Highlighting Complementary Benefits of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) Interventions Delivered Alongside Broader Community MHPSS Programming in Zummar, Ninewa Governorate of Iraq

Abstract

Internally displaced persons (IDPs), refugees, returnees and host communities in conflict settings experience high rates of mental health problems associated with prolonged and repeated exposure to multiple exposure to distress, as is the case in Iraq. We sought to highlight the outcomes and complementarity of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) in addressing the mental health and psychosocial support needs of IDPs, returnees and host community teens and adults in Zummar, Iraq. A total of 290 adults were included in the PM+ intervention, while DWM included 648 adults and 282 teens. DWM was delivered to adults with accessibility barriers to receiving PM+ and to all teens in the study due to security reasons and COVID-19 restrictions. The Patient Health Questionnaire (PHQ-9) and World Health Organization Disability Assessment Schedule (WHODAS 2.0) were used to measure psychological distress and functioning in adults, respectively. The Revised Children Anxiety and Depression Scale (RCADS) was also used to measure symptoms of depression and anxiety in teens pre and postintervention. Personally identified problems were measured using the Psychological Outcome Profiles (PSYCHLOPS) for adults and teens. Psychological and emotional challenges were the main problem faced by both teens and adults at baseline. For PM+ and DWM interventions in adults, the mean difference in PSYCHLOPS, WHODAS and PHQ-9 scores between preintervention and postintervention assessment were significant (P < 0.001). For DWM teens, the paired mean difference for pre and postintervention RCADS and PSYCHLOPS teens was 55.9 (SD = 8.0) and 4.8 (SD = 2.40), respectively (P < 0.001, Cohen’s d > 2). There was a significant reduction in the number of days off work and increased ability to carry out usual activities after both interventions. The study findings highlight the applicability of PM+ and DWM in conflict settings of Iraq when there are barriers to applying one.