 13 2 10

176 117 20 81

22 9 10 8

Saudi Arabia

13

27

111

4

Total

82

142

1,697

** Sessions underway in 2025

Phase 4: Performance in Practice The Master Faculty recruited two practices each from Brazil, Japan, and Nigeria to participate in a pilot Phase 4: Performance in Practice project. The projects were developed as a two-cycle improvement process with baseline measurement and final process cycles. Coaching by the Master Faculty and education on elements of performance/quality Improvement were held through four virtual calls and aligned with the data collection and reflection process. Learners were encouraged to interact using the Trello platform that housed the resources and sharing of data and ideas from the project participants.

The 12-week project was designed into four phases: 1. Baseline data collection; 2. Improvement Cycle 1; 3. Reflection and Improvement Cycle 2; and 4. Reflection and final data collection.

The practices completed process mapping through swim lane analysis and Plan-Do-Study-Act planning prior to beginning their improvement cycles.

The metrics for this project focused on implementing a systematic approach for screening patients with diabetes for depression. Patients with chronic disease are at increased risk for depression. The focus on patients previously diagnosed with diabetes provided the practices with a focused population that is frequently seen in family medicine practices. Practices evaluated the patient’s record for previous history of depression and then implemented a screening process aligned with the practice needs.

Results Seven practices participate in this 12-week project (3 Brazil, 2 Japan, 2 Nigeria). These practices had limited experience with quality improvement and used this project to build their quality

MDD MINDS | A partnership for mental health care27

improvement skills as well as their skills in treating patients with depression. All were encouraged to integrate their practice teams in the process.

Pacajus Brazil Practice Team

Irejas Brazil Practice Team

1,011 Total patients with diabetes seen as part of this project 177 Patients previously diagnosed with depression 487 Patients screened through the new process 49 Patients screened positive through the new process 158 Patients received a tool or resource 17.5% Of patients were previously diagnosed with depression 10.1% Of the patients screened during the QI process were diagnosed with depression 15.6 % Of all patients seen received a tool or resource 22.4% Of all diabetic patients were identified with depression Questions and Responses

Score/Average

Rating of overall experience Value of instructional videos Value of coaching videos Availability of adequate resources to support implementation How confident do you feel in using your process to screen for depression?

How well did your team work together during the project?

How much has the project improved depression screening in your practice?

How has the project affected patient outcomes related to depression and diabetes? Very negatively 1 to very positively 5 Would you be interested in applying quality improvement methods to other areas of your practice

4.43 4.29 4.57 4.57 4.29 3.57 4.0 3.86

28 MDD MINDS | A partnership for mental health care

100% (7)

Discussion Each practice personalized this project to their practice setting and population. From practices in large systems to clinics in rural communities, there were many common themes. ● Six practices selected a localized version of PHQ-9 with one practice selecting PHQ-2.

Each practice selected the screening tool and process most appropriate for their practice. ● The rates of previous depression diagnosis varied by practice. ● The practices had limited previous experience in quality improvement. ● Policies and practices influenced the implementation of the new processes. Challenges such as bureaucracy, physical plant (clinic structure), and culture were faced by the practices.

Participant Stories & Themes The MDD Minds Project has made a significant impact on primary care professionals worldwide, enhancing their ability to diagnose, manage, and support patients with Major Depressive Disorder (MDD). Through structured training, interactive sessions, and peer learning, participants gained essential skills, reshaped their clinical practices, and extended their knowledge to their colleagues and communities.

While there are many stories of success as well as challenges, the following represent the varied impact of their improvement work. ● A dentist within the clinic administered the PHQ-9 to patients with diabetes. One patient screened positive and was scheduled for an appointment with a psychologist. ● Community health workers began screening patients during home visits. Follow-up visits were made at the clinic. ● One clinic had experienced the personal toll of depression. Through this project, they implemented not only screening for their patients but also care for each other.

“I was able to care for the mental health of patients with diabetes. Most of the time, we are unable to address this issue during consultations. With the PHQ-9 tool, I had the opportunity to evaluate this aspect. I also used it during consultations with patients enrolled in a mental health program. The idea that other professionals can also use this tool is very important.” – PIP participant MDD Minds Project Testimonials The following sections highlight key themes that emerged from participant experiences throughout the Project, illustrating the project’s real-world impact on healthcare professionals and their patients.

Summary of Themes Drawn from Participant Testimonials

MDD MINDS | A partnership for mental health care29

Theme 1 – Strengthening Clinical Competence in Mental Health Care Mental health care in primary care settings has long been underdeveloped, with many practitioners lacking structured training in diagnosing and managing depression. The MDD Minds Project addressed this gap by providing evidence-based tools such as PHQ-9, nonpharmacological interventions, and structured communication approaches. Participants reported increased confidence in recognizing and treating depression, moving beyond intuition-based diagnoses to standardized screening methods. They highlighted the value of shared decision-making, patient-centred care, and the integration of mental health within primary care settings. For many, this training demystified the complexity of depression management, leading to more structured and effective treatment approaches.

