Common mental health problems such as depression and anxiety are at epidemic levels in low and middle income countries. Over the past 25 years, mental health researchers have implemented hundreds of clinical trials investigating whether standard, structured manualized psychotherapies such as cognitive behavioral therapy, problem solving therapy, and similar treatments, can be effective in treating depression among low income individuals struggling with poverty and everything that goes with it—hunger, marginalization, exclusion, and despair. Yet, recently, emerging evidence suggests that psychotherapy in these circumstances has weak effects. Even when it helps with depression in the short term, it’s impact is temporary. Some have proposed that while psychotherapy can be a powerful treatment, it is not powerful enough in the context of severe social and economic problems.
With a grant from the National Institute of Mental Health, I am working with researchers at the ICDDR,B Research Institute in Dhaka to implement a ground breaking clinical trial in a rural area of northern Bangladesh. We will be selecting rural women with depressive symptoms and assigning them to one of two treatment groups. The first group will receive a standardized depression treatment. The second will receive depression treatment plus an agricultural asset—most likely a small herd of Black Bengal goats that you see in the picture above. Women will also receive agricultural skill training, veterinary and feed costs, and other supports. Our goal is to determine whether women in the experimental group (receiving both depression treatment and poverty alleviation support) will experience more benefit, and more lasting benefit, than those receiving psychotherapy alone. Two papers about our preparatory studies may be found here:
https://pubmed.ncbi.nlm.nih.gov/26639376/
https://pubmed.ncbi.nlm.nih.gov/33401489/
Check back here for updates on the project. In another post, I’ll be talking about how my work with economic empowerment in Bangladesh has shaped my approach to practice in Fort Greene, Brooklyn.
