Depression is one of the most important causes of morbidity and disability in developing countries.1 Zimbabwe, in common with other developing nations, has absolute poverty, economic reform programmes, limited public health services, widespread private and traditional healthcare services, civil unrest, cultural diversity, and sex inequality. We have conducted research on depression in Zimbabwe over the past 15 years, covering ethnographic and epidemiological studies in a range of populations. We compared our findings with research from other developing countries and with evidence from industrialised countries. In the context of developing countries we examined the validity of World Health Organization classifications and medical concepts of depression, the public health implications of depression, and the implications for clinical practice and research.

BackgroundThere are few accounts of evidence-based interventions for depression and other common mental disorders (CMDs) in primary care in low-income countries. The Friendship Bench Project is a collaborative care mental health intervention in primary care in Harare for CMDs which began as a pilot in 2006.Case presentationWe employed a mixture of quantitative and qualitative approaches to investigate the project’s acceptability and implementation, 4–8 years after the initial pilot study. We carried out basic descriptive analyses of routine data on attendance collected between 2010 and 2014. We also conducted five focus group discussions (FGDs) with LHWs in 2013 and 12 in-depth interviews, six with staff and six with patients, to explore experiences of the intervention, which we analysed using grounded theory. Results show that the intervention appears highly acceptable as evidenced by a consistent number of visits between 2010 and 2014 (mean 505 per year, SD 132); by the finding that the same team of female community LHWs employed as government health promoters continue to deliver assessment and problem-solving therapy, and the perceived positive benefits expressed by those interviewed. Clients described feeling ‘relieved and relaxed’ after therapy, and having their ‘mind opened’, and LHWs describing satisfaction from being agents of change. Characteristics of the LHWs (status in the community, maturity, trustworthiness), and of the intervention (use of locally validated symptom screen, perceived relevance of problem-solving therapy) and continuity of the LHW team appeared crucial. Challenges to implementation included the LHWs ongoing need for weekly supervision despite years of experience; the supervisors need for supervision for herself; training needs in managing suicidal and hostile clients; poor documentation; lack of follow-up of depressed clients; and poor access to antidepressants.ConclusionsThis case study shows that a collaborative care intervention for CMDs is positively received by patients, rewarding for LHWs to deliver, and can be sustained over time at low cost. Next steps include evaluation of the impact of the intervention through a randomised trial, and testing of a technological platform for supporting supervision and monitoring clients’ attendance.

BackgroundSocial support is strongly implicated in the aetiology of perinatal mental disorder: particularly the quality of the marital and family environment. Family structures are important under-researched potential modifiers. Turkey offers particular advantages for research in this area because of long-standing coexistence of Western and Middle Eastern family structures. We aimed to investigate associations between the quality of key relationships and depression in women in their third trimester of pregnancy, and the extent to which these associations were modified by family structure.MethodWomen attending antenatal clinics in their third trimester were recruited from urban and rural settings in Ankara. A nuclear family structure was defined as a wife and husband living alone or with their children in the same household, whereas a traditional/extended family structure was defined if another adult was living with the married couple in the same household. Depression was ascertained using the Edinburgh Postnatal Depression Scale (EPDS) and social support was assessed by the Close Person Questionnaire with respect to the husband, mother and mother-in-law. Social support was compared between participants with/without case-level depression on the EPDS in linear regression models adjusted for relevant covariates, then stratified by nuclear/traditional family structure.ResultsOf 772 women approached, 751 (97.3%) participated and 730 (94.6%) had sufficient data for this analysis. Prevalence of case-level depression was 33.1% and this was associated with lower social support from all three family members but not with traditional/nuclear family structure. The association between depression and lower emotional support from the husband was significantly stronger in traditional compared to nuclear family environments.ConclusionsLower quality of relationships between key family members was strongly associated with third trimester depression. Family structure modified the association but, contrary to expectations, spousal emotional support was a stronger correlate of antenatal depression in traditional rather than nuclear family settings. Previous psychiatric history was not formally ascertained and the temporal relationship between mood state and social support needs to be clarified.

Background. Capacity building is essential in low- and middle-income countries (LMICs) to address the gap in skills to conduct and implement research. Capacity building must not only include scientific and technical knowledge, but also broader competencies, such as writing, disseminating research and achieving work–life balance. These skills are thought to promote long-term career success for researchers in high-income countries (HICs) but the availability of such training is limited in LMICs. Methods. This paper presents the contextualisation and implementation of the Academic Competencies Series (ACES). ACES is an early-career researcher development programme adapted from a UK university. Through consultation between HIC and LMIC partners, an innovative series of 10 workshops was designed covering themes of self-development, engagement and writing skills. ACES formed part of the African Mental Health Research Initiative (AMARI), a multi-national LMIC-led consortium to recruit, train, support and network early-career mental health researchers from four sub-Saharan African countries. Results. Of the 10 ACES modules, three were HIC-LMIC co-led, four led by HIC facilitators with LMIC training experience and three led by external consultants from HICs. Six workshops were delivered face to face and four by webinar. Course attendance was over 90% and the delivery cost was approximately US$4500 per researcher trained. Challenges of adaptation, attendance and technical issues are described for the first round of workshops. Conclusions. This paper indicates that a skills development series for early-career researchers can be contextualised and implemented in LMIC settings, and is feasible for co-delivery with local partners at relatively low cost.

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