1. “Mental suffering is an increasingly common health problem in primary care. For this reason, courses like this project are essential to improve the qualification of professionals and, consequently, the care of patients. After completing this course, I feel more confident in treating patients with mild depression.” – Clara Aleida Prada Sanabria, Brazil 2. “The teaching method in this project helped me contextualize the issues involved in depression, broadening my perception of verbal and non-verbal expressions in my patients and even in my own behaviour. This has given me more confidence in providing care and in my own self-care.” – David Lima Nogueira, Brazil 3. “This training program was one of the most effective training programs that I had. Our mentor Dr. Abdullah Al-Khathamy and his training methodology, the interactive sessions, the experience sharing, and the diversity of colleagues’ backgrounds added more value to learning sessions, the curriculum, and follow-up to ensure having the best practice and maximum benefits to start our learning journey with our colleagues.” – Marwa Mahmoud Hosny Mahdy, Saudi Arabia 4. “The WONCA MDD Minds Project enabled me to deepen my knowledge and skills on the importance of prioritising screening, treating and managing depression to enhance quality of life.” – Dr. Aisha Mohamed Mwatuwano, Kenya 5. “A fascinating experience that added a lot to my practice in looking to my specialty as a psychiatrist through the eyes of family physicians within their clinical privilege as first-line providers with a duty to refer based on clear professional boundaries!” – Dr. Mohammedelamin Mukrim, Saudi Arabia 6. “I had a very positive experience with the WONCA MDD Minds Project. Our trainer was highly professional, knowledgeable, and kind, creating an engaging and supportive learning environment. Additionally, I greatly appreciated the insightful discussions with the other participating doctors, which enhanced the overall learning experience.” – Dr. Mendis Appu Prasath, Sri Lanka 7. “It was a great opportunity for me to develop my insight into treating depression and manage the patients in a rural area.” – R. B Nayanthe, Sri Lanka 8. “I was able to relearn the diagnosis and non-pharmacological treatment of depression, which has been very useful in my daily practice. Thank you very much.” – Gorou Hoshi, Japan

Theme 2 – Transforming Patient Care Through Evidence-Based Approaches

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The program equipped healthcare professionals with new methodologies that improved the quality of care provided to patients with depression. Many participants emphasized how the training led to direct changes in clinical protocols, the adoption of new screening tools, and the integration of psychological interventions into routine practice. Some reported success in implementing mindfulness techniques, progressive muscle relaxation, and other nonpharmacological approaches, reducing reliance on medication where possible. Others noted that they had incorporated routine depression screening for at-risk populations, such as patients with chronic conditions like diabetes. This transformation in patient care extended beyond the individual practitioners, influencing multidisciplinary teams and healthcare systems within primary care.

1. “Participating in the MDD Minds Train the Trainer program had a transformative impact on my work as a doctor in primary care. The training enabled me to identify and manage depression and other common mental disorders more accurately and humanely, using practical tools like the PHQ-9 and empathetic communication approaches. This not only improved the quality of care provided to patients but also strengthened my ability to educate and engage the multidisciplinary team, promoting an integrated approach to mental health.

Furthermore, the project broadened my perspective on the importance of community support and reducing stigma around mental illnesses, which has contributed to a lasting positive impact on the health of the population I serve.” – Cláudio Costa Cardoso, Brazil 2. “The project is a very laudable one. I particularly like the language; it was simple and easily comprehensible even to non-physicians. The content was relatable, the case scenarios were not far-fetched and the module on non-pharmacologic management was very valuable. I personally gained a lot from the module on self-care and well-being for Healthcare Providers which I have started practicing.” – Odunaye-Badmus Sekinat, Nigeria 3. “I appreciate going through the rudiments of Major Depressive Disorder. I enjoyed the case examples and how management was done through shared decision making, which is different from the paternalistic approach to patient’s management that we are accustomed to. Overall, I enjoyed the interactive sessions where personal experiences with patients were shared.” – Adetola Bolaji, Nigeria 4. “For many years now, I have been looking forward to something like this, because Family Physicians see many clients in primary care with mental disorders. Since attending this project, my management of patients with mental disorders has improved greatly. Many of them find the non-drug interventions helpful and impactful.” – Dr. Charles Ayodeji Erinle, Nigeria 5. “Participating in the WONCA MDD Minds Project has been an incredibly valuable experience. The program enhanced my understanding of depression in primary care, equipping me with effective tools for early detection, accurate diagnosis, and patient-centred treatment. I gained practical skills in using screening tools, developing tailored care plans, and addressing stigma surrounding mental health. Additionally, the project emphasized collaborative care and provided insights into managing depression holistically, improving overall patient outcomes. I truly appreciate the opportunity to learn, collaborate with global peers, and integrate evidence-based strategies into my daily practice.” – Dr. Shatha Alzuhair, Saudi Arabia 6. “It was truly a wonderful and useful experience. Dr. Abdullah Al-Khathami did not skimp on any useful information or effective guidance. He was a great guide. We benefited a lot

