Effectiveness of a psychosocial training intervention in reducing psychological distress among caregivers of intellectually disabled children in Malawi - a randomized wait-list trial

BackgroundRates of disability are high in resource-poor settings with eighty-five percent of disabled children living in these settings. Long-term caregiving for disabled children is associated with fatigue, financial difficulties, parenting distress, and other psychological issues. Studies have shown a link between parenting children with intellectual disabilities and psychological distress as well as overall Health-Related Quality of Life (QoL). However, with interventions, these negative impacts may not be as severe as thought before. This study aimed at developing and testing the impact of a contextualized psychological intervention, Titukulane, in reducing psychological distress among caregivers with intellectually disabled children in Malawi. MethodsWe conducted a randomized waitlist trial of a psychosocial training intervention (Titukulane) provided to caregivers of children with intellectual disabilities. Caregivers of children with intellectual disabilities aged 0 to 18 years were recruited, screened, and then enrolled in the trial through two disability organizations operating in Mzuzu (St John of God) and Lilongwe (Children of Blessings). They were then randomized in blocks to the Titukulane intervention or waitlist and provided with the intervention or standard care for 3 months respectively. Assessment of socioeconomic status, age, gender, and maternal psychological distress (through the Self Reported Questionnaire (SRQ) were conducted at baseline and follow-up. ResultsWe found that psychological distress on SRQ was significantly lower in caregivers of children with intellectual disability in the Titukulane intervention in comparison to the waitlist control group even when the confounding variables of age, gender, and social-economical status were taken into account (Cohen d = 0.08; CI = 0.33-0.754; p =0.0005). ConclusionsPyschosocial interventions such as the Titukulane intervention provided over a few months can improve caregiver mental health and quality of life - an important factor for supporting families of children with intellectual disability.