Piloting a stepped care model for treating women’s depression in Tajikistan

This study assessed the feasibility, acceptability, pre-post changes, and change experiences of stepped-care depression treatment for women in Tajikistan. The research participants were 45 women patients at an urban primary care clinic who scored >16 on the Hamilton Depression Scale. Step 1 was an 8-session psychosocial education and support group called BRIDGES, co-led by a nurse and mental health peer. Step 2 involved 6 sessions of Interpersonal Counseling (IPC) delivered by trained nurses or peers. Step 3 was treatment with amitriptyline managed by a physician. All participants were assessed at baseline, 3, and 6 months, with only Step 3 participants completing a 9 month assessment. Following each step, participants were referred to the next step if their Hamilton Depression scores indicated need for further treatment. Of those completing Step 1, 29% were referred to Step 2, and 42% of those completing Step 2 were referred to Step 3. For the entire group, depression scores decreased significantly from 25.8 after Step 1 to 10.6 after Step 2 and then to 7.7 after Step 3. Modest yet statistically significant reductions in anxiety and PTSD scores also were observed. Participants expressed high levels of satisfaction with each step and described how and why the intervention reduced their depression. Stepped care was found to be feasible and acceptable, with significant improvements in women’s depression and other symptoms. The Tajikistan Ministry of Health and the U.S. National Institute of Mental Health supported the scale-up of stepped care to examine its effectiveness and implementation.