Abstract
Depression is a significant public health concern in low- and middle-income countries, with high prevalence rates and limited access to mental health care due to resource constraints, stigma, and a shortage of trained professionals. Group Interpersonal Therapy (IPT-G) has been identified as an effective, scalable intervention for addressing depression in low-resource settings. However, most evaluations of IPT-G have been conducted in controlled research settings or with longer intervention durations, leaving a gap in understanding its effectiveness when implemented as part of a real-world program. The StrongMinds model, a six-week adaptation of IPT-G designed for community settings, offers a promising, more accessible alternative to the standard eight-week model. The StrongMinds model is designed to be scalable within government health systems.
This study aims to evaluate the impact of the StrongMinds IPT-G model on depressive symptoms (primary outcome) and measures related to quality of life, social, economic, educational outcomes, and within-household spillover effects (secondary outcomes). A randomized controlled trial (RCT) will be conducted in Luuka and Buikwe districts in Uganda. The research team will sample 40 villages in Luuka and 60 villages in Buikwe (100 villages total). To minimize contamination and ethical concerns regarding offering treatment to some eligible individuals within a village and not to others, the study will randomly allocate half of the villages in each district to the intervention cluster and half to the control cluster: 20 villages to intervention and 20 to control in Luuka, and 30 villages to intervention and 30 to control in Buikwe. Eligible participants from villages will be pre-screened using the PHQ-4 by StrongMinds program staff and then assessed using the PHQ-9 by research assistants. Those who score 10 or higher on the PHQ-9 will be invited to enroll in the study. Participants from the intervention villages will receive 6-week IPT-G immediately. Participants from the control villages will receive Enhanced Treatment as Usual (ETAU), involving psychoeducation and referral to a Psychiatric nurse.
Research assistants will obtain informed consent and administer baseline, two-week post-treatment, and follow-ups over time (six-month, 12-month, and 24-month post-treatment) surveys. During follow-up rounds post treatment, surveys will be conducted with two non-participant household members, one adolescent and one adult per enrolled household to measure spillover.
The primary outcome will be the reduction in depressive symptoms measured by the PHQ-9. Secondary outcomes will include Anxiety (GAD-7), Externalization of Depression (MDRS-7) Functioning (WHODAS), Subjective Well-being (Cantril Ladder, WHO-5), Social Support (MSPSS), Perceived stress (SOS-4), Nutrition and Food security, Economic (Labor supply/Income), and Consumption measures.
The study is expected to provide evidence on the effectiveness of the StrongMinds’ model in reducing depression in a real-world program setting. Findings will inform the scalability and integration of IPT-G into community-based mental health programs and national health policies in Uganda and similar low-resource settings. By being the first rigorous evaluation of a six-week IPT-G model in a programmatic setting, this study will fill a critical gap in the evidence base for community-based mental health interventions. The results could contribute to efforts to scale up mental health services and improve access to effective depression treatment in Uganda and other LMICs.