Abstract
Depression, a debilitating disorder, is highly prevalent among low-income women in low- and middle-income countries. Standard psychotherapeutic approaches may be helpful, but low treatment uptake, low retention, and transient treatment effects reduce the benefit of therapy. This pilot randomized controlled trial examined the effectiveness and feasibility of an integrated depression treatment/economic strengthening intervention. The study took place in two villages in the Sirajganj district in rural Bangladesh. Forty-eight low-income women with depressive symptoms (Patient Health Questionnaire (PHQ-9) score ≥ 10) were recruited and randomized to intervention or control arms. The intervention included a six-month group-based, fortnightly depression management and financial literacy intervention, which was followed by a cash-transfer of $186 (equivalent to the cost of two goats) at 12 months’ follow-up. The cash transfer could be used to purchase a productive asset (e.g., agricultural animals). The control arm received no intervention. Findings showed significant reduction in depression scores in the intervention group. The mean PHQ-9 score decreased from 14.5 to 5.5 (B ± SE, −9.2 ± 0.8 95% CI −10.9, −7.5, p < 0.01) compared to no change in the control group. Most other psycho-social outcomes, including tension, self-esteem, hope, social-support, and participation in household economic decision-making, also improved with intervention. An integrated depression treatment and financial empowerment intervention was found to be highly effective among rural low-income women with depression. Next steps involve formal testing of the model in a larger trial.
Highlights
Depression is a frequent consequence of poverty and its sequelae, including hunger, deprivation, social marginalization, and hopelessness [1,2,3,4,5,6]
With the goal of developing a new treatment model for low-resource settings that would a) engage and retain low-income individuals and b) have potential to create lasting benefits, we developed an integrated depression treatment/economic strengthening intervention using matched savings accounts (MSA)
This paper reports on a pilot test of the ASHA model in an economically deprived area of rural Bangladesh
Summary
Depression is a frequent consequence of poverty and its sequelae, including hunger, deprivation, social marginalization, and hopelessness [1,2,3,4,5,6]. The global mental health (GMH) movement, promoted in recent years by researchers and policy makers at the WHO [24,25], seeks to address the pandemic of depression in low- and middle-income countries (LMIC) lacking a developed mental health workforce. Evidence suggests that people in low-income communities endorse conceptual models of depression that emphasize the social and economic causes of suffering They are pessimistic about the benefits of standard depression treatments, whether pharmacological or psychotherapeutic [21,41,42,43,44,45,46]. With the goal of developing a new treatment model for low-resource settings that would a) engage and retain low-income individuals and b) have potential to create lasting benefits, we developed an integrated depression treatment/economic strengthening intervention using matched savings accounts (MSA). We tested whether the ASHA intervention reduced depressive symptoms at 12 months compared to a no-treatment control
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