Group Interpersonal Psychotherapy for Depression in Perinatal Adolescents in Kenya: A Pilot Randomized Clinical Trial.

Abstract

Group interpersonal psychotherapy (IPT-G) is effective across diverse populations and adaptable to low-resource settings. To assess whether shortened 4-session mini IPT-G vs full IPT-G delivered by lay health care workers reduces depression and improves family functioning among perinatal adolescents. This pilot randomized clinical trial of group IPT for depression used a 3-arm longitudinal type 1 implementation-effectiveness design between May 13, 2022, and April 1, 2024, at 2 primary care maternal and child health clinics in Nairobi, Kenya. The study applied a collaborative care approach within the World Health Organization (WHO) Mental Health Gap Action Programme framework for training a nonspecialist workforce, where trained nurses screened participants and supervised group sessions delivered by community health promoters collaboratively with psychologists. Participants included perinatal adolescents, aged 13 to 18 years, in their first to second trimester of pregnancy. Participants were randomized to treatment as usual (TAU [n = 44]), mini IPT-G (n = 38), or full IPT-G (n = 40). TAU involved information sheets; mini IPT-G was culturally adapted; and full IPT-G followed the WHO protocol. Primary outcomes included depression measured by the 9-item Patient Health Questionnaire (PHQ-9) and functional impairment within 1 week post intervention and at 6-month follow-up. Secondary outcomes were posttraumatic stress disorder, psychological distress, disability, and self-efficacy. Linear mixed models were used to evaluate the preliminary effectiveness of the interventions. Among the 122 adolescents included in the analysis (median age, 17 [IQR, 17-18] years), 97 (79.5%) were single, and 91 (74.6%) had at least a secondary education level. Retention included 101 participants (82.8%) at 1 week post intervention and 91 (74.6%) at 6-month follow-up. Both IPT arms demonstrated significantly greater reductions in depression than the TAU arm post intervention. Mean (SD) PHQ-9 score decreased from 12.38 (5.90) at baseline to 2.15 (1.94) in the full IPT-G arm (β vs TAU = -5.79; 95% CI, -7.67 to -3.91; P < .001), from 11.58 (4.93) to 3.94 (2.81) in the mini IPT-G arm (β vs TAU = -3.97; 95% CI -5.83 to -2.10; P < .001), and from 11.00 (4.97) to 7.94 (3.71) in the TAU arm. At 6 months, effects were attenuated. Scores in the full IPT-G arm remained significantly lower than in the TAU arm (β = -2.22; 95% CI, -4.25 to -0.18; P = .03) but not in the mini IPT-G arm (β = -1.38; 95% CI, -3.25 to 0.48; P = .15). In this trial, IPT-G delivered by nonspecialists was feasible, acceptable, and effective. Mini IPT-G improved completion rates, while full IPT-G showed more sustained benefits at follow-up. These findings support task-sharing of mental health interventions for perinatal adolescents in low-resource settings. Pan African Clinical Trial Registry Identification: PACTR202501888041900.