Global educational initiative for managing major depressive disorders in primary care: The MDD Minds Project. Community Case Study for Frontiers in Family Medicine and Primary Care

Christopher Dowrick^1*Mary Ales²Abdullah Al-Khatami³Dewanto Andoko⁴Adekunle Joseph Ariba⁵Ryuki Kassai⁶Cindy L.K. Lam⁷Christos D Lionis⁸Joy Mugambi⁹Sankha Randenikumara¹⁰Shelly Rodrigues¹¹André Tavares¹²Ana Bertha Pérez-Villalva^13,14

• ¹University of Liverpool, Liverpool, United Kingdom
• ²Mosaica Solutions LLC, Madison, United States
• ³Postgraduate Medicine Eastern Province, Dammam, Saudi Arabia
• ⁴Universitas Pelita Harapan, Tangerang, Indonesia
• ⁵Olabisi Onabanjo University, Ago-Iwoye, Nigeria
• ⁶Fukushima Medical University, Fukushima, Japan
• ⁷University of Hong Kong School of Medicine, Hong Kong, China
• ⁸University of Crete, Heraklion, Greece
• ⁹Kenya Association of Family Physicians, Nairobi, Kenya
• ¹⁰College of General Practitioners of Sri Lanka, Colombo, Sri Lanka
• ¹¹Mosaica Solutiona LLC, Kansas City, United States
• ¹²Universidade do Porto, Porto, Portugal
• ¹³Institute of Social Security and Services for State Workers, Mexico City, Mexico
• ¹⁴Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico

Depressive disorders are common and disabling, and a substantial treatment gap exists particularly in low-resource settings. Family doctors are well-placed to bridge this gap but often lack the confidence, knowledge and skill to do so. MDD Minds project was designed to improve care for major depressive disorders delivered by family doctors in Africa/Middle East (Kenya, Nigeria and Saudi Arabia), Asia (Indonesia, Japan and Sri Lanka) and Latin America (Brazil, Mexico and Peru). Organizational structure included a steering committee, a design and measurement team and a group of master faculty composed of primary mental health care experts from participating countries. Project delivery was in three phases: MDD Minds 101, an online programme with seven modules; Train-the-Trainer, a group-based approach combining online and real-time elements and leading to delivery of in-country educational activities; and Performance-in-Practice, focused on enhanced depression screening for patients with diabetes. Recruitment was conducted by the World Organisation of Family Doctors in collaboration with national primary care organizations. Project delivery began in October 2023 and was completed in December 2024. Enrollment and completion rates were tracked: 2,892 family doctors enrolled in MDD Minds 101; 581 (20%) completed the course. In Train-the-Trainer 210 scholars enrolled; 126 (60%) completed the program, delivering 143 educational sessions to 1,697 other healthcare professionals in their respective regions. Nine primary care teams in Brazil, Kenya, Japan and Nigeria participated in the Performance-in-Practice program; among 1,592 diabetes patients screened, 26.6% were diagnosed with depression and promptly managed. Strategic alignment between partnering organizations, in combination with world-wide expertise in mental health, ensured effective participation. Language and cultural adaptation were important to serving the diverse range of learners, as was ease of access to online platforms and enhanced use of social media. Our online course completion rate exceeded our expectations. The MDD Minds project demonstrates WONCA's ability to deliver high-quality educational programming at scale, as well as the benefits of localized frameworks that support family doctors, primary care teams, and patients in improving the care of those with major depressive disorder. It offers a replicable and sustainable approach to enhancing mental healthcare in diverse primary care settings.