The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation

Abstract

Background There is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe. Methods Rural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test. Results Ten VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0); p = 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6); p < 0.001] after the 6-week intervention. Conclusion VHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders.

The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub‐Saharan Africa: state of the science and research priorities

“…There are already several tools that fit this description but may need to be adjusted for ease of use. Both the 14‐item Shona Symptom Questionnaire [ 93 ], developed to screen for depression and anxiety in Zimbabwe [ 94 , 95 ], and the 16‐item South African Depression Scale [ 96 ] could be shortened and tested among PPW, as can tools that have been developed for patients with low literacy levels [ 97 ]. As SSA continues to cope with the spread of COVID‐19, with corresponding challenges to community mental health, advancing our understanding of mental health barriers to PrEP use via appropriate screening among PPW is particularly timely.…”

Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial

“… 40 Interventions that address psychosocial stress may be important 41 and are being piloted. 42 Pharmaceutical interventions that show promise are high-dose calcium (which is recommended by WHO to prevent preeclampsia but is also associated with a 24% reduction in preterm birth 43 ); low-dose aspirin (recommended for decades specifically for high risk pregnancies but recently shown in the ASPIRIN trial of 12 000 women in six LMICs to be safe and effective in reducing preterm birth by 11%) 44 ; and multiple micronutrients (MMS) which include iron-folate, in lieu of iron-folate only (compared with iron-folate, MMS reduced preterm birth by 11%, when initiated before 20 weeks’ gestation 45 ). Zimbabwean women may particularly benefit from these interventions because their diet is among the lowest in micronutrient density of any country worldwide.…”

Will Including Health at COP28 Mean Transformation of Global Mental Health Action? And will Mental Health Professionals transform to help achieve it?

“…There is growing evidence that alternative approaches can work. Two examples are; (Fernando et al 2021) Friendship Bench; and (Raghaven et al 2021) Community Theatre.…”