Using Group Interpersonal Psychotherapy to Improve the Well-Being of Adolescent Girls

Study Overview
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Brief Summary
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Adolescent girls in developing countries face high rates of adversity and are at an elevated risk of depression and other forms of psychological distress. Untreated depression can have negative consequences on life outcomes such as early pregnancies, social exclusion and school dropout. These can result in a cycle of poverty for young women and their families. Despite this being a very pressing problem there is little evidence on what types of interventions can help break the vicious cycle of poor mental health and poverty. This research program aims to evaluate, through the use of a cluster-Randomized Control Trial (cluster- RCT), the effect of group-based interpersonal psychotherapy (IPT-G) and unconditional cash transfers on adolescent girls' mental health and social functioning. Working with Strong Minds Uganda in collaboration with BRAC Uganda's Empowerment and Livelihood for Adolescents (ELA) clubs, the evidence generated from this research will create a better understanding of whether adolescent mental health improves through this cost-effective approach, and whether improved mental health impacts other outcomes of interest.

Official Title
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Using Group Interpersonal Psychotherapy to Improve the Well-Being of Adolescent Girls

Conditions
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Mental Depression

Intervention / Treatment
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* Behavioral: IPT-G
* Behavioral: Unconditional Cash Transfer


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 13-19 year old female who scores 10 or above on PHQ-8 Exclusion Criteria: male Score below 10 on PHQ-8

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: group-based interpersonal therapy (IPT-G)<br>14 weeks of group-based interpersonal therapy (IPT-G): StrongMinds is focused on treating depression in Uganda by training community members (in this case ELA club mentors) to act as mentors in IPT-G techniques. This intervention will be offered to 13-19 year old young women who score a 10 or higher on the PHQ-8. These adolescents who take up the offer will then be enrolled in the 14 weeks of therapy. Group therapy sessions build bonds between young women and encourage them to actively engage in the healing process and to support each other in the exploration of their depression triggers. With new healthier patterns and skills, women can learn to manage their current depression and ensure future depressive episodes can be quickly identified and resolved before the onset of any long-term consequences. | Behavioral: IPT-G<br>* 14 weeks of group-based interpersonal therapy (IPT-G)<br>|
| Experimental: IPT-G + Unconditional Cash Transfer:<br>A one time lump sum of 200,000 UGX ( $54) be provided to all study participants in a random sub-set of intervention (IPT-G) clusters near or at the conclusion of the 14-week therapy. This treatment variation will allow for determination of whether complimentary income support enhances the effects of IPT-G on psychological wellbeing and other outcomes of interest. | Behavioral: IPT-G<br>* 14 weeks of group-based interpersonal therapy (IPT-G)<br>Behavioral: Unconditional Cash Transfer<br>* Lump sum cash transfer<br>|
| No Intervention: control<br>ELA clubs function as normal | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Minimal Depression 1a | Score <=10 Primary Health Questionnaire 8 (0-24, higher is worse) | 6 months | 
| Minimal Depression 1b | Score <=10 Primary Health Questionnaire 8 (0-24, higher is worse) | 12 months | 
| Minimal Depression 1c | Score <=10 Primary Health Questionnaire 8 (0-24, higher is worse) | 24 months | 
| Psychological Distress 2a | Score >=3 on the General Health Questionnaire 12 (0-12, higher is worse) | 6 months | 
| Psychological Distress 2b | Score >=3 on the General Health Questionnaire 12 (0-12, higher is worse) | 12 months | 
| Psychological Distress 2c | Score >=3 on the General Health Questionnaire 12 (0-12, higher is worse) | 24 months | 
| Self Esteem a | score on Rosenberg self esteem (0-30, higher is better) | 6 months | 
| Self Esteem b | score on Rosenberg self esteem (0-30, higher is better) | 12 months | 
| Self Esteem c | score on Rosenberg self esteem (0-30, higher is better) | 24 months | 
| Resilience a | score on Child & Youth Resilience Measure-Revised (0-34, higher is better) | 6 months | 
| Resilience b | score on Child & Youth Resilience Measure-Revised (0-34, higher is better) | 12 months | 
| Resilience c | score on Child & Youth Resilience Measure-Revised (0-34, higher is better) | 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Indicator for Self-Reported School Enrollment a | Indicator for enrolled in school (=1 if Adolescent Self-Reports Enrolled in school at time of survey) | 12 months | 
| Indicator for Self-Reported School Enrollment b | Indicator for enrolled in school (=1 if Adolescent Self-Reports Enrolled in school at time of survey) | 24 months | 
| incidence of pregnancy a | incidence of pregnancy from baseline | 12 months | 
| incidence of pregnancy b | incidence of pregnancy from baseline | 24 months | 
| Child Marriage a | incidence of marriage from baseline | 12 months | 
| Child Marriage b | incidence of marriage from baseline | 24 months | 
| Competencies a | Score on competency test. This is a score that takes on a value of 0-3 across a set of three questions on ability to answer skills based math questions. Higher is better | 12 months | 
| Competencies b | Score on competency test. This is a score that takes on a value of 0-3 across a set of three questions on ability to answer skills based math questions. Higher is better | 24 months | 
| Indicator for self -reported condom use at last sex a | condom use during last sexual encounter (=1 if Adolescent self reports using a condom at last sex) | 12 months | 
| indicator for self-reported condom use at last sex b | condom use during last sexual encounter (=1 if Adolescent self reports using a condom at last sex) | 24 months |