Exploring the impact of a complex intervention for women with depression in contexts of adversity: A pilot feasibility study of COURRAGE-plus in South Africa.
Exploring the impact of a complex intervention for women with depression in contexts of adversity: A pilot feasibility study of COURRAGE-plus in South Africa.
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DOI：
10.1177/00207640211010203
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发表时间：
2022-06
影响因子：
7.5
通讯作者：
Ncube Mlilo, Ncazelo
中科院分区：
文献类型：
--
作者：
Burgess, Rochelle A.;Jeske, Niklas;Rasool, Shahana;Ahmad, Ayesha;Kydd, Anna;Ncube Mlilo, Ncazelo
抑郁症是世界范围内疾病负担的主要原因，但在低收入和中等收入国家往往得不到充分治疗。治疗差距背后的原因各不相同，但许多人强调缺乏针对包括南非在内的许多环境中与精神卫生问题相关的社会经济和结构现实的干预措施。courage - plus干预措施通过将集体叙事治疗（9周）干预与促进群体主导的针对不良心理健康结构性决定因素的实际行动的社会干预（4周）相结合，弥补了这一差距，共计13次会议。总体目标是促进精神健康，同时增强社区的权能，以当地有意义的方式承认和应对与精神痛苦发展有关的社会逆境。通过患者健康问卷（PHQ-9）在南非豪登省面临逆境的妇女样本中进行试点和评估一项复杂干预措施- courage - plus对抑郁症症状的有效性。PHQ-9评分分别在基线、集体叙事治疗后（中线）和社会干预后（终点）进行评估。计算所有时间点的中位数得分和相应的四分位数范围。时间点之间的得分差异用非参数Friedman检验进行检验。对不同症状严重程度的影响进行描述性比较，以确定样本中不同症状严重程度类别影响的潜在差异。参与者（n = 47）在基线时的抑郁评分中位数为11 (IQR = 7)，在中线时降至4 (IQR = 7)，在终点时降至0 （IQR = 2.5）。经Friedman检验，各时间点抑郁得分差异有统计学意义，(2)= 49.29,p < 0.001。干预后，四个严重程度组的抑郁评分中位数均降至0或1。在南非豪登省面临逆境的妇女样本中，courage - plus在减轻各种严重程度的抑郁症状方面非常有效。研究结果支持需要进行更大规模的试验，以调查集体叙事、讲故事和社会干预作为社区干预对经历逆境和精神痛苦的人群的影响。
Depression is a leading cause of disease burden worldwide but is often undertreated in low- and middle-income countries. Reasons behind the treatment gap vary, but many highlight a lack of interventions which speak to the socio-economic and structural realties that are associated to mental health problems in many settings, including South Africa. The COURRAGE-PLUS intervention responds to this gap, by combining a collective narrative therapy (9 weeks) intervention, with a social intervention promoting group-led practical action against structural determinants of poor mental health (4 weeks), for a total of 13 sessions. The overall aim is to promote mental health, while empowering communities to acknowledge, and respond in locally meaningful ways to social adversity linked to development of mental distress. To pilot and evaluate the effectiveness of a complex intervention – COURRAGE-PLUS on symptoms of depression as assessed by the Patient Health Questionnaire (PHQ-9) among a sample of women facing contexts of adversity in Gauteng, South Africa. PHQ-9 scores were assessed at baseline, post collective narrative therapy (midline), and post social intervention (endline). Median scores and corresponding interquartile ranges were computed for all time points. Differences in scores between time points were tested with a non-parametric Friedman test. The impact across symptom severities was compared descriptively to identify potential differences in impact across categories of symptom severity within our sample. Participants’ (n = 47) median depression score at baseline was 11 (IQR = 7) and reduced to 4 at midline (IQR = 7) to 0 at endline (IQR = 2.5). The Friedman test showed a statistically significant difference between depression scores across time points, (2) = 49.29, p < .001. Median depression scores were reduced to 0 or 1 Post-Intervention across all four severity groups. COURRAGE-PLUS was highly effective at reducing symptoms of depression across the spectrum of severities in this sample of women facing adversity, in Gauteng, South Africa. Findings supports the need for larger trials to investigate collective narrative storytelling and social interventions as community-based interventions for populations experiencing adversity and mental distress.
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影响因子：
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