Culturally and developmentally adapting group interpersonal therapy for adolescents with depression in rural Nepal

Abstract

Background: Evidence-based interventions are needed to reduce depression among adolescents in low-and middle-income countries (LMICs). One approach could be cultural adaptation of psychological therapies developed in high-income countries. We aimed to adapt the World Health Organization's Group Interpersonal Therapy (IPT) Manual for adolescents with depression in rural Nepal. Methods: We used a participatory, multi-stage adaptation process involving: translation and clinical review of the WHO Manual; desk reviews of adaptations of IPT in LMICs, and literature on child and adolescent mental health interventions and interpersonal problems in Nepal; a qualitative study to understand experiences of adolescent depression and preferences for a community-based psychological intervention including 25 interviews with adolescent boys and girls aged 13-18 with depression, four focus group discussions with adolescents, four with parents/caregivers and two with teachers, six interviews with community health workers and one with a representative from a local non-governmental organisation (total of 126 participants); training of IPT trainers and facilitators and practice IPT groups; and consultation with a youth mental health advisory board. We used the Ecological Validity Framework to guide the adaptation process. Results: We made adaptations to optimise treatment delivery and emphasise developmental and cultural aspects of depression. Key adaptations were: integrating therapy into secondary schools for delivery by school nurses and lay community members; adding components to promote parental engagement including a pre-group session with the adolescent and parent to mobilise parental support; using locally acceptable terms for mental illness such as udas-chinta (sadness and worry) and man ko samasya (heart-mind problem); framing the intervention as a training programme to de-stigmatise treatment; and including activities to strengthen relationships between group members. We did not adapt the therapeutic goals of IPT and conserved IPT-specific strategies and techniques, making edits only to the way these were described in the Manual.

The experience of receiving a diagnosis of depression in adolescence: A pilot qualitative study in Brazil

“…The role of relationships emerges as a defining factor: it is in relations that adolescents can explore and differentiate the meaning of sadness and depression, and disclosure becomes a central discussion regarding stigma, family and peer relationships, and help-seeking. This finding is consistent with previous research in LMICs that put social relations and social experiences as central in the experience of adolescent depression (i.e., (Rose-Clarke et al, 2020)), and point to culturally-relevant directions regarding receiving a diagnosis in LMICs.…”

Social isolation as a core feature of adolescent depression: a qualitative study in Porto Alegre, Brazil

“…There is evidence to support the effectiveness of interpersonal psychotherapy (IPT) among adolescents in LMICs (Bolton et al, 2007). And the focus on social experience in IPT lends itself well to cultural adaptation for adolescents in diverse settings (Rose-Clarke et al, 2020). On this note, a model of adolescent depression that highlights social interactions may also contribute positively to early identification and management of depression (see Figure 2 for highlights).…”

A cross-cultural interpersonal model of adolescent depression: A qualitative study in rural Nepal

“…The goal of our study was to employ qualitative methods to evaluate how adolescent depression could be conceptualised using the interpersonal model in a non-Western youth population in rural Nepal. The study was part of a larger research programme to adapt and test the feasibility of IPT in this setting ( Rose-Clarke, 2020 ).…”