title: Effect of a Primary Care-Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: A Randomized Clinical Trial.
abstract: Depression and anxiety are common mental disorders globally but are rarely recognized or treated in low-income settings. Task-shifting of mental health care to lay health workers (LHWs) might decrease the treatment gap.
  
  
  
  To evaluate the effectiveness of a culturally adapted psychological intervention for common mental disorders delivered by LHWs in primary care.
  
  
  
  Cluster randomized clinical trial with 6 months' follow-up conducted from September 1, 2014, to May 25, 2015, in Harare, Zimbabwe. Twenty-four clinics were randomized 1:1 to the intervention or enhanced usual care (control). Participants were clinic attenders 18 years or older who screened positive for common mental disorders on the locally validated Shona Symptom Questionnaire (SSQ-14).
  
  
  
  The Friendship Bench intervention comprised 6 sessions of individual problem-solving therapy delivered by trained, supervised LHWs plus an optional 6-session peer support program. The control group received standard care plus information, education, and support on common mental disorders.
  
  
  
  Primary outcome was common mental disorder measured at 6 months as a continuous variable via the SSQ-14 score, with a range of 0 (best) to 14 and a cutpoint of 9. The secondary outcome was depression symptoms measured as a binary variable via the 9-item Patient Health Questionnaire, with a range of 0 (best) to 27 and a cutpoint of 11. Outcomes were analyzed by modified intention-to-treat.
  
  
  
  Among 573 randomized patients (286 in the intervention group and 287 in the control group), 495 (86.4%) were women, median age was 33 years (interquartile range, 27-41 years), 238 (41.7%) were human immunodeficiency virus positive, and 521 (90.9%) completed follow-up at 6 months. Intervention group participants had fewer symptoms than control group participants on the SSQ-14 (3.81; 95% CI, 3.28 to 4.34 vs 8.90; 95% CI, 8.33 to 9.47; adjusted mean difference, -4.86; 95% CI, -5.63 to -4.10; P < .001; adjusted risk ratio [ARR], 0.21; 95% CI, 0.15 to 0.29; P < .001). Intervention group participants also had lower risk of symptoms of depression (13.7% vs 49.9%; ARR, 0.28; 95% CI, 0.22 to 0.34; P < .001).
  
  
  
  Among individuals screening positive for common mental disorders in Zimbabwe, LHW-administered, primary care-based problem-solving therapy with education and support compared with standard care plus education and support resulted in improved symptoms at 6 months. Scaled-up primary care integration of this intervention should be evaluated.
  
  
  
  pactr.org Identifier: PACTR201410000876178.
authors.affiliation: Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare.
authors.forename: Dixon
authors.initials: D
authors.lastname: Chibanda
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.affiliation: Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare.
authors.forename: Ruth
authors.initials: R
authors.lastname: Verhey
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.affiliation: Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare.
authors.forename: Ronald
authors.initials: R
authors.lastname: Munjoma
authors.affiliation: Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare.
authors.forename: Simbarashe
authors.initials: S
authors.lastname: Rusakaniko
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare.
authors.forename: Alfred
authors.initials: A
authors.lastname: Chingono
authors.affiliation: Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare.
authors.forename: Epiphania
authors.initials: E
authors.lastname: Munetsi
authors.affiliation: Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare.
authors.forename: Tarisai
authors.initials: T
authors.lastname: Bere
authors.affiliation: Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare.
authors.forename: Ethel
authors.initials: E
authors.lastname: Manda
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors.forename: Melanie
authors.initials: M
authors.lastname: Abas
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
mesh_terms: D000328:Adult; D017677:Age Distribution; D001007:Anxiety / Q000453:epidemiology / Q000628:therapy; D003150:Community Health Workers / Q000193:education; D065246:Culturally Competent Care; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D018579:Patient Selection; D010379:Peer Group; D011320:Primary Health Care; D011340:Problem Solving; D011613:Psychotherapy; D017678:Sex Distribution; D063189:Symptom Assessment; D016896:Treatment Outcome; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology