Innovative Depression Intervention Also Targets Poverty

By: Jonathan Block

It has long been established that depression and poverty are inter-related. Despite this knowledge, relatively few interventions tackling depression have included elements that seek to address poverty. Recognizing this gap in treatment, Victoria Ngo, PhD, and colleagues developed a new program, the Livelihood Integration for Effective Depression Management (LIFE-DM), which combines evidence-based depression care with microfinance service to address depression and poverty at the same time. The innovative intervention was studied in Vietnam’s primary health system.

LIFE-DM is a 12-session CBT-based psychotherapy group that teaches behavioral activation (BA) and problem-solving therapy (PST) skills focused on mood management and livelihood problems. The program begins with lessons about BA to help clients increase pleasurable and healthy behavior in order to improve mood. Then they are taught PST skills to increase their awareness and control of their problems using a simple approach to accurately define and prioritize problems, generate solutions, and take steps to solve their problems. To build a strong foundation for the group, they meet weekly for the first 8 sessions, and every other week for the last 4 sessions.

“We developed LIFE-DM to address the numerous economic barriers to mental health that face poor people around the world, including Vietnam,” Ngo, who is director of SPH’s Center for Innovation in Mental Health, said. “Mental health is not a priority when you need to put food on the table, so we repackaged depression care with loans and livelihood support to make it more relevant. It worked and we had no problems recruiting participants into the groups. Participants also shared with us how it taught them how to deal with and overcome life stressors that they struggled with.”

The non-randomized controlled trial compared the effectiveness of the LIFE-DM program to enhanced treatment as usual (E-TAU) in low-income, depressed women in four commune health stations (CHS) in Danang, Vietnam. CHSs are the most accessible and basic locations for Vietnamese to receive health care, managed by general practitioners but typically with no personnel with mental health services training.

Women in the intervention group received the LIFE-DM depression therapy group and were offered microfinance loans and livelihood support through the group, while the women in the E-TAU group were offered enhanced standard treatment at the CHS, which generally involved referral to the psychiatric hospital and Women’s Union for livelihood support. Baseline interviews with participants were conducted, and then follow-up interviews at 6 months and 12 months later.

Results indicated that those in the LIFE-DM group achieved better outcomes than those in the E-TAU group, especially in terms of depression and functioning. Full results of the trial are expected to be published in a peer-reviewed journal in the future.

While further research is needed to understand the impact of a depression treatment with livelihood support program on economic incomes, Ngo says that results from the LIFE-DM trial are promising.

“The trial on LIFE-DM showed us that if we integrated depression care with poverty alleviation tools, like microfinance, we can move the needle on both mental health and economic outcomes,” she said. “It was exciting to see our results which were also confirmed in our qualitative interviews as well as our own observations of real changes in women’s lives.”