Problem-Solving and Behavioural Activation for Young Mothers with Depression in Harare, Zimbabwe: A Mixed-Methods Case Series

Abstract

Background. Depression and anxiety among young people in Africa are highly prevalent and a significant public health concern. Evidence-based interventions (EBIs) tailored to this demographic’s unique cultural and contextual needs are limited. Methods. We evaluated an intervention that integrates Behavioural Activation (BA) into Problem-Solving Therapy (PST), focusing on its acceptability, feasibility, preliminary impact on depression and anxiety, and necessary adaptations. Three participants with clinically elevated depression received the six-week intervention. Measures of depression (PHQ-9) and anxiety (GAD-7) were administered pre-intervention and at six subsequent time points. Results. PHQ 9 scores decreased from a baseline median score of 15 (Q1–Q3: 11–17) to a follow-up median score of 3 (Q1–Q3: 1–8). GAD-7 score decreased from a baseline median score of 12 (Q1–Q3: 5–14) to a median score of 6 (Q1–Q3: 1–8). Participants endorsed BA components, emphasizing social interaction and achievement-oriented activities, which were perceived as empowering and culturally resonant. Qualitative feedback highlighted the need for adaptations, including simplified language and localized examples, to enhance relevance. Conclusions. Findings support the feasibility of task-sharing BA-enhanced PST with lay workers, but point to the necessity of iterative cultural adaptation to address socioeconomic barriers.