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)1-11
Number of pages11
JournalPsychological Medicine
DOIs
StateAccepted/In press - Feb 15 2018

Fingerprint

Nodding Syndrome
Uganda
Health Resources
Group Psychotherapy
Caregivers
Psychology
Depression
Therapeutics
Odds Ratio
Social Stigma
Confidence Intervals
Risk Reduction Behavior
Health Policy

Keywords

  • Caregivers
  • depression
  • government health system
  • group interpersonal psychotherapy
  • low- and middle-income country
  • nodding syndrome
  • Uganda

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

Cite this

@article{71f4bc82bc0a43ef9cc33993b499cf2f,
title = "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",
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.",
keywords = "Caregivers, depression, government health system, group interpersonal psychotherapy, low- and middle-income country, nodding syndrome, Uganda",
author = "Mutamba, {Byamah B.} and Kane, {Jeremy C} and {de Jong}, {Joop T.V.M.} and James Okello and Seggane Musisi and Kohrt, {Brandon A.}",
year = "2018",
month = "2",
day = "15",
doi = "10.1017/S0033291718000193",
language = "English (US)",
pages = "1--11",
journal = "Psychological Medicine",
issn = "0033-2917",
publisher = "Cambridge University Press",

}

TY - JOUR

T1 - Psychological treatments delivered by community health workers in low-resource government health systems

T2 - effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda

AU - Mutamba, Byamah B.

AU - Kane, Jeremy C

AU - de Jong, Joop T.V.M.

AU - Okello, James

AU - Musisi, Seggane

AU - Kohrt, Brandon A.

PY - 2018/2/15

Y1 - 2018/2/15

N2 - 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.

AB - 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.

KW - Caregivers

KW - depression

KW - government health system

KW - group interpersonal psychotherapy

KW - low- and middle-income country

KW - nodding syndrome

KW - Uganda

UR - http://www.scopus.com/inward/record.url?scp=85042098297&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042098297&partnerID=8YFLogxK

U2 - 10.1017/S0033291718000193

DO - 10.1017/S0033291718000193

M3 - Article

SP - 1

EP - 11

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

ER -