Background: Perinatal depression is common in Sub Saharan Africa, where mental health services are limited and literacy levels low. Cognitive behavioral therapy (CBT) is effective in high income settings, but uses written materials. We evaluated the effectiveness of a culturally adapted CBT intervention designed for non-literate women with perinatal depression, delivered by trained lay counselors in rural Sierra Leone. Methods: This study was an outcomes assessor and investigator blinded, individually randomized controlled trial of an adapted CBT program versus standard care (no mental health intervention) among undernourished pregnant and postpartum women with depression in Pujehun, Sierra Leone. Participants were drawn from the COGENT cohort, a randomized, controlled trial of antenatal nutritional supplementation. Depression was identified using the adapted Patient Health Questionnaire9 (aPHQ9). Eligible women scoring ≥9 on the aPHQ9 were randomized 1:1 to receive six weekly CBT sessions or standard care. The primary outcome was aPHQ9 score at 8 weeks post-randomization. Secondary outcomes included clinically meaningful symptom reduction and depression remission (aPHQ9 3 point drop) were more common in the CBT group (96% vs 55%; OR 19, 95% CI 6 to 86; p0.90). Interpretation: A culturally adapted CBT program reduced perinatal depression symptoms in malnourished antenatal and postpartum women in rural Sierra Leone, with sustained effects through nine months postpartum. This study demonstrates the feasibility and effectiveness of delivering CBT via trained lay counselors. Funding provided by Open Philanthropy.
Kleban et al. (Tue,) studied this question.