MDD MINDS | A partnership for mental health care31

from him. We learned with him the five-step approach to treating common mental cases in primary health care centres. This approach is truly wonderful, characterized by clarity, smoothness, and ease. It saved me time in the clinic for quick and early detection of mental cases. Patients became more convinced and accepting of starting treatment, whether it was pharmacological or non-pharmacological, and we saw effective results. My performance in the clinic when facing mental cases became much better, and I became more confident and in control. I enjoy finding that patients in primary health centres are satisfied with the service and mental guidance provided to them, as it is always one of the forgotten things with the crowding of patients and the usual pressure of the clinic in primary health centres.” – Eman Attyah Alqurashi, Saudi Arabia 7. “It was a very interesting experience, I was amazed by stories of success in fighting mental illness, and the change we may be able to make in our patient’s lives, by careful history taking in a short period of time.” – Sukayna, Saudi Arabia 8. “The training modules were quite interesting and easy to follow. I have started applying psychological interventions such as mindfulness meditation, slow breathing exercises and progressive muscle relaxation to my patients with good results. I also find the 5 ways to wellbeing very useful, not only to MDD patients but to others also. The module on selfcare and wellness is vitally important. I will recommend this module for all healthcare workers not only mental health specialists. Thank you.” – Dr. Charles Ayodeji Erinle, Nigeria 9. “I gained a better understanding of how to implement non-pharmacological interventions for mental health patients encountered in primary care. The sessions were practical and abundant, making it easy to apply what I learned in daily practice. I plan to continue refining my skills and sharing them with my staff.” – Akimichi Tanaka, Japan 10. “The WONCA MDD Minds Project has helped to demystify the diagnosis and management of Major Depressive Disorder. Patients who would have been casually labelled as having depression can now be objectively screened using recommended screening tools and by extension, for other psychiatric disorders. It has helped to simplify the use of nonpharmacological methods in the management of such patients, and I can confidently apply them as a family physician.” – Dr. Sosanwo Bolajoko M, Nigeria 11. “My experience with the WONCA MDD Minds Project has been incredibly enriching and transformative. The program provided valuable insights into managing depression within primary care, emphasizing practical approaches and collaborative care. The interactive sessions and evidence-based tools were highly effective, equipping me with the skills and confidence to address mental health challenges more comprehensively. I deeply appreciate the opportunity to participate in this impactful initiative.” – Dr. Shatha Z. Alzuhair, Saudi Arabia 12. “MDD Minds Project has revolutionized my understanding, recognition and management of depression in a resource-limited setting.” – Olajide Oyewunmi Joseph, Nigeria

Theme 3 – Real-World Impact: Bringing Knowledge to Local Communities A defining feature of the MDD Minds Project was the ability of participants to replicate and extend their learning beyond their personal practice, creating ripple effects in their local healthcare environments. Many participants became trainers and advocates for improved mental health care, delivering sessions to their colleagues, integrating mental health

32 MDD MINDS | A partnership for mental health care

education into academic institutions, and even launching community-led initiatives. Several participants established peer-support networks, particularly among medical students and young professionals, ensuring that mental health awareness and early intervention were prioritized in their regions. This knowledge-sharing has helped dispel stigma around mental health, particularly in communities where depression is often misunderstood or neglected.

1. “My experience in the MDD Minds-WONCA Project was extremely enriching. The course provided a collaborative environment where I could learn from the leadership of the psychiatry expert and alongside colleagues in family health. The discussions on mental health practices and the focus on a person-centred approach to MDD expanded my perspective on comprehensive care. Additionally, the practical activities and exchange of experiences contributed to my professional development as a trainer for other colleagues, allowing me to apply new knowledge directly to my daily practice. I believe this experience has made me a more prepared professional, sensitive to the needs of my patients and colleagues.” – Marcelo Sousa Oliveira Nunes, Brazil 2. “An incredible opportunity to learn with focused and high-quality materials, having an excellent moderator to guide us, and even experience the positive results in practice through replication activities.” – Ana Milca Oliveira Santana Calmon, Brazil 3. “This MDD Minds – WONCA project is of utmost importance for healthcare professionals who work on the front lines of continuous care. We are the ones who are in the community daily, building relationships with patients and their families. With this program, we have improved our approach, treatment techniques, and shared experiences and frustrations.

Through this exchange of information, we realize that we are not alone and that we can indeed provide better care for our patients.” – Raquel Batista Melo, Brazil 4. “This project has really sparked my interest in mental health issues especially the challenge of depression. I have been equipped with the right knowledge and have developed the confidence to execute mental health services and projects locally and globally. Following this series of trainings, I have established a mental health support group for undergraduates in the university where I practice. My goal is to train many undergraduates as peer educators to deliver mental health services. I am currently seeking support to facilitate peer-educationled psychosocial interventions to reduce the burden of mental health problems among undergraduates. I have incorporated routine screening of patients with diabetes mellitus for depression in my practice setting using PHQ-9. I am currently working on a proposal to incorporate this routine screening for depression into the care of diabetic patients in many primary care settings in Nigeria. I look forward to future opportunities to work more with WONCA. I am very grateful for the privilege.” – Dr. Adeleke Thomas Olumide, Nigeria 5. “In Dammam City, I’ve noticed a growing emphasis on mental health, particularly in clinics where they’ve adopted an Alkathami five-step process to help manage depression and other common psychological issues. The journey begins with a thorough, extensive training by experts and clinicians, taking the time to understand each patient’s unique situation, identifying symptoms and underlying problems. Clinicians start to apply this approach with the suspected cases in the clinic. Tailored interventions follow, which might include nonpharmacological therapy, medication, or lifestyle changes. The focus is on what will work best for the individual. Regular follow-ups are essential. These sessions help track progress and allow for adjustments to the treatment plan as needed. Overall, this structured method is not only helping to reduce the stigma around mental health but also encouraging more

