A Randomized Controlled Trial

DEPRESSION IS A LEADING cause of disability in both developed and developing regions of the world, including Africa. In 2000, we conducted a community-based survey in an impoverished part of southwest Uganda that has been severely affected by the human immunodeficiency virus (HIV) epidemic. Using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) major depression criteria, we found a current depression prevalence rate of 21% (P.B., unpublished data, 2000), consistent with previous research implicating socioeconomic disadvantage and bereavement in depressive symptoms. World Vision International, a nongovernmental humanitarian organization, was interested in addressing this substantial mental health burden in Uganda. Both antidepressants and psychotherapy have been shown to be efficacious in numerous controlled trials in developed countries, including evidence of equivalence in reducing the symptoms of acute depression. However, use of antidepressants is not feasible in this region because of high cost Author Affiliations are listed at the end of this article. Corresponding Author and Reprints: Paul Bolton, MBBS, 159 Tilden Rd, Scituate, MA 02066 (e-mail: [email protected]). Context Despite the importance of mental illness in Africa, few controlled intervention trials related to this problem have been published.