ASHA: Using Participatory Methods to Develop an Asset-building Mental Health Intervention for Bangladeshi Immigrant Women.

BACKGROUND: Common mental disorder (CMD) is highly prevalent among low-income immigrant women, yet few receive effective treatment. This underutilization is partly owing to a lack of conceptual synchrony between biopsychiatric theories underlying conventional mental treatments and explanatory models in community settings. The Action to Improve Self-esteem and Health through Asset building (ASHA) program is a depression intervention designed by and for South Asian women immigrants. ASHA helps women to build psychological, social, and financial assets.

OBJECTIVES: This paper describes the development and a preliminary pilot evaluation of the ASHA intervention.

METHODS: Researchers, clinicians, activists, and women from the Bronx Bangladeshi community collaboratively designed a depression intervention that would synchronize with local concepts of distress. In addition to providing mental health treatment, ASHA addresses social isolation and financial dependence. ASHA was evaluated in a pilot study described in this paper. Participants were assigned to intervention or delayed intervention (control) groups. Data collection at baseline and time 2 (6 months) included the Patient Health Questionnaire-9 (PHQ-9) and an indigenous measure of psychological and somatic distress.

RESULTS: Eighty percent of intervention participants completed the 6-month program. After treatment, mean PHQ-9 scores in the intervention group decreased from 9.90 to 4.26 (p < .001). Participants saved an average of $10 per week. To date, participants have applied their skills and savings toward such activities as starting small businesses and enrolling in community college.

CONCLUSIONS: ASHA was effective in improving depression and increasing financial independence. Using a culturally synchronous approach to psychological treatment may be effective in ameliorating distress in immigrant populations.