MDD MINDS | A partnership for mental health care33

people in Dammam City to seek the help they need. It’s inspiring to see positive changes in how mental health is approached in our community.” – Areej Alqahtani, Saudi Arabia 6. “Participating in the WONCA MDD Minds Project has been an incredibly enriching experience for me as a healthcare professional. This initiative provided a platform to explore the multifaceted dimensions of mental health within a primary care setting, fostering an environment of collaboration, learning, and innovation. The project emphasized the integration of mental health care into routine primary care, which resonated deeply with my practice. I gained a deeper understanding of the challenges faced by patients with mental health disorders and the strategies needed to address them effectively. One of the highlights was the opportunity to connect with like-minded professionals from diverse backgrounds.

This network facilitated the exchange of ideas, experiences, and solutions that were both practical and culturally sensitive. The resources and tools shared during the project have been invaluable in enhancing my ability to provide holistic care to my patients. I am particularly inspired by the emphasis on reducing stigma and promoting early intervention.

The knowledge and skills I acquired have not only strengthened my practice but have also empowered me to advocate for mental health awareness within my community. In conclusion, the WONCA MDD Minds Project has been a transformative journey, equipping me with the insights and tools necessary to make a meaningful impact in mental health care.

I highly encourage fellow healthcare providers to engage with this initiative and contribute to its mission of improving mental health outcomes globally.” – Dr. A H Amjath Hasan, Sri Lanka 7. “I will apply what I learned in this project in my practice in two public health institutions in México and as a professor of undergraduate medical students for the benefit of mental health of the community and health personnel.” – Dulce Adelaida Rivera Avila, Mexico 8. “I gave lectures on pharmacological and non-pharmacological treatments. Regarding nonpharmacological treatments, there are multiple techniques, and through repeated learning, I found many aspects useful for implementation. I currently work while also managing a training program for family doctors, sometimes collaborating with psychiatrists and emergency medicine specialists. Rather than solely relying on organ-specific specialists, I believe it is beneficial to consider the patient’s context, incorporate non-pharmacological treatments, and utilize community resources in treatment. Participating in this course allowed me to learn more about these topics, and I hope to share this knowledge within my local community.” – Toshiharu Kitamura, Japan 9. “As you know we see various kinds of symptoms in our practice, and no one disagrees that all patients with mental health conditions should be seen only by psychiatrists. Many family doctors can provide appropriate mental health care. Through this MDD Minds Train the Trainer Program, we can strengthen our confidence in caring for patients and recognize the importance of training trainees.” – Kentaro Asakura, Japan 10. “By participating in the MDD Minds lectures, I was able to deeply understand the content beyond just watching the MDD Minds 101 materials. This experience has helped me take a step forward in internalizing these concepts. I have also become more positive about engaging in mental health care. I hope to share what I have learned in my local community.”

– Akiko Hanamoto, Japan 11. “Participating in this project gave me an opportunity to gain more confidence in providing mental health care at the clinic level as a family physician. It also allowed me to reflect on

34 MDD MINDS | A partnership for mental health care

new perspectives and reassess my strengths. The knowledge gained and the project’s progress were discussed within my clinic team, leading to an improved team-based approach to mental health care.” – Yoshinori Matsui, Japan 12. “This training was a great opportunity to have further comprehensive information about depression and mental health problems. The teaching methods, interactive sessions, case studies and educational resources were very effective. Learning new approach “the 5 steps approach “and non-drug management protocol. Very grateful to be part of this training.

Hope to deliver the message to all my colleagues.” – Marwa Mahdy, Saudi Arabia 13. “The MDD Train the Trainer course has opened my eyes to my role as a Family Physician in the reduction of the burden of depression in the world. I enjoyed each meeting session as it added significantly to my knowledge of depression and care. I was also able to interact with colleagues and learn from their wealth of experiences. A major influence this training had on me and my practice is the better understanding of the non-pharmacological approach of care. This has resulted in recorded successes in my patients I picked with depression and on whom I have applied this. It also reduced the rate at which I resorted to the use of medication in these patients. And I have had good outcomes with management using only the nonpharmacological treatment without necessarily needing to use an antidepressant. The ability to train my colleagues has also improved our care. It has also opened their eyes to what can be done at the primary level to reduce depression rates and as a clinic what preventive actions can be taken to improve self-care amongst ourselves and the patient to enhance their quality of life. Thank you.” – Dr. Victoria Iyabo Olafimihan, Medical Unit, IITA, Ibadan, Nigeria Theme 4 – Challenges Overcome: Lessons from the Field Providing mental health care in primary care settings is not without its challenges.

Participants shared experiences of overcoming clinical hesitation, stigma, and gaps in mental health integration within healthcare teams. Some entered the program with scepticism, believing that they already had sufficient knowledge of depression management. However, they later realized how structured frameworks and collaborative learning significantly improved their practice. Others faced emotional burnout before joining the program but found that the tools learned in MDD Minds helped them regain their motivation and resilience. Another major challenge was breaking through traditional, paternalistic models of care—where physicians make decisions for patients rather than with them. Many participants noted how the MDD Minds approach to patient-centred communication and shared decisionmaking led to better adherence to treatment and more positive outcomes.

