Group interpersonal psychotherapy for depression and anxiety among adolescents in rural Nepal: a feasibility and pilot study

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Our study seeks to understand how a group interpersonal psychotherapy (IPT) intervention can be made relevant, feasible and acceptable for adolescents with depression and anxiety in rural Nepal. Addressing depression and anxiety in adolescence is key to improving adolescent health since these disorders are two of the leading causes of disability in this age group. Depression and anxiety are also associated with mortality due to suicide, and have negative long-term health, social and economic effects. In Nepal, adolescents are at high risk of depression and anxiety, due to a complex picture of recent and historical trauma (two major earthquakes in 2015 and a 10-year civil war between 1996-2006) on a background of socio-economic deprivation. Our study will take place in Sindhupalchowk, one of the districts in Nepal that was most severely affected by the earthquakes and where many young people lost family and friends, as well as their homes and schools. Globally there is a lack of services for child and adolescent mental health. This is especially true in low-and middle-income countries (LMICs) including Nepal, where the burden is highest. The World Health Organization (WHO) Mental Health Gap Action Programme outlines a role for psychological therapies including IPT in the treatment of child and adolescent emotional disorders such as depression and anxiety, however few studies have adapted these for young people in LMICs. We aim to adapt and pilot the WHO group IPT intervention, which was originally developed for adults. IPT is a psychological therapy to treat depression, and has also been shown to be effective in treating anxiety. It focuses on addressing difficulties linked to four common problems that can trigger depression and anxiety: grief, interpersonal disputes, role transitions and interpersonal isolation. IPT has been shown to be beneficial for adolescent mental health and compared to other psychological therapies it may be more acceptable to adolescents. It has also been delivered by non-specialists in group settings, which is a potentially scalable model for low-resource settings such as Nepal. Our study will involve a preliminary qualitative study, translation and expert-led revision of the IPT manual, practice training, an intervention adaptation workshop and a community advisory board, and pilot IPT groups. The qualitative study will include interviews and focus group discussions with adolescents, their parents/guardians, teachers, community health workers and government officers to understand how adolescents experience depression and anxiety, how they seek help and potential barriers to intervention. Informed by the qualitative study findings, our team of Nepalese and international investigators, including psychiatrists and psychologists, will then culturally and developmentally adapt the manual for adolescents in Nepal. We will conduct practice training with experienced counsellors and ask for feedback and input from a community advisory board in Sindhupalchowk, comprising adolescents, their parents/guardians, a teacher and community health workers. In the final stage of the project, we will pilot eight IPT groups. We will pilot both community- and school-based groups in order to engage in-school and out-of-school adolescents and to identify a suitable cadre of group facilitators, such as teachers or community health volunteers. Throughout the intervention we will track symptoms of depression and anxiety, and functioning, in order to estimate optimal treatment duration. Post-intervention, we will collect data on intervention acceptability, adherence, quality and cost.Our study will generate new and important findings that will help us to understand how to deliver psychological interventions for adolescents in LMICs, and will enable us to conduct a randomised controlled trial to evaluate the effectiveness and cost value of an IPT intervention in Nepal.