Development of a psychological intervention for people with bipolar disorder in rural Ethiopia

• Published in: BJPsych open 2021-09, Vol.7 (5), Article e168
• Main Authors: Demissie, Mekdes, Hanlon, Charlotte, Ng, Lauren, Mayston, Rosie, Abayneh, Sisay, Fekadu, Abebaw
• Format: Article
• Language: English
• Subjects: behavioural intervention; individual therapy; Medical Psychotherapy; Psychoeducation; relapse prevention; theory of change approach
• ISSN: 2056-4724; 2056-4724
• DOI: 10.1192/bjo.2021.999

Background Evidence from high- and middle-income countries indicates that psychological interventions (PSIs) can improve the well-being of people with bipolar disorder. However, there is no evidence from low-income countries. Cultural and contextual adaptation is recommended to ensure that PSIs are feasible and acceptable when transferred to new settings, and to maximise effectiveness. Aims To develop a manualised PSI for people with bipolar disorder in rural Ethiopia. Method We used the Medical Research Council framework for the development and evaluation of complex interventions and integrated a participatory theory-of-change (ToC) approach. We conducted a mental health expert workshop (n = 12), four independent ToC workshops and a final workshop with all participants. The four independent ToC workshops comprised people with bipolar disorder and caregivers (n = 19), male community leaders (n = 8), female community leaders (n = 11) and primary care workers (n = 21). Results During the workshops, participants collaborated on the development of a ToC roadmap to achieve the shared goal of improved quality of life and reduced family burden for people with bipolar disorder. The developed PSI had five sessions: needs assessment and goal-setting; psychoeducation about bipolar disorder and its causes; treatment; promotion of well-being, including sleep hygiene and problem-solving techniques; and behavioural techniques to reduce anxiety and prevent relapse. Participants suggested that the intervention sessions be linked with patients’ monthly scheduled healthcare follow-ups, to reduce economic barriers to access. Conclusions We developed a contextually appropriate PSI for people with bipolar disorder in rural Ethiopia. This intervention will now be piloted for feasibility and acceptability before its wider implementation.