Interpersonal psychotherapy, a group-based modality that focuses on resolving social conflicts and addressing recent life stressors, is a feasible therapy option for major depressive disorder (MDD) in an incarcerated population, according to a study in Administration and Policy in Mental Health and Mental Health Services Research.
This hybrid type 1 trial assessed the feasibility and acceptability of interpersonal psychotherapy among providers, prison administrators, and incarcerated patients. Incarcerated participants with MDD were assigned to interpersonal psychotherapy (n=90), although only 67 of these participants had attendance records available for analysis. The median number of sessions attended by participants was 22 out of 24, and approximately 86% of these patients completed treatment. An inability to attend sessions or being shy/uncomfortable with a group setting were common reasons participants gave for ending treatment even though treatment satisfaction was high.
Another analysis that used the Stakeholder Acceptability Survey assessed the acceptability, relative advantage, relative priority, and compatibility of interpersonal psychotherapy among prison providers and administrators (n=71). Prison providers and administrators slightly agreed that interpersonal psychotherapy would be more effective for managing MDD compared with current methods that they were using.
In 8 prison providers who delivered interpersonal psychotherapy, all of these providers indicated that they were very satisfied with the treatment. They also suggested that it was moderately easy or easy to learn, and all providers felt that they were very enthusiastic about the treatment modality. Many noted that they enjoyed watching symptoms improve in prison participants with MDD.
Group participants, who already knew each other, were more likely to trust interpersonal psychotherapy, and incarcerated participants with longer sentences took more of an interest in therapy compared with participants who had been in prison for a shorter period of time. Men were slower to communicate their feelings in a group setting compared with women, which represents a potential barrier to implementation of the therapy.
Limitations of this study included its potential lack of generalizability across all institutions and prison facilities and the inclusion of only 8 provider/administrator surveys.
Findings from this study “may inform future efforts to implement [interpersonal psychotherapy] and other mental health treatments in prisons and perhaps in other justice contexts.” To address potential barriers to therapy, the investigators advocated countering stigma in men’s facilities, providing scalable provider training models, generating strategies to improve organizational climate, and offering financial support to hire additional supervisors and reduce stress among providers.
Johnson JE, Hailemariam M, Zlotnick C, et al. Mixed methods analysis of implementation of interpersonal psychotherapy (IPT) for major depressive disorder in prisons in a hybrid type I randomized trial. Adm Policy Ment Health. 2020;47(3):410-426.