ArticleBMJ global health2025
Retention and effectiveness of group interpersonal psychotherapy (IPT-G) to treat depression at scale in Uganda and Zambia.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionDepression is the most common mental disorder in sub-Saharan Africa (SSA). Group interpersonal therapy (IPT-G) is a recommended first-line treatment for depression, shown to be safe and effective in clinical trials. However, less is known about its real-world retention and effectiveness when delivered at scale in SSA. We describe retention patterns and associated factors in a large IPT-G programme in Uganda and Zambia.
methodsWe analysed routine data from adults (≥18 years) who initiated community-based IPT-G in Uganda and Zambia (2020-2021). Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9), and individuals with probable depression were offered IPT-G. We classified clients based on their attendance across eight IPT-G sessions using latent class analysis. Sociodemographic and programme-related factors associated with latent classes were examined using multinomial logistic regression. Changes in PHQ-9 scores from pretreatment to post-treatment were compared across latent classes. Statistical significance of differences was assessed using the Wald χ
resultsAmong 45 349 clients, overall average attendance was 82%. Four classes emerged from attendance patterns: high attendance (63%), moderate attendance (27%), early dropout (6%) and late dropout (4%). Relative to the high attendance class, the early drop-out class had higher odds of being age <25 (adjusted OR (aOR) 1.19, 95% CI 0.99 to 1.44), in teletherapy (aOR 3.46, 95% CI 2.89 to 4.13) and presenting with moderate than moderately severe to severe depression (aOR 1.27, 95% CI 1.17 to 1.40). The overall mean reduction in PHQ-9 scores was 13.0 (SD 4.2), but the early drop-out group showed smaller improvements (10.32, SD 8.78) compared with the high attendance group (13.3, SD 6.15, p=0.001).
conclusionRetention in a scaled IPT-G programme in Uganda and Zambia was high. Still, early dropout-linked to younger age, teletherapy and moderate depression-was associated with less reduction in depressive symptoms. These findings highlight areas for innovation in IPT-G implementation to improve engagement and outcomes.
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