Table 4 Barriers and opportunities for IPT contextual adaptation and implementation

Barriers to depression intervention development

Intervention specific-mhGAP intervention guide needs structured MH system strengthening strategies beforehand, Group IPT is acceptable but needs modifications in format and dose, cost of adaptation and training are considerable, training requires a sustainable supervisory structure

Adolescent specific- Pregnant adolescents have poor mental health service access, little family or community support, poor access to educational or vocational, parenting training, often without male partner support

Opportunities for using IPT for depression intervention

Intervention specific- National level ratification & proposed scale up of WHO mhGAP-IG. High acceptability of G-IPT, demonstrates feasibility delivered in health facilities by lay health workers, improves depression and social support in peripartum adolescents

System specific- Politically receptive to SRH, adolescent centered services and integrating MH, peer models championed

Adolescent specific- focusing on their everyday relationship challenges and psychosocial problems, developing strategies to address role transitions and disputes in key familial and romantic relationships and sharing coping strategies to address social isolation, loneliness and grief