Exploring the Mediating Effects of Depression on the Effectiveness of a Brief Negotiational Intervention in Reducing Harmful Alcohol Use in Moshi, Tanzania: A Mixed Method Study

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2026-06-06

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2024

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Alcohol Use Disorder (AUD) and Major Depressive Disorder (MDD) account for millions of deaths and disabilities each year with many theories on the interaction between the two disorders. Tanzania has a high rate of harmful alcohol use, depression, and alcohol-related injuries. To address the growing burden, a nurse-led Brief Negotiational Intervention (BNI) was implemented in the Kilimanjaro Christian Medical Centre Emergency Department in 2020. Three-month outcomes from this study have shown that AUDIT scores are not significantly reduced by the intervention. Thus, this study aims to explore the relationship and potential mediating effects of depression within the context of the BNI at KCMC ED. For quantitative aims, we used secondary data from the PRACT 6-month outcomes. We compared demographic characteristics between AUDIT/PHQ-9 categories using median, IQR, Kruskal-Wallis, and Fisher’s Exact Test. We then specified two cross-sectional structural equation models at 3 and 6 months to explore depression as a mediator between BNI and AUDIT scores. For our qualitative aim, we conducted 15 semi-structured interviews and analyzed data using a thematic coding approach. Out of our 282 participants, demographic characteristics differed between AUDIT/PHQ-9 groups on gender and education. Additionally, depression does not mediate the relationship between BNI and AUDIT scores at 3 or 6 months. However, BNI is reducing AUDIT and PHQ-9 scores at 6 months. Our qualitative data highlights the association between AUD and MDD and explores the importance of social communities for both disorders. More research is needed to determine the temporality between AUD and MDD in this context. Yet, this study has provided evidence that an alcohol-based BNI has provided benefits for AUD and MDD. Thus, it’s imperative to capitalize on this unintended intervention effect and modify the intervention to include a mental health component.

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Buono , Mia Kaitlin (2024). Exploring the Mediating Effects of Depression on the Effectiveness of a Brief Negotiational Intervention in Reducing Harmful Alcohol Use in Moshi, Tanzania: A Mixed Method Study. Master's thesis, Duke University. Retrieved from https://hdl.handle.net/10161/31002.

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