Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial

Abstract

Background In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan. Methods A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N = 192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM + plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS 2.0) at 20 weeks after baseline. Results The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20 weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, − 3.10; 95% CI, − 0.26 to − 5.76); p = 0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, − 4.35; 95% CI, − 1.45 to − 7.24); p = 0.004 in PM + plus TAU versus TAU arm. The follow-up rate was 67% at primary end-point. Conclusions Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered March 23, 2016. Retrospectively registered, https://www.anzctr.org.au/Default.aspx/ ACTRN12616000381482

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

“…Table 1 presents the characteristics of the 23 studies, comprising 5,298 participants (range of sample sizes: 8 to 680), included in our review [10][11][12][13][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] . These were performed in Pakistan (four studies); Lebanon, Kenya (three studies each); Jordan, The Netherlands, Nepal (two studies each); Australia, Austria, China, Colombia, Switzerland, Turkey and the UK (one study each).…”

Informe mundial sobre la salud mental: Transformar la salud mental para todos

“…En Islamabad, la intervención se realizó dentro del entorno de atención especializada, pero por asesores no especializados, que habían completado una licenciatura en psicología sin ninguna formación clínica. Se observó que incorporar la intervención psicológica mejoró sustancialmente los resultados para las personas con depresión y ansiedad (461). Si los centros de atención más especializados incluyeran ese asesoramiento no especializado basado en la evidencia en su atención habitual, estarían en buenas condiciones para orientar y apoyar la aplicación de dicho asesoramiento en la atención primaria y los entornos comunitarios.…”

Advancing Posttraumatic Stress Disorder Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Nonrandomized Controlled Trial

“…PM+ was designed to promote brief psychological interventions for adults with sessions once per week during a 5-week period, promoting behavioral, stress management, and everyday problem-solving tools [ 15 ]. Emerging data from feasibility trials and randomized controlled trials in Pakistan [ 16 - 18 ], Nepal [ 19 , 20 ], and Kenya [ 21 , 22 ] indicate that PM+ is promising for the effective management of psychological distress, including trauma symptoms, and problems in daily life via app in emergency settings. Alongside additional studies on PM+ taking place in Europe to attend to the needs of refugees and asylum seekers [ 23 - 27 ], the European Union STRENGTHS program is also a promising initiative examining the efficacy of PM+ in attending to the psychological needs of Syrian refugees across Europe and Middle Eastern countries [ 28 ].…”