Why THRIVE

Depression is a leading contributor to the global burden of disease and is closely intertwined with poverty. Severe depression impairs social and occupational functioning, reduces workforce participation, and increases the risk of financial instability. At the same time, poverty characterized by insecure employment, low-skilled work, and volatile incomes is a major social determinant of depression. In India, where baseline poverty remains high and financial risk protection is limited, this cycle is especially difficult to break. The challenge is even greater in rural areas, where access to mental health specialists is extremely limited. As a result, many individuals with severe depression remain untreated or receive delayed care.

THRIVE was developed in response to these dual gaps. By integrating community-based, culturally adapted mental health care with financial aid, the project addresses both depressive symptoms and the financial stressors that sustain them. This intersectoral approach aims to reduce barriers to care, strengthen recovery, and generate scalable evidence.

How are we addressing the issue?

Cash Plus program: Integration of unconditional cash plus program with standard mental health care for a period of six months, designed to address both psychological and economic vulnerabilities.

Health systems-based care: Provision of a brief, culturally adapted psychological intervention delivered by trained lay health workers within primary care settings, ensuring accessibility and scalability within the public health system.

Adopting intersectoral approach: By simultaneously addressing depressive symptoms and key social determinants such as financial stress, THRIVE seeks to disrupt the reinforcing cycle between poverty and depression.

What is the potential impact?

THRIVE is one of the first trials to test a combined poverty-alleviation and depression treatment program in a low-resource setting. It will measure not just symptoms but also disability, work participation, and household income, generating comprehensive evidence.

By evaluating clinical, social, and economic outcomes together, THRIVE can show whether income support directly improves mental health. Positive results could shape policy directions by integrating cash transfers as part of mental health strategy.

The program uses existing rural health and welfare infrastructure, so it does not rely on specialised mental health professionals. This novel delivery model of cash assistance plus lay-worker therapy, could be scaled up if effective. It also opens new pathways to integrate mental health care into social welfare programs.

Future Directions

Informing national policy: If THRIVE shows that cash-plus program is effective, the model has a potential to be incorporated into Indian welfare and health schemes.

Scaling and follow-up: Success could lead to scaling up similar interventions nationally or in other low-resource settings. Prior research indicates that expanding effective depression treatment yields large economic benefits. The protocol’s planned cost-effectiveness and return-on-investment analyses will help quantify those benefits, making a clear case for broader investment. Future studies might also examine longer-term outcomes and refine how financial aid is delivered alongside