1. “Participating meant a lot to me. I was going through a phase of mental exhaustion that was affecting my decisions and interactions with patients. Learning about tools and realizing how multidisciplinary support makes a difference in mental health treatment opened my eyes and reignited my enthusiasm for treating mental health.” – Bianca Lopes Omizzolo, Brazil 2. “When I saw the project’s advert, I said to myself, “what is there to know about depression anyway?”. This perception changed while going through the course. I was able to see how valuable it is for family physicians to know the right approach to screening, management and follow up of depression.” – Fatusin Bolatito Betty, Nigeria

MDD MINDS | A partnership for mental health care35

3. “Participating in this project has been one of the most rewarding decisions of my career.

In my area, there is still a stigma surrounding mental health, especially depression, where vulnerability is often viewed as a weakness. This project has empowered me to confidently screen my patients for depression and provide immediate interventions. The training and resources have equipped me with crucial skills to better address my patients’ needs.

Additionally, connecting with colleagues from various practices has expanded my understanding of mental health care. Sharing insights has enhanced my knowledge and significantly boosted my confidence. I want to express my sincere gratitude to the WONCA MDD Minds Project for this incredible opportunity. The support I received has been truly transformative, and I am deeply thankful for the experience.” – Ogadinma Mba, Nigeria

Theme 5 – Personal Growth and Future Commitment Beyond professional training, the MDD Minds Project fostered a sense of personal transformation and long-term dedication to mental health advocacy. Many participants felt reinvigorated in their medical practice, expressing a renewed passion for mental health care.

Some took their commitment further by applying for specialized mental health fellowships, seeking additional training, or planning to integrate mental health programs into their workplaces. Additionally, participants highlighted how the project emphasized the importance of self-care for healthcare providers, leading them to adopt strategies to maintain their own mental well-being while caring for others. This commitment reflects a shift in mindset—not just in treating depression as a clinical condition but in creating a culture of mental health awareness, resilience, and continuous learning within primary care settings.

1. “As a Family Medicine physician, I was always seeking new ways to help my patients, especially those battling the silent storm of depression. When I first encountered the WONCA “MDD Minds” program, I felt a spark of hope. MDD Minds introduced me to what felt like a hidden key to unlocking better care for those struggling with mental health.

From the very first session, I was hooked. Dr. Abdullah’s infectious enthusiasm and the interactive discussions made each step come alive, transforming theory into practice. Real clinical cases painted the approach in vibrant colours, making it not just a tool, but a way to truly connect with my patients. Every session felt like discovering a new layer of understanding, and I saw my own practice transform — more empathetic, more patient, more equipped.

One of the highlights of the program was Trello, an incredible platform that kept me organized, connected, and engaged. It was a game changer. With Trello, I could easily track progress, collaborate on cases, and share ideas seamlessly. It became more than just a tool; it was my virtual meeting ground, where knowledge flowed, and teamwork flourished.

The impact of this program was not confined to my personal practice. Eager to share the knowledge and tools I gained, I conducted two teaching sessions in my workplace to educate my colleagues about the principles and skills I learned in the MDD Minds program.

These sessions became an opportunity to spread awareness, promote structured approaches to depression, and foster a collective commitment to improving mental health care within our clinic.

As the program unfolded, I began to feel a deep, almost magical shift in how I viewed depression — not as an isolated condition, but as something that could be approached with

36 MDD MINDS | A partnership for mental health care

compassion, care, and a structured plan. By the final session, I was not just applying the Approach — I was living it, spreading its impact to my colleagues and patients alike.

This journey did not just change my approach to medicine; it reignited a burning passion within me to continue learning, to deepen my understanding of mental health, and to make a real difference. Now, with the spark of the MDD Minds program lighting the way, I am ready to take the next step and apply for a Mental Health Fellowship in Ireland — to continue the journey and learn from even more magical experiences.” – Manar Alghamdi, Saudi Arabia 2. “We have learned how to take care of ourselves by using MDD Minds 101 Module 7 and Resilience and Wellness and how to help our patients by using the 5-Steps Approach.” – Jehad Ibrahim Azzouni, Saudi Arabia 3. “The WONCA MDD Minds Project has been a very rewarding experience. Participating in this project, I gained insights into approaches to managing major depressive disorder (MDD) and promoting mental health awareness. This project deepened my understanding of evidence-based practices. It has been both a professional and personal journey, encouraging me to become more engaged in mental health advocacy and education.” – Manoj Liyanage, Sri Lanka 4. “My participation in the MDD Minds-WONCA Project was a transformative journey, both professionally and personally. As a family and community doctor, I have always sought ways to expand my knowledge and improve the quality of care for my patients. The project provided a unique opportunity to integrate these practices with a global and collaborative perspective.

5. In the MDD Minds-WONCA project, I had the chance to share experiences and challenges from Primary Health Care (PHC) in my local context while learning from the practices and solutions implemented by colleagues from other regions. This exchange of ideas strengthened my understanding of public health and broadened my perspective on the impact of global strategies in regional contexts, especially in strengthening the Unified Health System (SUS).

