Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda: an intervention cohort study

Juliet E M Nakku; Oliva Nalwadda; Emily Garman; Simone Honikman; Charlotte Hanlon; Fred Kigozi; Crick Lund

doi:10.1186/s12884-021-04043-6

Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda: an intervention cohort study

BMC Pregnancy Childbirth. 2021 Aug 25;21(1):584. doi: 10.1186/s12884-021-04043-6.

Authors

Juliet E M Nakku¹, Oliva Nalwadda², Emily Garman³, Simone Honikman⁴, Charlotte Hanlon^{5

6}, Fred Kigozi¹, Crick Lund^{4

5}

Affiliations

¹ Butabika National Referral Mental Hospital, Kampala, Uganda.
² Butabika National Referral Mental Hospital, Kampala, Uganda. olivianalwadda@gmail.com.
³ Department of psychiatry and mental health, University of Cape Town, Cape Town, South Africa.
⁴ Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
⁵ Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
⁶ Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Abstract

Background: Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda.

Methods: Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14.

Results: A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI - 6.79 to - 3.47, p < 0.001) and 7.13 (95%CI - 8.68 to - 5.59, p < 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by - 11.78 points (CI 17.64 to - 5.92, p < 0.001) at midline and - 22.92 points (CI 17.64 to - 5.92, p < 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4-76.6%) and 93.7% (95%CI 87.8-96.8%) of respondents at midline and endline, respectively.

Conclusion: An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.

Keywords: Depression; Group problem solving therapy; Perinatal; Primary health care.

MeSH terms

Adult
Cohort Studies
Depression / therapy*
Female
Humans
Maternal Health / ethnology
Mental Health / ethnology
Patient Health Questionnaire
Perinatal Care*
Pregnancy
Pregnant People / psychology*
Primary Health Care
Problem Solving*
Psychotherapy, Group*
Rural Population
Uganda / epidemiology
Young Adult

Grants and funding

GB-1-201446/UKAID