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

<b>Background.</b> 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. <b>Methods.</b> 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. <b>Results.</b> 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. <b>Conclusions.</b> 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.