Journal Article

The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation

Dzapasi, Lloyd, Shamiso Fernando, Chidhanguro, Dzivaidzo, Nyachowe, Chandiwana, Brown, Tim, Chasekwa, Bernard, Datta, Kavita, Mutasa, Batsirai, Chandna, Jaya, Prendergast, Andrew J, Tavengwa, Naume V, Ntozini, Robert, Munetsi, Epiphania, Dixon Chibanda

2021

Overview

BackgroundThere is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe.MethodsRural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test.ResultsTen VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0); p = 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6); p < 0.001] after the 6-week intervention.ConclusionVHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders.

• Publisher: Cambridge University Press
• Subject: Acceptability / Anxiety / Brief interventions / Confidentiality / Developing countries / Disorders / Friendship / Gossip / Home based / Intervention / LDCs / Low income groups / Medical treatment / Mental depression / Mental disorders / Mental health / Mixed methods research / Peers / Postpartum depression / Postpartum period / Problem solving / Psychological intervention / Rural areas / Rural communities / Scores / Social support / Suicidal ideation / Suicide / Support groups / Therapy / Women / Womens health