Developing a culturally sensitive group support intervention for depression among HIV infected and non-infected Ugandan adults: a qualitative study.
BACKGROUND
Depression is ranked first among neuropsychiatric diseases that contribute to the burden of disease in low- and middle-income countries. However, access to antidepressants is limited and there is a dearth of locally developed psychotherapeutic interventions targeted to treat depression.


OBJECTIVE
We aimed to obtain information on the cultural understanding of depression symptoms, complications and treatment methods used in post-conflict communities in northern Uganda in order to inform the development of an indigenous group support intervention to treat depression.


METHODS
Focus group discussions (FGDs) were conducted with a total of 110 men and women aged 19-68 years. FDGs took place in a private space, lasted about 2-3h and were conducted in the local language for patients and their caregivers and in English for health workers. Interview transcripts from the FGDs were reviewed for accuracy, translated into English and transcribed. QRS Nvivo 10 qualitative data analysis software was used for coding and thematic analysis.


RESULTS
Our study revealed community misperceptions about etiology, presentation and treatment of depression. Regardless of HIV status, most FGD participants who were not health workers linked depression symptoms to HIV infection. Although there were concerns about confidentiality of issues disclosed, many FGD participants were supportive of a group support intervention, tailored to their gender and age, that would not only focus on treating depression but also provided them with skills to improve their livelihoods. Simple CBT techniques were deemed culturally appropriate and acceptable.


CONCLUSIONS
Generalizability of study findings may be limited given that the sample was primarily of Luo ethnicity yet there are different ethnic populations in the region.


CONCLUSIONS
Local communities can directly inform intervention content. The participants׳ preferences confirmed the need for a gender-specific intervention for depression that extends beyond medications and empowers them emotionally, socially and economically.
Makerere University, College of Health Sciences, Kampala, Uganda; Peter C. Alderman Foundation, NewYork, USA. Electronic address: ethelmpungu@yahoo.com.
Etheldreda
E
Nakimuli-Mpungu
African Center for Tortured Victims, Kampala, Uganda.
Kizito
K
Wamala
Peter C. Alderman Foundation, NewYork, USA; Gulu University, Department of Psychiatry, Gulu, Uganda.
James
J
Okello
Peter C. Alderman Foundation, NewYork, USA.
Stephen
S
Alderman
Makerere University, College of Health Sciences, Kampala, Uganda; Peter C. Alderman Foundation, NewYork, USA.
Raymond
R
Odokonyero
Makerere University, College of Health Sciences, Kampala, Uganda; Peter C. Alderman Foundation, NewYork, USA.
Seggane
S
Musisi
Johns Hopkins School of Public Health, Department of Mental Health, Baltimore, United States.
Ramin
R
Mojtabai
D000328:Adult; D000368:Aged; D017028:Caregivers; D003466:Cultural Characteristics; D003863:Depression / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000523:psychology*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012657:Self-Help Groups; D014454:Uganda
Culture; Depression; Group support psychotherapy; HIV/AIDS; Northern Uganda; Social support