Connecting with Recent Topics in Psychiatric Epidemiology

A previous NAMI Newsletter article introduced to readers the field of psychiatric epidemiology, which is an area of research dedicated to studying the prevalence of mental disorders across cities, states, countries, and even across the world. Psychiatric epidemiology also seeks to quantify the effects of psychiatric treatments on mental health outcomes. A recent study by Mpungu et al. (2022) titled “Long-Term Effect of Group Support Psychotherapy on Depression and HIV Treatment Outcomes: Secondary Analysis of a Cluster Randomized Trial in Uganda” is a great example of this.

The study by Mpungu et al. (2022) sought to determine whether group support psychotherapy (GSP; an intervention in which mental health providers discuss and normalize mental health conditions in a group setting) or group HIV education (GHE; an intervention in which information related to HIV and its progression, transmission, and prevention, is disseminated in a group setting) more positively benefited depression and HIV treatment outcomes of 1473 individuals with HIV and depression living in Uganda. The GSP intervention was culturally sensitive, meaning that it was tailored to meet the needs of the population in which it was being delivered—in this case, adults living in northern Uganda. To do this, the researchers conducting the study spoke to individuals living in the community to understand their perceptions towards depression, what treatments for depression they may have undergone in the past, and their thoughts regarding what components should be included in a group support psychotherapy intervention designed for people with depression and HIV. The findings were used to develop the eight week GSP intervention, which consisted of lessons focusing on the relationship between HIV and depression, positive coping skills, income-generating skills (given that poverty can contribute to the development of depression), and problem-solving skills. The GHE intervention also lasted eight weeks long. 

The researchers found that, at the end of the eight week interventions, fewer participants in the GSP group had depression than participants in the GHE intervention. Additionally, a greater number of GSP participants demonstrated improved viral suppression (i.e., having no greater than 200 copies of the HIV virus per milliliter of blood) and adherence to the antiretroviral therapy (ART) treatment for their HIV. Importantly, these positive health outcomes were still observed 24 months after the intervention ended. These results indicate that GSP can contribute to long-term improvements in depression and HIV outcomes. This finding is important given that as many as 9-32% of individuals in Sub-Saharan Africa living with HIV also have depression, which has been found to exacerbate negative health outcomes associated with HIV. 

This study was limited in a few key ways. For example, the researchers assessing depression and HIV outcome measurements were aware of which study participants were assigned to the GSP intervention, and which were assigned to GHE. As a result, assessors may have measured outcomes differently for individuals in the GSP versus the GHE group–a phenomenon known as detection bias. Additionally, instead of using current viral load measurements in the study, which can cost up to $400 per study participant, researchers relied on past clinical viral load records, which may not accurately reflect present viral load of study participants. 

Notwithstanding these limitations, the study was also strengthened by a variety of factors. For example, it is not uncommon for participants to drop out of studies lasting long periods of time. This study demonstrated high retention of participants, even though it was over two years in length. Additionally, the GSP intervention is very inexpensive compared to other HIV interventions that also target depression. These strengths, in the context of the studying’s findings, demonstrate the utility of the GSP intervention for ameliorating both depression and HIV treatment outcomes. 

Even though the GSP intervention was not tested in the United States, GSP can, in theory, be used in other regions where HIV is a public health issue. Future studies should investigate the efficacy of GSP in such geographic areas. Interventions such as GSP that are efficacious in preventing both mental and physical health are important in that they can lessen the burden of these diseases that can otherwise result in poor health and social outcomes such as job loss or cancer.