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Group Interpersonal Psychotherapy for Depression in Rural Uganda
A Randomized Controlled Trial
Paul Bolton, MBBS;
Judith Bass, MPH;
Richard Neugebauer, PhD, MPH;
Helen Verdeli, PhD;
Kathleen F. Clougherty, MSW;
Priya Wickramaratne, PhD;
Liesbeth Speelman, MA;
Lincoln Ndogoni, MA;
Myrna Weissman, PhD
JAMA. 2003;289:3117-3124.
Context Despite the importance of mental illness in Africa, few controlled intervention trials related to this problem have been published.
Objectives To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa.
Design, Setting, and Participants For this cluster randomized, controlled clinical trial (February-June 2002), 30 villages in the Masaka and Rakai districts of rural Uganda were selected using a random procedure; 15 were then randomly assigned for studying men and 15 for women. In each village, adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function. Based on these interviews, lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression or subsyndromal depression. Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village, totaling 284. Of these, 248 agreed to be in the trial and 9 refused; the remainder died or relocated. A total of 108 men and 116 women completed the study and were reinterviewed.
Intervention Eight of the 15 male villages and 7 of the 15 female villages were randomly assigned to the intervention arm and the remainder to the control arm. The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks.
Main Outcome Measures Depression and dysfunction severity scores on scales adapted and validated for local use; proportion of persons meeting DSM-IV major depression diagnostic criteria.
Results Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls (P<.001). Mean reduction in dysfunction was 8.08 and 3.76 points, respectively (P<.001). After intervention, 6.5% and 54.7% of the intervention and control groups, respectively, met the criteria for major depression (P<.001) compared with 86% and 94%, respectively, prior to intervention (P = .04). The odds of postintervention depression among controls was 17.31 (95% confidence interval, 7.63-39.27) compared with the odds among intervention groups. Results from intention-to-treat analyses remained statistically significant.
Conclusions Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction. A clinical trial proved feasible in the local setting. Both findings should encourage similar trials in similar settings in Africa and beyond.
Author Affiliations: Center for International, Emergency, Disaster and Refugee Studies (Dr Bolton) and Department of Mental Health (Ms Bass), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Epidemiology of Developmental Brain Disorders Department and International Program on Refugee Trauma (Dr Neugebauer) and Division of Clinical and Genetic Epidemiology (Drs Verdeli, Wickramaratne, and Weissman and Ms Clougherty), New York State Psychiatric Institute, New York; Gertrude H. Sergievsky Center, Faculty of Medicine (Dr Neugebauer), and Department of Psychiatry (Drs Verdeli, Wickramaratne, and Weissman and Ms Clougherty), College of Physicians and Surgeons, and Department of Epidemiology Mailman School of Public Health (Drs Verdeli, Wickramaratne, and Weissman and Ms Clougherty), Columbia University, New York, NY; and World Vision International, Washington, DC (Ms Speelman and Mr Ndogoni).
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