Productivity benefits of treatment of depression and post-traumatic stress disorder in Kenya

Bibliographic Data

ID21879486
AuthorsDaniel Mwai (0000-0002-6750-9480, University of Nairobi), Susan M Meffert (0000-0002-5882-7102, University of California, San Francisco), Easter Olwanda (0000-0002-3158-9415, Kenya Medical Research Institute), Easter E Olwanda (Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya), Muthoni Mathai (0000-0002-1480-5833, University of Nairobi), Muthoni A Mathai (University of Nairobi, Nairobi, Nairobi, Kenya), Linnet Ongeri (0000-0003-2330-6144, Kenya Medical Research Institute), Rachel Burger (0000-0001-9373-2910, University of California, San Francisco), Anne Mbwayo (0000-0003-4888-2375, University of Nairobi), Grace Rota (0000-0002-3294-2313, University of Nairobi), Ammon Otieno (University of Nairobi), Craig R Cohen (0000-0001-8654-6634, University of California, San Francisco), David Bukusi (0000-0003-1910-4179, University of Nairobi), Gregory A Aarons (0000-0001-8969-5002, University of California San Diego), Thomas C Neylan (0000-0002-1572-2626, University of California, San Francisco), Charles E Mcculloch (0000-0002-1279-6179, University of California, San Francisco), Chengshi Jin (0000-0002-6431-790X, University of California, San Francisco), Dickens Akena (0000-0002-8886-4553, Makerere University), Simon Njuguna Kahonge (Ministry of Health), Simon Kahonge (Kenya Ministry of Health, Nairobi, Kenya), James G Kahn (0000-0002-1259-7233, University of California, San Francisco)
Year2025
Volume10
Issue11
Pagese018204
Publication date2025-11-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2024-018204
PMID41184028
OpenAlexW4415824089
LanguageEN
References cited24

INTRODUCTION: Depression and post-traumatic stress disorder (PTSD) significantly contribute to the global disease burden, adversely affecting health, medical costs and economic productivity. The SMART-DAPPER project in western Kenya approached this challenge by deploying trained non-specialists to administer proven depression and PTSD treatments. METHODS: Participants were public sector primary care outpatients at Kiumu County Hospital with major depression and/or PTSD. They were randomised to first-line treatment with interpersonal psychotherapy (IPT) or fluoxetine. We evaluated three measures of economic productivity: income, absenteeism and presenteeism (lowered work efficiency). Change over baseline and comparisons between treatments were conducted using generalised estimating equations regression. RESULTS: There were statistically significant gains in economic productivity from baseline to the end of first-line treatment. The percentage of participants earning a monthly income rose from 54.9% at baseline to 59.8% after treatment in the IPT group and from 54.5% to 61.5% in the Fluoxetine group. Improvement was significantly associated with illness remission. Average monthly income among earners increased by Kenya shillings (KES) 1920 (46 Intl$) with IPT and KES 1350 (31 Intl$) with fluoxetine. Absenteeism dropped in both treatment arms, by 1.5 days per month for IPT and 1.9 days per month for fluoxetine. Presenteeism decreased more with fluoxetine (4.8 days per month) than with IPT (3.3 days per month). CONCLUSION: Treating common mental disorders with IPT and fluoxetine in public sector primary care settings was associated with economic productivity. Leveraging a non-specialist workforce for treatment delivery at scale may build individual and community economic well-being. FUNDING: R01MH113722(NIMH), R01MH115512(NIMH-GACD). TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT03466346

Major depressive disorder · Productivity · Public health · Employment and Welfare Studies · Mental Health Treatment and Access · Posttraumatic Stress Disorder Research

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