Early, Late and Sequential Psychosocial Mediators of Reduction in Depression Symptoms Six Months Following Group Support Psychotherapy among People Living with HIV in Uganda: A Longitudinal Mediation Analysis

This study looked at how Group Support Psychotherapy (GSP) helps people living with HIV recover from depression, not just whether it works, but what changes during therapy that make recovery last. We analysed data from a clinical trial in Uganda where people with mild to moderate depression received either GSP or group HIV education. We found that recovery appears to happen in stages. Early in therapy, people began to open up emotionally, accept their experiences, and draw on spiritual or personal beliefs to cope. These early emotional shifts were linked to improvements in mood both during treatment and several months later. As therapy progressed, other positive changes became important. Participants increasingly used practical coping strategies, reduced self-blame and denial, and strengthened their social connections. These later improvements helped maintain recovery over time. We also found that when participants started actively seeking emotional support during therapy, this often led to continued help-seeking afterwards, which further supported longer-term improvement. Overall, the findings suggest that GSP works by first helping people process emotions safely, and then building stronger coping skills and social support systems that protect against relapse. Understanding these stages can help refine and strengthen future mental health interventions.

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