Context Despite the importance of mental illness in Africa, few controlled intervention
trials related to this problem have been published.
Objectives To test the efficacy of group interpersonal psychotherapy in alleviating
depression and dysfunction and to evaluate the feasibility of conducting controlled
trials in Africa.
Design, Setting, and Participants For this cluster randomized, controlled clinical trial (February-June
2002), 30 villages in the Masaka and Rakai districts of rural Uganda were
selected using a random procedure; 15 were then randomly assigned for studying
men and 15 for women. In each village, adult men or women believed by themselves
and other villagers to have depressionlike illness were interviewed using
a locally adapted Hopkins Symptom Checklist and an instrument assessing function.
Based on these interviews, lists were created for each village totaling 341
men and women who met Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (DSM-IV)
criteria for major depression or subsyndromal depression. Interviewers revisited
them in order of decreasing symptom severity until they had 8 to 12 persons
per village, totaling 284. Of these, 248 agreed to be in the trial and 9 refused;
the remainder died or relocated. A total of 108 men and 116 women completed
the study and were reinterviewed.
Intervention Eight of the 15 male villages and 7 of the 15 female villages were randomly
assigned to the intervention arm and the remainder to the control arm. The
intervention villages received group interpersonal psychotherapy for depression
as weekly 90-minute sessions for 16 weeks.
Main Outcome Measures Depression and dysfunction severity scores on scales adapted and validated
for local use; proportion of persons meeting DSM-IV major
depression diagnostic criteria.
Results Mean reduction in depression severity was 17.47 points for intervention
groups and 3.55 points for controls (P<.001).
Mean reduction in dysfunction was 8.08 and 3.76 points, respectively (P<.001). After intervention, 6.5% and 54.7% of the intervention
and control groups, respectively, met the criteria for major depression (P<.001) compared with 86% and 94%, respectively, prior
to intervention (P = .04). The odds of postintervention
depression among controls was 17.31 (95% confidence interval, 7.63-39.27)
compared with the odds among intervention groups. Results from intention-to-treat
analyses remained statistically significant.
Conclusions Group interpersonal psychotherapy was highly efficacious in reducing
depression and dysfunction. A clinical trial proved feasible in the local
setting. Both findings should encourage similar trials in similar settings
in Africa and beyond.