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Biomedical subjects

Paul Bolton

Publications and source records attributed to Paul Bolton.

11 recordsLinked to original sources
PubMed2006

Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: randomised controlled trial.

BACKGROUND: A randomised controlled trial comparing group interpersonal psychotherapy with treatment as usual among rural Ugandans meeting symptom and functional impairment criteria for DSM-IV major depressive disorder or sub-threshold disorder showed evidence of effectiveness immediately following the intervention. AIMS: To assess the long-term effectiveness of this therapy over a subsequent 6-month period. METHOD: A follow-up study of trial participants was conducted in which the primary outcomes were depression diagnosis, depressive symptoms and functional impairment. RESULTS: At 6 months, participants receiving the group interpersonal psychotherapy had mean depression symptom and functional impairment scores respectively 14.0 points (95% CI 12.2-15.8; P<0.0001) and 5.0 points (95% CI 3.6-6.4; P<0.0001) lower than the control group. Similarly, the rate of major depression among those in the treatment arm (11.7%) was significantly lower than that in the control arm (54.9%) (P<0.0001). CONCLUSIONS: Participation in a 16-week group interpersonal psychotherapy intervention continued to confer a substantial mental health benefit 6 months after conclusion of the formal intervention.

Adult↗
PubMed2004

The role of the applied epidemiologist in armed conflict.

BACKGROUND: Applied epidemiologists are increasingly working in areas of insecurity and active conflict to define the health risks, suggest feasible means to reduce these risks and, monitor the capacity and reconstruction of the public health system. In 2001, The Carter Center and the United States Institute for Peace sponsored a conference within which "Violence and Health" was discussed and a working group on applied epidemiology formed. The group was tasked to describe the skills that are essential to effective functioning in these settings and thereby provide guidance to the applied epidemiology training programs. METHODS: We conducted a literature review and consultation of a convenience sample of practitioners of applied epidemiology with experience in conflict areas. RESULTS AND CONCLUSIONS: The health programs designed to prevent and mitigate conflict are in their early stages of implementation and the evaluation measures for success are still being defined. The practice of epidemiology in conflict must occur within a larger humanitarian and political context to be effective. The skills required extend beyond the normal epidemiological training that focuses on the valid collection and interpretation of data and fall into two general categories: (1) Conducting a thorough assessment of the conflict setting in order to design more effective public health action in conflict settings, and (2) Communicating effectively to guide health program implementation, to advocate for needed policy changes and to facilitate interagency coordination. These are described and illustrated using examples from different countries.

Journal Article↗
PubMed2004

Assessment of depression prevalence in rural Uganda using symptom and function criteria.

BACKGROUND: We sought to assess the prevalence of major depression in a region of sub-Saharan Africa severely affected by HIV, using symptom and functional criteria as measured with locally validated instruments. METHOD: Six hundred homes in the Masaka and Rakai districts of southwest Uganda were selected by weighted systematic random sampling. A locally validated version of the depression section of the Hopkins Symptom Check List (DHSCL) and a community-generated index of functional impairment were used to interview 587 respondents. RESULTS: Of respondents, 21% were diagnosed with depression using three of the five DSM-IV criteria (including function impairment) compared with 24.4% using symptom criteria alone. Increased age and lower educational levels are associated with a greater risk for depression; however, a gender effect was not detected. CONCLUSIONS: Most community-based assessments of depression in sub-Saharan Africa based on the DSM-IV have used symptom criteria only. We found that expanding criteria to more closely match the complete DSM-IV is feasible, thereby making more accurate assessments of prevalence possible. This approach suggests that major depression and associated functional impairment are a substantial problem in this population.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial.

CONTEXT: Despite the importance of mental illness in Africa, few controlled intervention trials related to this problem have been published. OBJECTIVES: To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa. DESIGN, SETTING, AND PARTICIPANTS: For this cluster randomized, controlled clinical trial (February-June 2002), 30 villages in the Masaka and Rakai districts of rural Uganda were selected using a random procedure; 15 were then randomly assigned for studying men and 15 for women. In each village, adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function. Based on these interviews, lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression or subsyndromal depression. Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village, totaling 284. Of these, 248 agreed to be in the trial and 9 refused; the remainder died or relocated. A total of 108 men and 116 women completed the study and were reinterviewed. INTERVENTION: Eight of the 15 male villages and 7 of the 15 female villages were randomly assigned to the intervention arm and the remainder to the control arm. The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks. MAIN OUTCOME MEASURES: Depression and dysfunction severity scores on scales adapted and validated for local use; proportion of persons meeting DSM-IV major depression diagnostic criteria. RESULTS: Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls (P<.001). Mean reduction in dysfunction was 8.08 and 3.76 points, respectively (P<.001). After intervention, 6.5% and 54.7% of the intervention and control groups, respectively, met the criteria for major depression (P<.001) compared with 86% and 94%, respectively, prior to intervention (P =.04). The odds of postintervention depression among controls was 17.31 (95% confidence interval, 7.63-39.27) compared with the odds among intervention groups. Results from intention-to-treat analyses remained statistically significant. CONCLUSIONS: Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction. A clinical trial proved feasible in the local setting. Both findings should encourage similar trials in similar settings in Africa and beyond.

