Community-based networks matter for mothers’ mental health

Caregiving responsibilities can be a significant source of stress. Research from the last three decades indicates that caregivers commonly experience impaired health habits, psychological distress and psychiatric illness (Schulz and Sherwood, 2008), and that these are even more pronounced among caregivers experiencing violence and displacement (World Health Organization, 2022). Prossy’s story offers an insight into this. (The names mentioned in this article have been changed for anonymity.)

Prossy, a 30-year-old South Sudanese woman, fled her home with her four  children to escape the country’s violent civil war. After the long journey to Palabek refugee settlement in northern Uganda, she learned her husband had been unfaithful and she felt abandoned and isolated while trying to make a new home.

She was severely depressed, and had begun making plans to end her life, when she encountered a StrongMinds volunteer Peer Facilitator, who came through the settlement conducting mental health outreach. Prossy learned more about her depression symptoms and agreed to join a StrongMinds therapy group.

Over the following weeks, Prossy learned positive coping techniques, including how to improve her communication skills and resilience. Once her mood improved, she began to take better care of herself – and her children. Prossy also made a new group of friends who have continued to meet and support each other in the years since their therapy sessions ended. treatment.”

“According  to the WHO, up to 85% of people in low- and medium income countries have no access to effective mental health treatment.”

Why mothers need mental health support

Mothers are particularly impacted by the mental health challenges of caregiving, with one in three experiencing clinically significant anxiety or depression during pregnancy or in the first few years of her child’s life (Shuman et al., 2022).

When a pregnant woman is depressed, the safety of her pregnancy is compromised. She is at greater risk for obstetric complications, symptoms that involve visits to clinics and hospitals, and greater need for pain relief during labour (WHO and United Nations Population Fund, 2008).

And yet most pregnant women, mothers and caregivers have no access to mental healthcare. According to the World Health Organization, up to 85% of people in low- and medium-income countries have no access to effective mental health treatment. Caregivers who are older, of disadvantaged socioeconomically, and have limited support networks are more likely to report poorer psychological health (Schulz and Sherwood, 2008).

The impact of the StrongMinds approach

The StrongMinds group therapy model provides direct care to women who are living with depression in low-resource communities in sub-Saharan Africa. When a woman recovers from depression, her entire ecosystem flourishes – particularly her children, who enjoy better health and education outcomes as a result. A woman who has received depression treatment can also better recognise the signs of depression in herself and others, deploy emotional tools to prevent future depressive episodes, and leverage her lived experience as a way to help others who may be struggling. As Prossy shared, “I encourage StrongMinds to reach out to more women in the settlement so they can also undergo the life change I went through.”

Our model for treating depression is rooted in Group Interpersonal Psychotherapy (IPT-G) and facilitated by lay counsellors over a period of six to ten weeks. The WHO (2016) recommends IPT-G as cost-effective first-line treatment for depression in low-resource settings.

The majority of StrongMinds’ clients – people who are experiencing depression in Uganda and Zambia – are mothers in their childbearing years and adolescents. Our groups provide safe and easily accessible spaces for pregnant women, new mothers, and caregivers of young children. Children are nursed, play and sleep while the women open up about their struggles and find peer support.

A mother named Doreen, who sought support from StrongMinds in Zambia when depressed due to conflict within her household, says of her fellow group members:

“Sometimes we come together to boost our businesses. Also, if I have a challenge with my schoolchildren, they come to my aid and support me if I need help finding resources or even things that the child needs to get back to school. It really helps us because we are able to support each other in the day-to-day challenges.”

Approximately 80% of those who complete StrongMinds therapy are depression-free at the conclusion, and those results are sustained six months later. StrongMinds graduates report feeling more engaged with their children and communities. Among the women we treat, we see a 28% increase after treatment in those who say they have someone to turn to for social support. In part this relates to the support networks formed in the groups.

“When a woman recovers from depression, her entire ecosystem flourishes.”

StrongMinds’ data also shows that, after therapy, our clients’ children go to school more often (a 30% increase), and their families eat more meals together each day (a 13% increase). Many patients become more economically productive, with 16% of clients reporting that they are able to work more frequently after completing therapy. The individuals we treat also report improved self-confidence and self-esteem across all areas of their lives, which improves their overall wellbeing.

Photo: Karin Schermbrucker

Treating depression at scale is a global challenge, one that StrongMinds addresses by leveraging community. To date, we have reached almost 400,000 women and adolescents in Uganda and Zambia, with the positive impact being felt by more than 1.6 million family and household members. By creating a support network for caregivers through the StrongMinds group therapy model, we are improving individual and collective wellbeing and livelihood outcomes for generations to come.

All references can be found in the PDF version of this article.