6. The exchange of knowledge on managing chronic diseases and mental health was particularly significant, as these areas require comprehensive and interdisciplinary attention.

I was able to explore innovative approaches and evidence-based practices that reinforce the role of family doctors in health promotion and person-centred care.

7. Additionally, the project encouraged deep reflection on my role as an educator and mentor, directly connecting with my background in family health training at Fiocruz. This experience motivated me to continue promoting the integration of teaching and service and to work towards strengthening healthcare networks, aligning PHC practices with local needs and global guidelines.

8. Participating in the MDD Minds-WONCA project reaffirmed my belief in the power of collaboration and the importance of humanized and accessible care for all. I am grateful for the opportunity to contribute and learn from such an impactful project, which reflects the fundamental principles of Family and Community Medicine.” – Marianna Pugliesi Soares Novais, Brazil

MDD MINDS | A partnership for mental health care37

A Lasting Impact on Primary Care Mental Health The MDD Minds Project has left a profound and lasting impact on healthcare professionals across multiple regions. The program has strengthened clinical knowledge, improved patient care, expanded mental health awareness into communities, and helped participants overcome professional and personal challenges. Their testimonies highlight growing confidence in detecting and managing depression, along with a commitment to sharing knowledge and reducing stigma across communities. As these methods continue to spread, they will strengthen mental health services for patients and providers alike, showing how targeted initiatives can drive lasting improvements in primary care settings worldwide.

Master Faculty The Master Faculty, representing the nine countries, played an integral role in the MDD MINDs project, serving as content developers, translators/interpreters, teachers, coaches, and advocates. Their engagement was crucial to the project’s success. Through the evaluation process, they shared their successes and challenges as well as the impact this project had on their own practices. Three Master Faculty members (Brazil, Japan, and Nigeria) both facilitated the Train-the-Trainer program and served as coaches for Performance in Practice.

Train-the-Trainer The Train-the-Trainer Master Faculty (n=10) found the overall experience highly positive (average 4.60) and felt they had adequate resources to support and deliver the overall content to their scholars (average 4.80). They valued the online curriculum available through the Trello platform (4.40).

The Master Faculty noted that additional resources customized to their country, language, and culture would be valuable. Specific resources requested included motivational interviewing, peer support networks, information linking depression with clinical comorbidities, pharmacologic and non-pharmacologic treatment strategies, video content, and opportunities to share across countries.

The most valuable aspects of the program were the focus on mental health, the completion rate of the scholars in delivering content to more than 1,500 learners in their communities, and the focus on self-care among the practices.

Performance in Practice The Performance in Practice Master Faculty (n=3) rated the overall experience as highly positive (4.5) and indicated they were provided with adequate resources to support the improvement projects with their practices (4.67). Additional resources for future programs would include

38 MDD MINDS | A partnership for mental health care

education for non-physician participants in quality improvement, a greater ability to customize the content for the local learning environment and practice setting, resources focusing on treatment strategies, and short, easy-to-use resources that could be used in the practice setting.

Overall Evaluation To further improve the program in the future, the Master Faculty proposed several key enhancements. These include: ● ● ● ●

Expanding the screening questionnaire to include hypertensive patients and the elderly.

Conducting a study on adolescent mental health with school participation Increasing staff participation.

Offering clear, localized, and culturally tailored instructions to enhance engagement and implementation. ● Allowing for longer training periods. ● Fostering collaboration among multiple clinics to facilitate shared learning and best practices. ● Providing materials that can be easily integrated into clinics with high patient volumes and limited consultation time.

The active engagement of the Master Faculty was integral to all aspects of this project. Their insight, dedication, and enthusiasm were central to this project’s success.

“Projects like this allow family doctors to feel capable of making a good diagnosis of depression, providing relevant treatment, and following up with their patients. … We have a deficiency of psychiatrists, but in institutional medicine, we have some limitations to carry out the aforementioned.” – Master Faculty member

Discussion Enrollment and completion rates in MDD MINDS 101 were the highest in Brazil (891) and Saudi Arabia (419), and learners from those countries had the highest participation rate in the Trainthe-Trainer program. As recruitment was encouraged through WONCA country member organizations, the MDD MINDS project had limited opportunities to influence participation.

Registration was distributed across the three regions. The overall completion rate of 20% for the online modules exceeded the average completion rate of 12.6%.5 Since MDD MINDS 101 was required for enrollment in Train-the-Trainer, learners may have been encouraged to complete the full curriculum.

MDD MINDS | A partnership for mental health care39

We noted that the initial confidence rating of female completers was lower than that of male completers. The gap between pre- and post-learning rating of confidence was higher for female learners.

Online education alone is less effective than longitudinal learning,6 yet the participants from MDD Minds 101 identified over 1100 intended changes in practice. Those changes most mentioned included Treatment Approaches (31.3%), Diagnosis and Screening Improvements (25.7%), and Self-Care (17.7%). Diagnosis, Screening, and Treatment Approaches were consistently identified as areas for change throughout this initiative.

