Social Emotional & Economic outcomes of Group Support Psychotherapy

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1 Social Emotional & Economic outcomes of Group Support Psychotherapy Etheldreda Nakimuli-Mpungu, MMED(Psych), PhD Senior Lecturer, Department of Psychiatry Makerere University (Uganda) 1

2 Outline of presentation The Problem statement The Innovative Solution - Group Support Psychotherapy(GSP) - The GSP Training of Trainers Model- Training goals & modules Training Outcomes Emotional Outcomes Social Outcomes Economic Outcomes Implications for Sustainable Development Goals 2

Burden of Depression Globally 350 million people suffer from depression WHO,2015 75% of sufferers are likely to be living in

3 Burden of Depression Globally 350 million people suffer from depression WHO, % of sufferers are likely to be living in resource-poor areas without access to treatment In Sub-Saharan Africa, 1 in 3 persons living with HIV has depression. Nakimuli-Mpungu et al.,2012 3

4 The Problem POOR HEALTH OUTCOMES DEPRESSION UNEMPLOYMENT POVERTY HIV TRANSMISSION ALCOHOL & DRUG USE Domestic Violence 4

5 The Innovate Solution: GSP Session 1: Introduction Session 2: Psych-education Session 3: Sharing problems Session 4: Sharing problems Session 5: Positive Coping Session 6: Problem solving Coping with stigma Session 7: Livelihood skills Session 8: Livelihood skills 5

6 Development & Pilot testing 6

7 Culturally Sensitive GSP Gender specific groups Local rituals incorporated into the group sessions Livelihood skills provided as therapy Cultural group names Homework assignments promote social norms & values Election of group leader besides the group facilitator Women prefer to sit down on a mat 7

8 8 YO MUCWIN- WA The Pain Reliever

9 COHORTS OF PLWH with Depression Cohort M ales Females Mean Age 109 treated by mental health workers treated by general health workers treated by lay health workers

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12 Proportion with depression Proportion with PTSD Depression Effect size = 1.71 Post traumatic stress Effect size = 0.33 Battaglia,2007 Rockland, baseline GSP 6 months GHE baseline 6 months 12

GSP Improves emotions Nakimuli-Mpungu et al; 2017 100

13 GSP Improves emotions Nakimuli-Mpungu et al; Disagree Agree Strongly agree GSP GHE 13

14 GSP Improves Social Connections Attending this group enabled me to unite with other people with the same problem whom I did not know before and we are now friends Female participant referring to benefits of GSP This intervention united people coming from different parts of the town council and created relationships among us. Male participant referring to benefits of GSP 14

15 GSP Improves Coping strategies Active Coping 100 Venting baseline GSP GHE 6 months 0 baseline GSP GHE 6 months 15

16 GSP Improves Coping strategies I have learnt that keeping secrets that are hurting without sharing with others is very dangerous. I have also learnt that I am useful and important to self and others and I am hopeful about the future - Female participant referring to benefits of GSP 16

17 GSP promotes healthy behaviors Alcohol & Substance Use I have been able to reduce the number of bottles of beer I drink. I now take only one bottle per week. Sometimes, I may take two weeks without taking any alcohol. 0 baseline GSP GHE 6 months - Male participant referring to the benefits of GSP 17

18 GSP promotes adherence to treatments YES NO In the past week, did you miss taking your anti-retroviral therapy? GSP GHE 18

19 GSP Improves Ability to Work Last year, at around this time, I had not paid fees for my children. Now, I no longer have a school fees problem. My relationship with my wife has improved Male participant referring to the benefits of GSP 19

20 GSP Improves Ability to Work Has an income generating activity Acquired new assets Belongs to a saving & loans group Has food security GSP GHE 20

21 CASUAL PATHWAYS:GSP INTERVENTION, DEPRESSION & OUTCOMES OF DEPRESSION TREATMENT Nakimuli-Mpungu et al.,

22 2 nd cohort: 537PLWH;GSP delivered by GHWs The SEEK-GSP Trial Goal: To strengthen the evidence base for GSP & increase accessibility 22

23 The GSP Training of Trainers Model Male LHW 10 Male patients Mental Health Specialists 1 Male & 1 Female PHW Female LHW Male LHW 10 Female patients 10 Male patients Female LHW 10 Female patients 23

24 Training GHW to deliver GSP 24

25 Proportion with major depression Impact of GSP delivered by GHW on depression months 6 months Time(months) GSP GHE 25

26 Function Scores Impact of GSP delivered by GHW on Function scores GSP GHE months 6 months Time(months) 26

27 Proportion with IGAs Impact of GSP on Income Generating Activities(IGAs) GSP GHE months Time(months) 27

28 Proportion with savings Impact of GSP on Saving Activities GHE GSP months Time(months) 28

29 Proportion with food security Impact of GSP on Food Security GHE GSP Months Time(months) 29

30 Impact of GSP on household assets Land 80 Animals/Poultry rearing baseline GSP GHE 6 months baseline GSP GHE 6 months 30

31 Impact of GSP on household assets At least one of these: Radio/television/fridge 60 At least one of these: Bicycle/ motorcycle/car baseline GSP GHE 6 months 0 baseline GSP GHE 6 months 31

Socio-economic outcomes https://youtu.be/vyvxuz4vjti?

group may stay together - Smaller groups of 3-4 members

32 Socio-economic outcomes Bee Keeping Project 49 pilot GSP groups were formed in 15 PHCs Sun Flower Project 78% initiated income generating projects - The group may stay together - Smaller groups of 3-4 members Sweet potato Project - Individuals projects but form a saving group 32

33 Implications for Economic Empowerment The GSP sessions conducted by HWs have potential to: Sesame Project EGG-PLANT PROJECT - ensure healthy lives and promote wellbeing of > 1000 individuals - Reduce poverty in rural communities - promote sustainable economic productivity. GOAT REARING PROJECT 33

Committee Prof. Ramin Mojtabai, MD,PhD,MPH Assoc Prof.

34 Acknowledgement Steering Committee Sheila Ndyanabangi, MBChB, MPH James Okelllo, MMED, PhD Josephine Birungi, MBChB, MPH Advisory Committee Prof. Ramin Mojtabai, MD,PhD,MPH Assoc Prof. Edward J Mills, PhD Prof. Seggane Musisi, FRCP Prof. Jean B Nachega, MD, PhD, MPH 34

35 THANK YOU FOR LISTENING 35

WAVES FOR CHANGE A N N U A L R E P O R T A N N U A L R E P O R T

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