Effectiveness of a Culturally Adapted Psychological Intervention for Common Mental Disorders in a Low-Income Setting

Among individuals screening positive for common mental disorders in Zimbabwe, lay health worker-administered, primary care-based problem-solving therapy with education and support compared with enhanced usual care resulted in improved symptoms at 6 months, according to a study appearing in the December 27 issue of JAMA.
Depression and anxiety are the most common mental disorders globally and major causes of disease burden in sub-Saharan Africa. Few people with common mental disorders in low-income settings have access to effective treatments. Task-shifting of mental health care to lay health workers (LHWs) might decrease the treatment gap. In this study, Dixon Chibanda, M.D., of the Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare, Zimbabwe, and colleagues randomly assigned 24 clinics in Harare to an intervention or enhanced usual care (control). Study participants were clinic attenders 18 years or older who screened positive for common mental disorders (such as depression, generalized anxiety). The intervention comprised 6 sessions of individual problem-solving therapy delivered by trained, supervised LHWs plus an optional 6-session peer support program. The control group received standard care plus information, education, and support on common mental disorders.
Among 573 randomized patients, 86 percent were women, median age was 33 years, 42 percent were human immunodeficiency virus positive, and 91 percent completed follow-up at 6 months. Intervention group participants had fewer symptoms than control group participants on measures of common mental disorders. Intervention group participants also had lower risk of symptoms of depression (14 percent vs 50 percent).
“Scaled-up primary care integration of this intervention should be evaluated,” the authors write.