Psychological treatments delivered by community health workers in low-resource government health systems: Effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda

Byamah B. Mutamba, Jeremy C. Kane, Joop T.V.M. De Jong, James Okello, Seggane Musisi, Brandon A. Kohrt

Research output: Contribution to journalArticle

Abstract

Background Despite increasing evidence for the benefits of psychological treatments (PTs) in low-and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma.Methods A non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention.Results Caregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10-0.62] and 6 months (RR 0.33, 95% CI 0.11-0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers.Conclusion IPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

Original languageEnglish (US)
Pages (from-to)2562-2572
Number of pages11
JournalPsychological medicine
Volume48
Issue number15
DOIs
StatePublished - Nov 1 2018

Keywords

  • Trial RegistrationID ISRCTN11382067

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

Fingerprint Dive into the research topics of 'Psychological treatments delivered by community health workers in low-resource government health systems: Effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda'. Together they form a unique fingerprint.

  • Cite this