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

Abstract

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). 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. 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. Participants were randomized 1:1 to 6-session problem area-concordant or 8-session problem area-discordant IPT-G. 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). 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. 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. Pan African Clinical Trials Registry Identifier: PACTR202306771120632.