Abstract
BackgroundIn humanitarian settings common mental disorders (depression, anxiety disorders, posttraumatic stress disorder) are highly prevalent. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a 5-session, individual psychological intervention program, delivered by paraprofessionals that addresses common mental disorders in people in communities affected by adversity. The objectives of this study are to test effectiveness and cost-effectiveness of the locally adapted PM+ compared to Treatment as usual (TAU) in Peshawar District, Pakistan.MethodsA randomised controlled trial will be conducted in 346 primary care attendees in 3 health care centres in Peshawar District, Pakistan. After informed consent, primary care attendees with high levels of psychological distress according to the General Health Questionnaire-12 (GHQ-12) and functional impairment (WHO Disability Assessment Schedule 2.0 (WHODAS)) will be assigned to PM+ (n = 173) or TAU (n = 173). At baseline, 1 week and 3 months following PM+, independent assessors will assess psychological distress with the Hospital Anxiety and Depression Scale (HADS), and functional disability with the WHODAS. Secondary outcomes are posttraumatic stress disorder (PTSD) symptoms, and client-perceived priority problems. Further, cost-effectiveness will be assessed using the Service Receipt Inventory (SRI).DiscussionIf proven effective, PM+ will be rolled out to other areas for further adaptation and testing in diverse humanitarian settings.Trial registrationACTRN12614001235695. Registered 26 November 2014. Australian New Zealand Clinical Trials Registry
Highlights
In humanitarian settings common mental disorders are highly prevalent
This paper provides an overview of the trial protocol for the initial study of PM+ in the Peshawar District
PM+ is a brief transdiagnostic psychological intervention delivered by paraprofessionals for people in low-income communities affected by adversity
Summary
In humanitarian settings common mental disorders (depression, anxiety disorders, posttraumatic stress disorder) are highly prevalent. Over the past 3 decades the north-western Pakistani province of Khyber Pakhtunkhwa, with Peshawar as its capital, has been affected by political instability, economic uncertainty, regional conflict, and continuous daily violence [1] In such settings, common mental disorders are highly prevalent [2]. There is little evidence for treating mental health conditions in humanitarian settings [2], and the trials that have been conducted have focused on treatments for posttraumatic stress disorder (PTSD) [2] Limitations of this approach are that PTSD treatments are usually relatively intensive and lengthy, and individuals affected by adversity and trauma typically have a range of other problems than PTSD, including depression and anxiety [2]
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