The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation

Naume V. Tavengwa,Bernard Chasekwa,Lloyd Dzapasi,Tim Brown,Dzivaidzo Chidhanguro,Epiphania Munetsi,Robert Ntozini,Jaya Chandna,Shamiso Fernando,Chandiwana Nyachowe,Andrew J. Prendergast,Batsirai Mutasa,Dixon Chibanda,Kavita Datta

doi:10.1017/gmh.2021.32

Abstract

AbstractBackgroundThere is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe.MethodsRural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test.ResultsTen VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0);p= 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6);p< 0.001] after the 6-week intervention.ConclusionVHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders.

Highlights

Depressive disorders are among the leading global causes of disability-adjusted life years (GBD 2019 Diseases and Injuries Collaborators, 2020), with a disproportionate burden in low- and middle-income countries (Walker et al, 2015)
We evaluated whether the Friendship Bench, which has been scaled up as an evidence-based intervention in urban Zimbabwe (Chibanda et al, 2016; Chibanda, 2017), could be successfully delivered by village health workers (VHWs) in rural Zimbabwe, where the majority of people live
Our mixed methods evaluation demonstrated that the intervention was highly valued by women and by VHWs, and that the combination of individualised therapy and peer-to-peer support led to quantitative and qualitative improvements in mental health, problem solving and income generation, despite multifaceted challenges in their rural lives

Summary

Introduction

Depressive disorders are among the leading global causes of disability-adjusted life years (GBD 2019 Diseases and Injuries Collaborators, 2020), with a disproportionate burden in low- and middle-income countries (Walker et al, 2015). Psychological interventions for common mental disorders delivered through task-sharing are efficacious and cost-effective in low-income countries (Patel et al, 2009) but there is a large treatment gap, in rural areas (Chibanda, 2017). The Friendship Bench is a brief psychological intervention delivered by trained lay health workers through individual problem-solving therapy (Chibanda et al, 2016). We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe. Rural women identified with depression in a previous trial received weekly homebased problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. VHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders

Objectives

Methods

Conclusion