Abstract
This study investigated local perceptions of changes stemming from a long-standing Group Interpersonal Psychotherapy (IPT-G) program for the treatment of depression in rural Uganda. The study was conducted in a lowincome, severely HIV/AIDS affected area where in 2001 the prevalence of depression was estimated at 21% among adults. Data were collected between May 10 and May 31, 2010, using free-listing and key informant qualitative interviewing techniques. A convenience sample of sixty free-list respondents was selected from among adults who had participated in IPT-G, their family members, and other community members, from 10 villages representing a range of sizes and geographical locations. Twenty-two key informants were also selected from these villages, based on their knowledge about changes reported by free-list respondents. Interviews were analyzed using content analysis and response frequency tallied. IPT-G facilitators were also interviewed about the reported changes. Free-list respondents identified 5 primary categories of change in the community related to the IPT-G program: 1) Improved school attendance for children; 2) Improved productivity; 3) Improved sanitation in communities; 4) Greater cohesion among community members; and 5) Reduced conflict in families. Key informant interviews with community members and IPT-G facilitators suggested that as depression remitted, IPT-G participants became more hopeful and motivated and resumed productive pursuits. Greater cohesion between group members and other affected community members led to increases in collaborative farming and building efforts, and to ongoing mutual emotional support and peer counseling. Changes reported in this study cannot uniquely be attributed to the IPT-G program as other development programs in the area, related to farming, sanitation, and education, may also have contributed. Nevertheless, results suggest that providing treatment for depression in communities where it is prevalent may lead to positive changes in a range of non-mental health areas that are perceived to be connected the depression services.
Highlights
Greater attention and resources have been devoted to improving mental health care in low and middle income countries (LMIC), though this support has not matched efforts in other areas of health and development [1,2,3,4]
The current study, explored the range of changes, beyond the reduction of symptoms and improved functioning, that local people in rural Uganda perceived to have resulted from a Group Interpersonal Psychotherapy (IPT-G) depression treatment program in their community
Free-list respondents reported five general categories of changes that happened because of the IPT-G program: 1) School attendance for children improved; 2) Productivity increased in agriculture and animal husbandry; 3) Sanitation in communities improved; 4) Togetherness and unity improved; and 5) Conflict in families was reduced
Summary
Greater attention and resources have been devoted to improving mental health care in low and middle income countries (LMIC), though this support has not matched efforts in other areas of health and development [1,2,3,4]. Depression, for example, is a leading cause of disability [6,7], associated with negative economic and health outcomes including reduced productivity and role functioning [8,9,10,11,12], poor prognosis and treatment adherence in HIV/AIDS [13,14], and poor outcomes in children of depressed mothers, such as low birthweight, undernutrition, reduced vaccination and well-child visits, and mental disorders [15,16,17,18].
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