A Mixed Methods Study of Acceptability and Efficacy: Culturally Adapted Cognitive Behavioural Therapy for Perinatal Depression in Addis Ababa

Perinatal depression is a significant public health concern in Ethiopia, where access to evidence-based psychological interventions is limited. Cognitive behavioural therapy (CBT) requires cultural adaptation to ensure its relevance and acceptability in this setting. This study aimed to develop a culturally adapted CBT manual for perinatal depression in Addis Ababa and to conduct a preliminary assessment of its acceptability and efficacy. A sequential mixed methods design was employed. Qualitative data from focus group discussions with perinatal women, community health workers, and mental health professionals informed the adaptation of a CBT manual. Subsequently, a pilot intervention study was conducted with a single group of perinatal women diagnosed with mild-to-moderate depression. Pre- and post-intervention assessments of depressive symptoms and a post-intervention acceptability questionnaire were used. Qualitative findings emphasised the importance of family, spiritual beliefs, and somatic expressions of distress, which were integrated into the therapy. In the pilot (n=42), depressive symptoms reduced significantly post-intervention, with 71% of participants moving below the clinical threshold for depression. Acceptability was high, with 88% reporting the adapted concepts were easy to understand and apply. Culturally adapted CBT shows promise as an acceptable and potentially efficacious intervention for perinatal depression in this setting. The adaptation process was crucial for achieving contextual relevance. The adapted manual should be tested in a larger, randomised controlled trial. Integration of the intervention into routine antenatal and postnatal care through task-sharing with trained community health workers is recommended. Perinatal depression, cognitive behavioural therapy, cultural adaptation, mixed methods, Ethiopia, acceptability This study provides a culturally adapted CBT manual for the Ethiopian context and preliminary evidence supporting its use, contributing to the scarce literature on psychological interventions for perinatal depression in the region.