Mental health: taking its place as an essential element of sustainable global development

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Abstract

As of 2015, with the adoption of the Sustainable Development Goals (SDGs), the United Nations has a new roadmap for development that will guide global and national agendas for the next 15 years. Mental health was explicitly included in the SDGs, for the first time being recognised as an essential component of development. This is a major achievement that has taken decades of unrelenting advocacy. Still, mental health lacks clear, measurable indicators within the SDGs, threatening its progress in the realm of global development. The task now is for the global mental health community to actively work within health systems, and with other sectors, to integrate mental health interventions and indicators into programmes aimed at other goals and targets. In this way, the direct impact of mental health on development and the impact of mental health on other development goals will be recognised and quantified.

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Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial.

Paul Bolton, Judith D. Bass, Richard Neugebauer … (2003)

Despite the importance of mental illness in Africa, few controlled intervention trials related to this problem have been published. To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa. For this cluster randomized, controlled clinical trial (February-June 2002), 30 villages in the Masaka and Rakai districts of rural Uganda were selected using a random procedure; 15 were then randomly assigned for studying men and 15 for women. In each village, adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function. Based on these interviews, lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression or subsyndromal depression. Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village, totaling 284. Of these, 248 agreed to be in the trial and 9 refused; the remainder died or relocated. A total of 108 men and 116 women completed the study and were reinterviewed. Eight of the 15 male villages and 7 of the 15 female villages were randomly assigned to the intervention arm and the remainder to the control arm. The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks. Depression and dysfunction severity scores on scales adapted and validated for local use; proportion of persons meeting DSM-IV major depression diagnostic criteria. Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls (P<.001). Mean reduction in dysfunction was 8.08 and 3.76 points, respectively (P<.001). After intervention, 6.5% and 54.7% of the intervention and control groups, respectively, met the criteria for major depression (P<.001) compared with 86% and 94%, respectively, prior to intervention (P =.04). The odds of postintervention depression among controls was 17.31 (95% confidence interval, 7.63-39.27) compared with the odds among intervention groups. Results from intention-to-treat analyses remained statistically significant. Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction. A clinical trial proved feasible in the local setting. Both findings should encourage similar trials in similar settings in Africa and beyond.

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Controlled trial of psychotherapy for Congolese survivors of sexual violence.

Judith K Bass, Jeannie Annan, Sarah McIvor Murray … (2013)

Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries. In this trial in the Democratic Republic of Congo, we randomly assigned 16 villages to provide cognitive processing therapy (1 individual session and 11 group sessions) or individual support to female sexual-violence survivors with high levels of PTSD symptoms and combined depression and anxiety symptoms. One village was excluded owing to concern about the competency of the psychosocial assistant, resulting in 7 villages that provided therapy (157 women) and 8 villages that provided individual support (248 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), PTSD symptoms (average score on the PTSD Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), and functional impairment (average score across 20 tasks [range, 0 to 4, with higher scores indicating greater impairment]) were performed at baseline, at the end of treatment, and 6 months after treatment ended. A total of 65% of participants in the therapy group and 52% of participants in the individual-support group completed all three assessments. Mean scores for combined depression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were significantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) (P<0.001 for all comparisons). Similar patterns were observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants in the therapy group and 42% of participants in the individual-support group met criteria for probable depression or anxiety (P<0.001), with similar results for PTSD. In this study of sexual-violence survivors in a low-income, conflict-affected country, group psychotherapy reduced PTSD symptoms and combined depression and anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.).

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Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis.

Nancy L Sin, M Robin DiMatteo (2014)

Depression is a risk factor for nonadherence to HIV/AIDS treatment.

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Author and article information

Journal

Journal ID (nlm-ta): BJPsych Int

Journal ID (iso-abbrev): BJPsych Int

Journal ID (publisher-id): BJI

Title: BJPsych International

Publisher: Cambridge University Press (Cambridge, UK )

ISSN (Print): 2056-4740

ISSN (Electronic): 2058-6264

Publication date (Print): November 2018

Volume: 15

Issue: 4

Pages: 72-74

Affiliations

[1 ]Researcher, Global Mental Health Program, Columbia University , New York

[2 ]MPH, Boston University

[3 ]Professor of Psychology, Departments of Psychiatry and Epidemiology, Columbia University ; and Director of the Global Mental Health Program, Columbia University , New York; email kmp2@ 123456cumc.columbia.edu

Author notes

Conflicts of interest. K.P. served as a member of the FundaMentalSDG group which advocated for the inclusion of mental health in the SDGs.

Article

Publisher Item ID: S2056474017000228 Publisher ID: 00022

DOI: 10.1192/bji.2017.22

PMC ID: 6277948

SO-VID: 605c7058-4fe8-4d6c-b0ad-5b44b5a5d663

License:

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivatives licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

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References: 15, Pages: 3

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Mental health: taking its place as an essential element of sustainable global development

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Abstract

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UN Sustainable Development Goals

Most cited references 10

Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial.

Controlled trial of psychotherapy for Congolese survivors of sexual violence.

Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis.

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