School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost.
Adolescent
Nepal
depression
interpersonal therapy
Journal
Global mental health (Cambridge, England)
ISSN: 2054-4251
Titre abrégé: Glob Ment Health (Camb)
Pays: England
ID NLM: 101659641
Informations de publication
Date de publication:
2022
2022
Historique:
received:
27
04
2022
revised:
22
07
2022
accepted:
28
07
2022
entrez:
9
1
2023
pubmed:
10
1
2023
medline:
10
1
2023
Statut:
epublish
Résumé
Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost. We recruited 32 boys and 30 girls (aged 13-19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0-2 weeks after IPT), and follow-up (8-10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective. Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70-95); functional impairment decreased by 288% (249-351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity. School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
Sections du résumé
Background
UNASSIGNED
Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost.
Methods
UNASSIGNED
We recruited 32 boys and 30 girls (aged 13-19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0-2 weeks after IPT), and follow-up (8-10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective.
Results
UNASSIGNED
Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70-95); functional impairment decreased by 288% (249-351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity.
Conclusions
UNASSIGNED
School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
Identifiants
pubmed: 36618751
doi: 10.1017/gmh.2022.46
pii: S2054425122000462
pmc: PMC9806967
doi:
Types de publication
Journal Article
Langues
eng
Pagination
416-428Subventions
Organisme : Medical Research Council
ID : MR/R020434/1
Pays : United Kingdom
Informations de copyright
© The Author(s) 2022.
Références
Community Ment Health J. 2012 Jun;48(3):336-41
pubmed: 21687982
Lancet Psychiatry. 2020 Jul;7(7):581-601
pubmed: 32563306
World Psychiatry. 2018 Feb;17(1):90-101
pubmed: 29352530
Lancet Child Adolesc Health. 2020 Aug;4(8):571-582
pubmed: 32585185
PLoS Med. 2013 Oct;10(10):e1001541
pubmed: 24204215
BMC Psychol. 2018 Nov 3;6(1):51
pubmed: 30390713
Glob Ment Health (Camb). 2021 Feb 19;8:e6
pubmed: 33996110
J Adolesc Health. 2012 Dec;51(6):544-50
pubmed: 23174463
Lancet. 2010 Dec 18;376(9758):2086-95
pubmed: 21159375
Harv Rev Psychiatry. 2020 Jan/Feb;28(1):4-13
pubmed: 31913978
Lancet Glob Health. 2020 Mar;8(3):e387-e398
pubmed: 32035035
Lancet. 2018 Oct 27;392(10157):1553-1598
pubmed: 30314863
Cult Med Psychiatry. 2008 Dec;32(4):462-91
pubmed: 18784989
J Affect Disord. 2014 Apr;158:78-84
pubmed: 24655769
Arch Gen Psychiatry. 1999 Jun;56(6):573-9
pubmed: 10359475
Lancet Psychiatry. 2021 Jun;8(6):535-550
pubmed: 33639109
Int J Psychiatry Med. 2006;36(2):231-41
pubmed: 17154151
Behav Cogn Psychother. 2015 Jan;43(1):1-19
pubmed: 25600515
J Child Psychol Psychiatry. 2010 Jul;51(7):818-26
pubmed: 20102428
J Couns Psychol. 2011 Jul;58(3):279-89
pubmed: 21604860
BMC Med Res Methodol. 2013 Sep 18;13:117
pubmed: 24047204
Arch Gen Psychiatry. 2004 Jun;61(6):577-84
pubmed: 15184237
Lancet. 2016 Jun 11;387(10036):2383-401
pubmed: 27174305
Soc Sci Med. 2021 Feb;270:113623
pubmed: 33461033
Lancet Psychiatry. 2020 Feb;7(2):162-172
pubmed: 31948935
J Consult Clin Psychol. 2010 Apr;78(2):260-7
pubmed: 20350036
Lancet. 2012 Mar 17;379(9820):1056-67
pubmed: 22305766
World Psychiatry. 2004 Oct;3(3):136-9
pubmed: 16633477
Cochrane Database Syst Rev. 2021 Aug 5;8:CD009149
pubmed: 34352116
Behav Res Ther. 2015 Jun;69:11-21
pubmed: 25847276
J Abnorm Child Psychol. 2020 Oct;48(10):1351-1365
pubmed: 32696103
Glob Ment Health (Camb). 2021 Feb 22;8:e7
pubmed: 34026237
Clin Psychol Rev. 2020 Dec;82:101920
pubmed: 33126037
World Psychiatry. 2015 Jun;14(2):207-22
pubmed: 26043339
Prev Med. 2021 Feb;143:106317
pubmed: 33159922
JAMA Psychiatry. 2020 Jul 1;77(7):694-702
pubmed: 32186668
J Affect Disord. 1994 Oct;32(2):115-25
pubmed: 7829763
Confl Health. 2015 Feb 06;9:3
pubmed: 25694792
Int J Cult Ment Health. 2016;9(4):387-398
pubmed: 28093575
Am J Psychother. 2004;58(2):220-37
pubmed: 15373283
Psychiatry Clin Neurosci. 2009 Aug;63(4):463-70
pubmed: 19531111
BMC Psychol. 2020 Aug 12;8(1):83
pubmed: 32787932
J Adolesc Health. 2002 Mar;30(3):196-204
pubmed: 11869927
Lancet Public Health. 2021 Aug;6(8):e541-e542
pubmed: 34332667
J Affect Disord. 2018 Jul;234:239-246
pubmed: 29549825
Child Adolesc Ment Health. 2019 Nov;24(4):307-317
pubmed: 32677350
BMJ Glob Health. 2018 Apr 17;3(2):e000526
pubmed: 29707243
J Affect Disord. 2018 Nov;240:17-26
pubmed: 30041074
BMC Psychiatry. 2016 Mar 08;16:58
pubmed: 26951403
Lancet Child Adolesc Health. 2020 Aug;4(8):634-640
pubmed: 32540024
Am J Psychother. 2014;68(4):443-62
pubmed: 26453346
Psychol Bull. 2013 Jul;139(4):735-65
pubmed: 23231534
Br J Psychiatry. 2015 Dec;207(6):501-6
pubmed: 26450582
Soc Psychiatry Psychiatr Epidemiol. 2002 Nov;37(11):537-43
pubmed: 12395144
Cultur Divers Ethnic Minor Psychol. 2008 Jul;14(3):234-45
pubmed: 18624588
Behav Ther. 2016 Nov;47(6):993-1014
pubmed: 27993346
Lancet Psychiatry. 2014 Oct;1(5):388-98
pubmed: 26361001
Lancet. 2009 Sep 5;374(9692):807-16
pubmed: 19699514
BMC Psychiatry. 2011 Aug 04;11(1):127
pubmed: 21816045
PLoS Med. 2021 Jan 11;18(1):e1003468
pubmed: 33428625
JAMA. 2007 Aug 1;298(5):519-27
pubmed: 17666672
Transcult Psychiatry. 2005 Jun;42(2):317-33
pubmed: 16114588
PLoS One. 2016 Mar 15;11(3):e0150205
pubmed: 26978655