The need for physician and team self-care was a theme throughout this project. Upon enrollment in MDD MINDS 101, learners identified their personal strategies for wellness. Those completing the curriculum received additional resources on self-care. Qualitative evaluations in all three phases identified the value of care for all health care providers so they could better care for their patients.

Learners participating in the Train-the-Trainer program found the learning format highly valuable (4.72 average score) and relevant to their practice. The goal of this program was to both engage family physicians in deeper knowledge and offer opportunities for shared learning.

By offering the Scholars Choice session, learners were able to identify the areas of specific needs. Topics included pharmacologic treatment discussions and non-pharmacologic interventions.

The evaluations provided by the scholars highlighted the diverse benefits of this program. While caring for patients with depression within the primary health care setting was an anticipated outcome, professional growth, the value of collaborative learning, interdisciplinary education, self-care, and advocating for mental health services were also identified as outcomes. Serving as faculty within their community provided personal satisfaction and inspired local projects focused on mental health.

Both the Train-the-Trainer and the Performance in Practice programs brought learning to the primary care team through these family physician leaders. Engaging the team was identified as an area for ongoing programming.

The Phase 4 Performance in Practice pilot demonstrated the implementation of systematic screening into the clinical workflow. More than 1,000 patients were screened, with rates of depression in adult patients with diabetes averaging 20%. Regional variations in care were noted: those practices in Japan faced barriers within their institutions in implementing new screening processes, while the practices in rural Brazil were able to engage other health care providers as they worked in temporary quarters.

40 MDD MINDS | A partnership for mental health care

Lessons Learned and Opportunities for Improvement As with any project, we had the opportunity to learn throughout the process, gleaning valuable insights into the value of the project to the clinicians, practice teams, and patients they serve.

Lessons Learned We identified a wealth of “lessons learned” that can be shared with working groups within WONCA’s spheres, spread to other WONCA membership organizations, and provide a framework for future projects in other clinical areas. They include: ● Language and cultural adaptation are important to serve the range of learners. While we were able to translate our work into Portuguese, Spanish, and Japanese, having all target languages available might have increased engagement and completion. The same can be said for cultural personalization; mental health (and other chronic diseases) are addressed and managed differently across the globe—what is managed by family doctors in one country may be the purview of only psychiatrists in another country.

Understanding these nuances is key to implementing a curriculum that improves care and patient health outcomes globally. ● Each country/region/community needs to have more than one leader to lead the project in-country. These leaders are key to recruitment, engagement, and completion of projects. We were fortunate to have key leaders in our nine countries who took it upon themselves to recruit, teach, coach, and even translate content. ● Alignment between WONCA, the MDD project teams, and the WONCA Working Party on Mental Health ensured a wider range of support, feedback, and participation in the initiative. With Professor Dowrick, immediate Working Party on Mental Health past chair, and Professor Christos Lionis, current chair, we were able to call on their worldwide expertise in mental health. ● The engagement of a Lead Faculty member who is involved in all aspects of the program as well as being a content expert is key to the success of a project. In a project of this size and scope, it was important to have one “go-to” leader available to assist in each phase. ● The support and engagement of in-country organizations were key to the recruitment process, providing another voice and invitation to local family doctors. In addition to the in-country organizations, we found the use of social media and WhatsApp to be both practical and cost-efficient means of communication among the participants and the Master Faculty.

MDD MINDS | A partnership for mental health care41

● While we intuited the importance, we learned via commentary and evaluation that the modules, content, and tools addressing self-care were as important to the learners as some of the MDD content. The need for family doctors to mind their own wellness cannot be understated and must, in fact, be an ongoing topic.

We encountered both obstacles and challenges as well; however, because of the strong organizational structure, we were able to identify issues and address them as they occurred rather than have them surface at the end of our work.

Five major obstacles were encountered: ● The development of the Phase 2 MDD 101 content and materials took more time than initially planned. The clinical content was based on a previously delivered curriculum, which required review and modification to address new clinical findings and integrate additional resources. We also realized the need for local language content in Portuguese, Japanese, and Spanish, which was completed by the Master Faculty. The online platform required extra time and review to ensure accuracy and easy navigation. ● Recruitment of learners was managed at the WONCA staff level, with the family medicine organizations in the nine selected countries also providing outreach. We believe that the complexity of registration and handoff from the local organizations affected enrollment. ● As with many online educational activities, drop-off or non-completion rates were expected but nevertheless were a disappointment. Various research studies have a percentage rate for completion of online courses between 5-15%, with research from Research Gate putting Massive Open Online Courses (MOOCs) at 3-6%. Because people are not completing their self-paced online courses, they are not getting the full impact of the learning. We designed the MDD 101 modules to be 15 to 20 minutes in hopes that learners would stay engaged with a cumulative time of learning less than two hours. Some of the drop-offs may be attributable to the length of time between registration and launch—particularly for those learners awaiting the non-English versions. ● The complexity of tracking data and ensuring that we had responses and results on each of the phrases and from the participants was a minor challenge that we were able to overcome. In future projects, it will be important to have the data collection methods confirmed prior to the start of the initiative. The use of multiple platforms may have also caused some delays in data sharing. ● Selecting the right in-country leader is a challenge to be addressed early in the process.

