Models of evaluating the clinical significance of depression treatment in developing countries: The case of group interpersonal psychotherapy in rural southwestern Uganda

Depression in the developing world is highly prevalent and associated with a range of negative outcomes. Evidence-based treatment for depression in the developing world is rare and, when implemented, tends to depend on the evidence-base derived from trials conducted in the developed world, which may not translate to the unique sociocultural contexts of developing countries. Although in recent years a number of trials of depression treatment in the developing world have been conducted, to date there is no accepted methodology for assessing the clinical significance of treatment in these settings. Clinical significance -- a distinct concept from statistical significance -- evaluates whether treatment made a meaningful difference in the lives of participants.;This study explores models for evaluating the clinical significance of a treatment's impact drawn from western research and cross-cultural literature. It applies two such models to the evaluation of outcome data from a trial of group Interpersonal Psychotherapy (IPT-GU) for depression conducted in rural southwestern Uganda. Using a standard method for evaluating clinical significance in western trials of depression, the study found that participants who received IPT-GU were more likely than those in a treatment as usual control to be remitted from the presenting depressive episode by the termination of treatment and to be recovered from the presenting episode by 6 months post-treatment. The study also implemented a cross-culturally appropriate model of evaluating the data, comparing post-treatment depression and functional impairment levels of the treated sample to that of the larger community, using data from an epidemiological study conducted in the same region. This analysis found that after treatment participants who received IPT-GU returned to a normative level of functioning for the region and had depressive symptoms significantly below the norm for the region. The control group continued to have functional impairment and depression above the norm. Both analyses thus provide strong evidence that IPT-GU had a clinically and practically meaningful impact on the lives of the depressed adults in southwestern Uganda who received it. Implications of this study for future evaluations of depression treatment in the developing world are discussed.