“SAATHI” – Study to Adapt Adolescent Interpersonal Therapy in Nepal: Dissemination of the results

The World Health Organization (WHO) Mental Health Gap Action Programme outlines a role for psychological therapies including Interpersonal Therapy (IPT) in the treatment of child and adolescent emotional disorders such as depression and anxiety. IPT is a psychological therapy to treat depression which has also been shown to be effective in treating anxiety. World Health Organization has recommended IPT as a possible first line treatment for depression. IPT focuses on four problem areas that can trigger depression and anxiety: grief, interpersonal disputes, role transitions and social isolation/loneliness. It can be delivered by non-specialists in group settings, which is a potentially scalable model for low-resource settings such as Nepal.

There is growing evidence of psychological interventions for adolescents’ depression and anxiety, yet the evidence base is weak in low- and middle-income countries such as Nepal. TPO Nepal, in collaboration with King’s College London, adapted and tested the feasibility, acceptability and implementation of IPT among adolescents in rural Nepal. The study was conducted in Barhabise Municipality of Sindhupalchowk district between September 2018 and December 2020. The learnings and findings of the study were disseminated separately among local stakeholders (in Barhabise Municipality), policy makers and other key national level stakeholders (in Kathmandu) and academician and service providers (in Tribhuvan University Teaching Hospital).

The results show that the adapted IPT can be delivered effectively in school by community psychosocial workers (CPSWs) and staff nurses. The results from a pilot study show significant improvements in depression, functional impairment, anxiety and post-traumatic stress disorder. The adolescents who participated in the IPT sessions considered it as a fun activity and problem-solving technique rather than psychological intervention. The major adaptation of IPT for use in Nepal included integrating IPT into secondary schools for delivery by nurses and lay community members, parental engagement, use of locally acceptable term for mental illness/depression and framing the IPT as a training program to de-stigmatize treatment. The initial economic analysis shows that IPT could be a low-cost intervention if delivered at scale through integrating within the school and community care system.

The stakeholders that participated in the dissemination program also considered IPT as a suitable intervention in school setting. They have made a commitment for providing support to continuation of the program in Barhabise, and future evaluation of the IPT through Randomized Controlled Trial. Mr. Ser Bahadur Lama, ward chairperson of Barhabise Municipality-2 said that he and all executive members will advocate to include this program in their upcoming annual program. Dr. Roshan Pokhrel highlighted the importance of IPT and how to incorporate it to Ministry of Health (MoH) and emphasized on scaling up to entire nation, and not limiting it to a district. Similarly, Dr. Basu Dev Pandey (EDCD) talked on continuing to support TPO Nepal. Similarly, Prof. Dr. Saroj Ojha appreciated this study. He further dragged the attention to the importance of talk therapy and IPT as one of the effective psychological intervention for depression.

 Dr. Pradip Gyawali (NHRC) while calling this project very interesting highlighted the importance of non-pharmaceutical interventions in mental health and many other researches to support it. Similarly, Dr. Kedar Marahatta said that this intervention along with child health needs be addressed through policy. He also emphasized to involve the students in the dissemination program so that they know the importance of research. Dr. Mita Rana made her closing remarks focusing on the need to study the intervention for its efficacy at schools and asked why the interventions was not carried out at hospitals along with how the students could be involved in the process.