Adult↗
PubMed2003

Adapting group interpersonal psychotherapy for a developing country: experience in rural Uganda.

The current prevalence of depressive symptoms in Southwest Uganda, an area greatly affected by the HIV epidemic, has been shown to be as high as 21%. Traditional healers have expressed inability to treat these symptoms. The lack of physicians and high cost of medication make the use of antidepressants unfeasible. Therefore, an evidence-based psychotherapy was considered a reasonable treatment option by a team of health researchers familiar with the local culture, who designed a randomized controlled clinical trial. Interpersonal psychotherapy in a group format (IPT-G) was selected because it was time limited, was described in a manual, and had evidence of efficacy from clinical trials. Moreover, its focus on interpersonal triggers of depression was considered compatible with the culture. This paper describes the process of adapting the psychotherapy manual and the training of the group leaders who undertook the first psychotherapy clinical trial in Africa.

Journal Article↗
PubMed2002

An alternative approach to cross-cultural function assessment.

BACKGROUND: This paper describes our work to create and validate a new method for cross-cultural and sex-specific function assessment that avoids the major problems with existing methods. METHODS: We used free listing to learn about tasks important to local people. Community-specific function questionnaires based on these tasks were then created and used in community-based surveys. The survey results were used to assess the questionnaires' internal reliability (Cronbach's alpha), combined test-retest and across-interviewer reliability using repeat interviews, and (in Uganda) criterion validity by comparing assessment by self to assessments by cohabiting adults. RESULTS: Field trials of this approach were conducted in rural Rwanda and Uganda. Differences between tasks identified by free listing were greater between sexes than sites. Cronbach's alphas for male and female questionnaires were respectively 0.815 and 0.822 in Rwanda and 0.886 and 0.881 in Uganda. Pearson correlations for combined test-retest and across-interviewer reliability were respectively 0.469 and 0.640 for Rwandan men and women and 0.797 and 0.871 in Uganda. Correlation between self-assessment and cohabiting adults was 0.904. CONCLUSIONS: We have developed an alternative to the existing approach of adapting western function instruments to other cultures and situations. The field trials have demonstrated that this approach is rapid, feasible and can yield valid and reliable instruments. Developing instruments locally avoids the problems of limited local relevance and appropriateness associated with adapting western instruments. Although each instrument created in this way is culturally bound, they are "cross-cultural" in the sense that each refers to the tasks most important to local people. This approach should prove useful for both researchers and aid agencies working in non-western countries.

Cross-Cultural Comparison↗
PubMed2002

Local perceptions of the mental health effects of the Uganda acquired immunodeficiency syndrome epidemic.

Despite much attention in developed countries, little is known about the relationship between mental health problems and the human immunodeficiency virus (HIV) in Africa. The objectives of the current study were a) to investigate how people in an African community severely affected by HIV view the mental health effects of the epidemic and b) to use these data to investigate the local construct validity of the Western concepts of depression and posttraumatic stress disorder. Ethnographic methods-free listing and key-informant interviews-were used among participants from the Rakai and Masaka districts of southwest Uganda. Participants described two independent depression-like syndromes (Yo'kwekyawa and Okwekubaziga) resulting from the HIV epidemic. No syndromes similar to posttraumatic stress disorder were detected. We conclude that local people recognize depression syndromes and consider them pertinent consequences of the HIV epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Prevalence of depression in rural Rwanda based on symptom and functional criteria.

The authors' objective was to estimate the prevalence of major depressive disorder among Rwandans 5 years after the 1994 genocidal civil war. They interviewed a community-based random sample of adults in a rural part of Rwanda using the Hopkins Symptom Checklist and a locally developed functional impairment instrument. The authors estimated current rates of major depression using an algorithm based on the DSM-IV symptom criteria (A), distress/functional impairment criteria (C), and bereavement exclusionary criteria (E). They also examined the degree to which depressive symptoms compromise social and occupational functioning. Three hundred sixty-eight adults were interviewed, of whom 15.5% met Criteria A, C, and E for current major depression. Depressive symptoms were strongly associated with functional impairment in most major roles for men and women. The authors conclude that a significant part of this population has seriously disabling depression. Work on appropriate, feasible, safe, and effective mental health interventions should be a priority for this population.

Adaptation, Psychological↗
PubMedDate not supplied

Using ethnographic methods in the selection of post-disaster, mental health interventions.

This paper describes a short, ethnographic study approach for understanding how people from non-Western cultures think about mental health and mental health problems, and the rationale for using such an approach in designing and implementing mental health interventions during and after disasters. It describes how the resulting data can contribute to interventions that are more acceptable to local people, and therefore, more effective and sustainable through improved community support.

Anthropology, Cultural↗