Browsing by Author "Nakimuli-Mpungu, Etheldreda"

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    Group Support Psychotherapy for Depression Treatment in People with HIV/AIDS in Northern Uganda: A Single-Centre Randomised Controlled Trial
    (The lancet HIV, 2015) Nakimuli-Mpungu, Etheldreda; Wamala, Kizito; Okello, James; Alderman, Stephen; Odokonyero, Raymond; Mojtabai, Ramin; Nachega, Jean B.; Musisi, Seggane
    Group support psychotherapy (GSP) is a culturally sensitive intervention that aims to treat depression by enhancing social support, teaching coping skills, and income-generating skills. We compared GSP with group HIV education (GHE) for treatment of depression in people with HIV in Uganda. In this open-label randomised controlled trial, we included men and women with HIV, aged 19 years or older, who met the Mini International Neuropsychiatric Interview criteria for major depression from an urban HIV care centre in Kitgum district, northern Uganda. Participants were randomly assigned to receive eight weekly sessions of either GSP or GHE. Randomisation was achieved by urn (men and women separately picked a paper containing the intervention allocation from a basket; ratio 1:1), and the intervention sessions were given to gender-specific groups. Participants were followed up immediately after the intervention and 6 months after the end of treatment. The primary outcomes were change in depressive symptom scores (measured with the Self-Reporting Questionnaire) and in function scores (measured with a locally developed method), analysed by intention to treat using cluster-adjusted t tests and permutation tests. This trial is registered with The Pan African Clinical Trials Registry, number PACTR201402000742370.Between Jan 6, and Jan 20, 2014, we assessed 150 individuals, of whom 109 were randomly assigned to receive eight weekly sessions of either GSP (n=57) or GHE (n=52). Change in mean depression scores immediately after intervention did not differ between groups (mean difference −0·19, 95% CI −1·77 to 1·39, p=0·78). Mean function scores did not differ between groups either (0·24, −0·41 to 0·88; p=0·41). At 6 months after end of treatment, participants in the GSP group had lower mean depression scores than did those in the GHE group (−2·50, −3·98 to 1·02, p value=0·005), and higher function scores (0·74, −0·17 to 1·65, p=0·09) than did participants in the GHE group. No adverse events were reported. The benefits of existing HIV educational interventions in HIV care services could be improved by the addition of GSP content. Potential benefits of the integration of GSP into existing HIV interventions, such as adherence counselling or group HIV educational programmes, should be addressed in future studies.
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    Major Depression in Postconflict Northern Uganda: A Case Report
    (American Journal of Psychiatry, 2014) Nakimuli-Mpungu, Etheldreda; Odokonyero, Raymond; Laker, Jean; Alderman, Stephen
    “Ms. A” was a 49-year-old mother of five with a long-standing history of depressive symptoms and a 3-year history of HIV infection. She was receiving antiretroviral therapy at Mucwini Health Center III in Kitgum District at the time of her mental health evaluation by staff at the Peter C. Alderman Foundation (PCAF) clinic. She had a score of 18 on the 20-item Self-Reporting Questionnaire (SRQ-20), a depression and anxiety screening measure on which a score ≥6 indicates significant depression and anxiety symptoms; a mean total score of 2.1 on the culturally adapted Harvard Trauma Questionnaire, a posttraumatic stress symptom measure on which a score of 2.25 indicates significant posttraumatic stress symptoms; and a score of 7 on a locally developed functional assessment tool, indicating moderate impairment. She was clinically diagnosed with moderate to severe major depression with posttraumatic stress symptoms and was started on 50 mg/day of amitriptyline. Given the multiple persistent stressors in her life, she was deemed a good candidate for a weekly eight-session group support psychotherapeutic intervention that had been locally developed to treat depression in HIV-affected individuals. After completing the intervention, Ms. A’s depressive symptoms were reduced by 60%, her functioning scores had increased by 30%, her social support and self-esteem were enhanced, and she was able to engage in income-generating activities. The PCAF clinic staff decided to maintain her on antidepressant medication for 1 year.
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    Outcomes, Feasibility and Acceptability of a Group Support Psychotherapeutic Intervention for Depressed HIV Affected Ugandan Adults: A Pilot Study
    (Journal of affective disorders, 2014) Nakimuli-Mpungu, Etheldreda; Wamala, Kizito; Okello, James; Alderman, Stephen; Odokonyero, Raymond; Musisi, Seggane; Mojtabaie, Ramin; Mills, Edward J.
    Psychotherapy is the recommended first line treatment for mild to moderate depression. However, its availability in low resource settings is limited. We developed a manualized culturally sensitive group support psychotherapeutic intervention for depressed HIV affected Ugandan adults. In this study, we aimed to assess its feasibility, acceptability and impact on depression, functioning, social support and self-esteem. A total of 77 depressed individuals were assigned to the group intervention (n=48) and a wait-list control group (n=29), and assessed before, during and at the end of the intervention. The self-reporting questionnaire, a locally relevant function assessment instrument, the Rosenberg self-esteem scale, and the multiple dimensions perceived social support scale were administered to assess depression symptoms, functioning, self-esteem and social support at three assessment periods. Multivariate longitudinal regression models were used to determine change in outcomes over time between the two groups. Participants were asked to evaluate the intervention. Post –intervention assessments indicate that, in comparison to the wait-list control group, the intervention group had a faster reduction in depression symptom scores [OR=0.00,95% CI, 0.00–0.003] and faster increase in functioning scores [OR=4.82, 95% CI, 2.39 to 9.75], social support scores [OR=2.68, 95% CI, 1.50–4.78] and self-esteem [OR=1.90, 95% CI 1.48–2.44]. Sixty-three percent of participants strongly agreed that the intervention had reduced their depression and would recommend it to other depressed individuals. Inadequate study power due to small sample sizes may result in imprecise confidence intervals even when there are significant differences. The use of non-random samples could have resulted in selection bias. This intervention appears feasible, acceptable and promising in treating depression and restoring function, enhancing social support and self-esteem. Larger and randomized evaluations are warranted.