Development of a cognitive behavioral therapy intervention among pregnant women in Pujehun District, Sierra Leone.

In rural, poor, largely illiterate Pujehun District of Sierra Leone there were no interventions available for perinatal depression (PND). To address this need, Project Peanut Butter established a counseling service. This process included selection and training of counselors and the creation, initiation and implementation of a standardized curriculum for counseling services. The screening tool was an adapted Patient Health Questionnaire - 9 (aPHQ-9). The PHQ-9 is validated and used worldwide. aPHQ-9 scores range from 0 to 27, with a score ≥ 9 used to define eligibility for counseling. The screening tool is administered by a counselor. A culturally adapted cognitive behavioral therapy (CBT) curriculum was developed, designed to mitigate the adverse consequences of dysphoria and empower participants to constructively reintegrate into their families and communities. All communication with the illiterate participants utilized pictures and verbal idioms. Counseling was largely delivered individually, and consisted of six 45-minute sessions. Sustained counseling participation was 92%, as defined by attending multiple sessions. This model serves as a replicable framework for similar initiatives in high illiteracy contexts, with the goal of ameliorating PND. A randomized controlled trial is underway to assess the impact of CBT within a broader nutritional intervention study.