Development of a psychological intervention for people with bipolar disorder in rural Ethiopia

Mekdes Demissie*, Charlotte Hanlon, Lauren Ng, Rosie Mayston, Sisay Abayneh, Abebaw Fekadu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
31 Downloads (Pure)


Background Evidence from high- A nd middle-income countries indicates that psychological interventions (PSIs) can improve the well-being of people with bipolar disorder. However, there is no evidence from low-income countries. Cultural and contextual adaptation is recommended to ensure that PSIs are feasible and acceptable when transferred to new settings, and to maximise effectiveness. Aims To develop a manualised PSI for people with bipolar disorder in rural Ethiopia. Method We used the Medical Research Council framework for the development and evaluation of complex interventions and integrated a participatory theory-of-change (ToC) approach. We conducted a mental health expert workshop (n = 12), four independent ToC workshops and a final workshop with all participants. The four independent ToC workshops comprised people with bipolar disorder and caregivers (n = 19), male community leaders (n = 8), female community leaders (n = 11) and primary care workers (n = 21). Results During the workshops, participants collaborated on the development of a ToC roadmap to achieve the shared goal of improved quality of life and reduced family burden for people with bipolar disorder. The developed PSI had five sessions: Needs assessment and goal-setting; psychoeducation about bipolar disorder and its causes; treatment; promotion of well-being, including sleep hygiene and problem-solving techniques; and behavioural techniques to reduce anxiety and prevent relapse. Participants suggested that the intervention sessions be linked with patients' monthly scheduled healthcare follow-ups, to reduce economic barriers to access. Conclusions We developed a contextually appropriate PSI for people with bipolar disorder in rural Ethiopia. This intervention will now be piloted for feasibility and acceptability before its wider implementation.

Original languageEnglish
Article numbere168
JournalBJPsych Open
Issue number5
Publication statusPublished - 14 Sept 2021


  • behavioural intervention
  • individual therapy
  • Psychoeducation
  • relapse prevention
  • theory of change approach


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