Six-Week Problem Area-Concordant vs 8-Week Problem Area-Discordant Group Interpersonal Psychotherapy: A Randomized Clinical Trial.

IMPORTANCE: Depression is a prevalent mental health condition contributing to morbidity worldwide. The World Health Organization (WHO) recommends group-based interpersonal psychotherapy (IPT-G) for first-line depression treatment in resource-constrained settings. Standard of care in the study context is 8 to 12 weekly sessions in groups with a mix of depression problem areas (eg, grief, life changes, loneliness, conflict). OBJECTIVE: To investigate whether grouping participants with a common depression problem area (problem area-concordant) using shortened IPT-G (6 sessions) is noninferior to grouping participants with a mix of problem areas (problem area-discordant) using standard IPT-G (8 sessions) in Uganda. DESIGN, SETTING, AND PARTICIPANTS: This noninferiority randomized clinical trial included adults 18 years or older in central Uganda with 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater, indicating symptoms consistent with probable depression. Assessors were masked to treatment arm. Data were accrued from October 31, 2022, to March 24, 2023. INTERVENTIONS: Participants were randomized 1:1 to 6-session problem area-concordant or 8-session problem area-discordant IPT-G. MAIN OUTCOME AND MEASURES: The primary outcome was PHQ-9 score reduction at 3 months. Secondary outcomes were treatment response (PHQ-9 5-point, 10-point, and 50% score reduction), reduction in disability (WHO Disability Assessment Schedule 2.0), and improvement in subjective quality of life (WHO Quality of Life tool). RESULTS: Among 328 enrolled participants (303 [92.4%] female; mean [SD] age, 42.3 [15.2] years), retention was high, with 321 [97.9%] undergoing assessment at the end of therapy and 292 [89.0%] at 3-month follow-up. From baseline to the end of therapy, PHQ-9 scores dropped a mean (SD) of 15.2 (5.1) points in the problem area-concordant arm and 13.3 (5.3) points in the problem area-discordant arm. Problem area-concordant 6-week IPT-G was noninferior (P < .001) at end of therapy and 3 months post therapy. Compared with the 8-week problem area-discordant arm, posttherapy PHQ-9 scores in the 6-week problem area-concordant arm were 1.86 (95% CI, 0.74-3.00) points lower (P = .001). At 3 months, PHQ-9 scores were 1.98 (95% CI, 0.60-3.36) points lower (P = .005). Disability score reduction was significantly larger post therapy in the 6-week arm compared with the 8-week arm (2.70 [95% CI, 0.95-4.44] points) but not significantly different between arms after 3 months. Quality of life scores across all domains were not significantly different between arms at end of therapy and 3 months post therapy. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, 6-week problem area-concordant IPT-G was noninferior to 8-week problem area-discordant IPT-G for reducing depression symptoms, with similar to larger improvements in disability and quality of life. Problem area-concordant group therapy appears to be a promising approach to increase efficiency and scalability of depression treatment. TRIAL REGISTRATION: Pan African Clinical Trials Registry Identifier: PACTR202306771120632.

Duke Scholars

Author Brandon A. Kohrt Psychiatry, Child & Family Mental Health & Community Psychia ...