Physicians are busy, schedules change, life happens, and we needed to identify additional in-country experts to take leadership roles after the project began.

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Plans for Sustaining the Impact of the Project: Where Do We Go Next?

One of the goals for this project was the potential for sustainability and spread. Our initial selection of nine countries proved successful, and the ability to use the curriculum and content in other countries and for other member organizations within WONCA is evident. In addition, the ability to build and launch new projects is a positive outcome of MDD MINDS.

Sustainability and Spread For the nine current countries, continued peer support is essential both for the Master Faculty and for their scholars and is required to ensure the long-term success and continuity of the program. Support of the Performance in Practice practices and their practice teams will also increase positive outcomes and sustained results.

The potential for WONCA to package MDD MINDS and spread its usage is significant. The curriculum, tools, and resources can also be made available to other countries, with a framework for recruitment, master faculty engagement, content translation (as needed), technology recommendations, and communications provided to leaders in selected locations or organizations. Funding will be required and could be investigated by WONCA. WONCA may also wish to use the MDD MINDS framework to design projects targeting other important clinical and public health topics.

Next Steps A series of next steps illustrate the opportunities presented to WONCA and its partners as potential follow-ups to the MDD MINDS project.

1. Presentations at the WONCA annual conference in Lisbon (September 2025) and other regional conferences, to be followed by the preparation of papers for publication, focusing on aspects such as qualitative findings from the Train-the-Trainer program, quantitative process and outcome data, and the educational and policy implications of the program.

2. The MDD MINDS 101 course to be offered online to a wide audience, with opportunities for in-person support. Efforts should be made to translate the course into major global languages, for example, Chinese, Hindi, and Urdu, and provide facilities for other

MDD MINDS | A partnership for mental health care43

3.

4.

5.

6.

7.

8.

languages upon demand. It can also contribute to other mental health care initiatives by enhancing the available training materials.

In the same fashion, the MDD MINDS 101 course could be offered to local and national groups in various settings across the globe. An appropriate dissemination and promotion strategy from the WONCA Brussels Office is necessary.

Phases 3 (Train-the-Trainer) and 4 (Performance in Practice) of the MDD MINDS program may also be offered to a wider audience, but these will require in-person support to ensure effective delivery and engagement.

The Performance in Practice Phase of this project focused on screening for MDD among patients with diabetes. New curricula could be developed to address the treatment and management of MDD in patients with comorbidities, with expanded content, tools, and resources.

A series of articles for newsletters and journals should be considered as well. These could be authored by members of the Steering Committee and Master Faculty, by participants in the project, or by the WONCA Working Party on Mental Health.

The synergy with the work and programming agendas of other WONCA Working Parties and Special Interest Groups should also be discussed and explored.

Finally, research should be conducted to explore the impact of the MDD MINDS program not only on patient care but also on patient outcomes, with the aim of assessing its broader effectiveness. Suitable calls for funding could be explored, and participation in international consortia will provide the chance to assess the MDD MINDS program’s clinical effectiveness.

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Final Statement The MDD MINDS initiative provides clear evidence of WONCA’s ability to deliver a high-quality educational program at scale. It illustrates the ability of WONCA and its partner Mosaica Solutions to meet defined objectives, complete the proposed work, and deliver outcomes.

Objective Diagnose major depressive disorder (MDD), in context of cultural variations in presentation Educate patients in health promotion and lifestyle change Employ shared decision-making Select appropriate pharmacologic and nonpharmacologic therapy, including group interventions Manage comorbidities of MDD, with focus on cardio-vascular disease Develop team approaches, including family and community support Communicate with specialists in making referrals Follow-up with patients to reevaluate care Implement activities for practice change Train other primary care and family medicine physicians in diagnosis and management of MDD

MDD 101

Train-theTrainer

Performance in Practice

X

X

X

X

X

X

X X

X X

X X

X

X

X

X

Measures were in diabetes care X

X X

X X X X

X X X X

-

The project also serves as an example and stimulus for similar ventures in other WONCA spheres of interest. In addition, MDD MINDS supports its capacity to work collaboratively with international partners to design and submit research proposals.

WONCA members have gained knowledge, skills, and confidence in managing a common health problem that has global reach and significance. The MDD MINDS Program supports the WONCA strategy and policy to promote continuous professional development.

Ultimately, the goal of improved care for patients with major depressive disorder is being reached. The patients of participating family doctors and their practice teams have benefited from improved communication and understanding of their condition, with a consequent positive impact on their mental health.

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Thank You We extend our heartfelt gratitude to everyone whose dedication and expertise made the MDD MINDS Initiative possible. First and foremost, we thank the Pfizer Global Medical Relations team for its independent educational grant supporting this project.

We also appreciate the participants who embraced the training, the local leaders who advanced learning in their communities, and the Master Faculty for guiding the curriculum. Special thanks to the WONCA Working Party on Mental Health and the Steering Committee for their invaluable support in shaping our vision. We are grateful to Mosaica Solutions for its ongoing collaborative partnership.

Finally, we recognize the unwavering commitment of family doctors and primary care professionals who provide compassionate, effective mental health care every day—your dedication creates a lasting impact in communities worldwide.

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2015;35(2):131. doi:10.1002/chp.21290

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