Innovation summary

Major depression is the most prevalent mental illness worldwide. Globally, 350 million people suffer from depression. According to the World Health Organization, it is expected that by the year 2030, depression will be the second largest contributor to the global burden of disease. In Africa, there are some 100 million people suffering from depression, 85% of whom have no access to treatment. African women are affected at twice the rate of men, and depression is the number one cause of disability globally.1

In response to this crisis, StrongMinds has identified a treatment that is both effective and scalable – group interpersonal psychotherapy (IPT-G)IPT-G is a proven, simple, and cost effective community-based model to treat depression.  Using this model, group members are led through a 12-week program that teaches strategies to address the root causes of participant’s depression and overcome those depressive triggers.2,3,4 Following treatment, impact assessments show that the vast majority of patients are depression-free and are better able to care for their children and to live healthy, productive lives.5

Impact summary

  • In its first three years of fieldwork, StrongMinds has treated nearly 10,000 women
  • 82% of women treated no longer had depression after receiving therapy

Innovation details

Group interpersonal psychotherapy or (IPT-G) is essentially a talk therapy program that is facilitated by a trained lay community health worker.  IPT was originally co-developed by Dr. Myrna Weissman3 and subsequently used as a therapy in Uganda in 2002 by Dr. Helen Verdeli and others.4  Both Dr. Weissman and Dr. Verdeli participate on StrongMinds’ Advisory Board.  The program does not require the use of antidepressant medication for patients -- a fact that is quite important, since access to such medication is limited and costly for most of the African population.  Moreover, the group approach has been shown to be acceptable in African contexts, given the strong presence of groups and group work in African cultures.

StrongMinds Therapy Groups focus on the interpersonal relationships of depressed group members and is led by a facilitator who uses a structured model over a period of 12-weeks to help group members identify and understand the root causes and triggers of their depression and then formulate strategies to overcome those triggers.  Since depression is episodic and will continue to recur throughout most people’s lives, these newly acquired skills have both an immediate impact and a long-term preventative effect.

We identify patients through individual one-on-one interviews and enroll symptomatic patients (free of charge) in locally run StrongMinds Therapy Groups. Measurement of depressive symptoms for individuals occurs before, during, and after the intervention so that we can accurately monitor progress.

Key drivers

  • Local human resources that can be trained in the StrongMinds Therapy Group
  • Depth of knowledge of region and communities
  • Expertise in delivering programmatic therapy in a variety of development settings
  • Core set of partners with strategic understanding of program potential

Challenges

  • Limited funding
  • Lack of awareness of depression as a treatable medical condition
  • Dispersed local population

Continuation

StrongMinds seeks to partner strategically with other NGOs to share knowledge and build awareness and ultimately reach underserved populations.  We do this by building bridges between Ministries of Health, NGOs, and regional experts to expand our program services.

Partners

  • Butabika National Hospital: Dr. Dorothy Kizza, based at Butabika, provides field expertise to StrongMinds Mental Health Facilitators
  • Columbia University: Dr. Helena Verdeli, Associate Professor of Clinical Psychology & Director of the Global Mental Health Lab, is a key partner and advisor
  • Medic Mobile: Medic Mobile’s SMS technology cost-effectively improves StrongMinds’ data collection/analysis and improves patient communication
  • FXB Uganda: StrongMinds treats depressed women in eastern Uganda before they enter FXB’s poverty alleviation programs
  • IRC: A joint pilot to provide depression treatment to refugee women with the goal of scaling the partnership throughout Uganda to treat tens of thousands of female refugees

Evaluation methods

The project is evaluated internally through routine monitoring and evaluation activities, and externally through an independent impact evaluation. The impact evaluation includes a controlled longitudinal cohort study comparing outcomes of women with depression receiving treatment in a StrongMinds Therapy Group, with outcomes of women with depression who have received no treatment. 

StrongMinds uses the Patient Health Questionnaire (PHQ-9) to evaluate an individual with depression immediately pre- and post-intervention, as well as at a 6 month follow-up. The PHQ-9 is contained within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and is endorsed by the World Health Organization for use in the developing world.

Cost of implementation

 

Impact details

Through 2016, StrongMinds has successfully reduced the depressive symptoms of 82% of the women treated in StrongMinds Therapy Groups. Results from assessments conducted six months post-therapy suggest that the well-being of participants and their families also improved:

  • Participants spent more time working in their primary occupation and expressed higher job satisfaction
  • Participants’ social networks improved significantly
  • Families consumed meals more regularly
  • Children missed fewer days of school
  • More families slept in protected shelters 

References

1. WHO (2012). Depression Fact Sheet. Geneva: World Health Organisation, Accessed 28 August 2014.

2. WFMH (2012). Depression: a Global Crisis. Occoquan, VA: World Federation for Mental Health.

3. Weissman M, Markowitz J, Klerman G (2000). Comprehensive Guide to Interpersonal Psychotherapy. New York, NY: Basic Books.

4. Bolton P et al. (2003). Group Interpersonal Psychotherapy for Depression in Rural Uganda: A Randomized Controlled Trial. JAMA, 289(23):3117-3124.

5. StrongMinds (2016). Our Impact. Accessed 6 April 2016.

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