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Getahun M, Mathai MA, Rota G, Allen A, Burger RL, Opiyo E, Oluoch D, Wangia J, Wambura R, Mbwayo A, Muchembre P, Obura RR, Neylan TC, Aarons GA, Ongeri L, Meffert SM. "The peace that I wanted, I got": Qualitative insights from patient experiences of SMART DAPPER interventions for major depression and traumatic stress disorders in Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002685. [PMID: 39236052 PMCID: PMC11376547 DOI: 10.1371/journal.pgph.0002685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/26/2024] [Indexed: 09/07/2024]
Abstract
SMART DAPPER is an implementation science study responding to mental health treatment gaps for depression and trauma-related disorders in Sub-Saharan Africa (SSA). We report on patient experiences in a study using a Sequential, Multiple Assignment Randomized Trial (SMART) design to test first and second line non-specialist treatment using psychotherapy (Interpersonal Psychotherapy [IPT] or medication (fluoxetine [FLX]), integrated within public sector primary care in western Kenya. An embedded qualitative study conducted in-depth interviews (n = 17) and three (n = 3) focus group discussions with participants (May to October 2021). Audio-recorded interviews were transcribed and translated into English; we deductively and inductively analyzed transcripts guided by grounded theoretical approaches and content analysis. We drew on the health belief model and socio-ecological framework to present findings, including perceived severity (motivations for taking part in the intervention), impacts of the intervention at the individual, interpersonal, and community and health systems levels as well as barriers and facilitators. Participants discussed family and marital conflict, loss of a child, loss of income or a job, and traumatic events such as a death or illness. Impacts at the individual level included reduced headaches, improved appetite and weight management, increased energy, improved sleep, better self-efficacy, and improved concentration, which was reported to lead to increased economic opportunities. At the interpersonal level, participants noted a reduction in conflict, better conflict management and resolution, increased harmony with family and community members, and improved relationships with their partners and children. Perceived challenges included balancing the intervention with livelihoods, preference for traditional medicines, actual or anticipated side effects with medication (FLX), mental health stigma, major life events, and perceived inadequate counseling and challenges with providers. The findings demonstrate the potential of the SMART DAPPER intervention for depression and trauma-related disorder treatments and underscore the challenges and barriers that must be addressed when scaling similar interventions. Trial registration: ClinicalTrials.gov identifier: NCT03466346.
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Affiliation(s)
- Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | | | - Grace Rota
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Ammon Allen
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Elizabeth Opiyo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Dennis Oluoch
- Global Programs for Research and Training, Nairobi, Kenya
| | - Josyline Wangia
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Thomas C Neylan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Susan M Meffert
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, United States of America
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Jennings EA, Chinogurei C, Adams L. Marital experiences and depressive symptoms among older adults in rural South Africa. SSM - MENTAL HEALTH 2022; 2:100083. [PMID: 36277994 PMCID: PMC9581082 DOI: 10.1016/j.ssmmh.2022.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 01/21/2023] Open
Abstract
This paper advances the understanding of how marital transitions may influence mental health by investigating these associations among a population of rural, Black South Africans aged 40+ that was directly impacted by apartheid. Using two waves of data from 4,176 men and women in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we investigated associations between marital experiences and depressive symptoms, by gender, and explored whether economic resources is a moderator of these associations. We found that experiencing a marital dissolution was associated with more depressive symptoms than remaining married for both men and women. We also found that men, but not women, report greater depressive symptoms if they remained separated/divorced, remained widowed, or remained never married between waves. We found no evidence that a decline in wealth moderated the impact of marital dissolution on depressive symptoms for women or men. These findings suggest that the documented benefits of marriage for mental health, and differences by gender in those benefits, may extend to older, rural South Africans, despite the unique experiences of this population.
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Affiliation(s)
- Elyse A. Jennings
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, USA
| | - Chido Chinogurei
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Leslie Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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