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.