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Save the Children Somalia/Somaliland
Approximately a third of the Somali population is affected by some kind of mental disorder; common among them is depression. Prevalence of violence, displacement, unemployment, and drug abuse are among some of the contributing factors. The country’s mental health services are unable to handle this high degree of mental disorders. In other parts of the world, psychosocial support (PSS) groups demonstrate effectiveness in alleviating depressive symptoms. PSS works by helping individuals to manage their interpersonal depression triggers through improved interpersonal functioning. Cash transfer programs have also shown promising effects in boosting psychosocial wellbeing and reducing depression by relieving financial strain. Although both approaches are known to alleviate depressive symptoms, they have never been tested together before.
To assess the marginal effects of adding structured peer-to-peer support groups to cash transfer program, Save the Children International (SCI) leveraged on existing cash transfer program in Baidoa, Somalia. The intervention involved peer-to-peer support where a group of 8 to 10 cash transfer beneficiaries met on a weekly basis to share life challenges/issues affecting their community. The weekly sessions were facilitated by one of the beneficiaries under the supervision of SCI staff. These facilitators were trained on the psychosocial approach and basic group facilitation. In total, each group ten sessions were held including one socialization session, eight actual “treatment” sessions, and one closure session. The study composed of a sample of 497 female cash transfer beneficiaries including 208 receiving structured peer-to-peer support groups (Cash+) and the remainder receiving only cash transfers. The main outcome considered in this study was psychological measures including depression, mental health, and psychosocial well-being. Cash+ has mixed effects on caregivers and children. On the positive side, results indicate a slight decline in depression levels among poorer households attributable to Cash+. It also increased the likelihood of male children attending school, but showed no effect among female children school attendance. The results show a battery of adverse effects including a marginal increase in depression levels among better-off households and a notable decline in psychosocial well-being among poorer households. We also find Cash+ beneficiaries were more likely use negative disciplinary measures and less likely to use positive disciplinary measures. Children of Cash+ beneficiaries participated more in work within and outside their homes, either paid or unpaid. Outside of the mixed findings from group sessions, results depict a clearer picture on cash transfer component based on the pre-post comparison. For instance, after cash transfers, we see reduced depression levels, improved psychosocial well-being, household food security, reduced approval and use of harsh disciplinary measures, increased investment in children healthcare and education, and reduced prevalence of child labour.
While the group sessions were modeled along World Health Organization’s Interpersonal Psychotherapy Group (IPT-G), group sessions significantly deviated in terms of contents discussed during the group sessions. Group sessions in this study focused on generic problems affecting the community rather than interpersonal triggers of depression, a key element in IPT-G. Most commonly discussed problems throughout the sessions included ways of managing stress, how to discipline children, water shortage and hygiene, among others. This potentially explains the noisy effects observed in this study. Therefore, future group sessions aimed at alleviating depression should adhere to interpersonal triggers of depression rather than generic issues affecting the community. Addressing so many issues at ago might have also thinned out time available as such future interventions should target fewer behaviors at a time.