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To the Editor: In the study of interpersonal psychotherapy in Ugandan war survivors by Dr Bolton and colleagues,¹ the choice of treatments for investigation deserves comment. It is not clear why the authors have targeted depression in treatment, when the clinical picture in the participants appears to be one of mixed anxiety and depression caused by traumatic stress. The symptoms listed under "anxiety-like syndromes" are consistent with fear-related stress symptoms; evidence suggests that depression in such cases is often secondary to chronic anxiety/fear caused by exposure to unpredictable and uncontrollable stressors.² This implies that treatment should focus on anxiety/fear as the causal process.

Fear-reducing behavioral interventions (eg, exposure-based treatments) have been shown to be efficacious in reducing both posttraumatic stress symptoms and depression, even when the latter is not specifically targeted in treatment and when the fear would be considered "legitimate".³ The misplaced treatment focus in the study by Bolton . . . [Full Text of this Article]

Metin Baolu, MD, PhD
m.basoglu@iop.kcl.ac.uk
Section of Trauma Studies
Institute of Psychiatry
King's College London
England