Management Of Common Mental Disorders Research Articles

Innovative strategies for the management of common mental disorders

Abstract Innovations such as computerized/internet-based interventions are taking centre stage in the management of common mental disorders. For example, computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. Results from our own research suggest that CCBT may have significantly greater effects on depressive symptoms than treatment as usual (TAU) in primary care patients with depression. Our study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT; hence, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings.

Association of Common Mental Disorders with Diabetes Mellitus - Evidence from Community-based Matched Case-Control Study in North India.

Diabetes mellitus (DM) and depression are major public health problems globally. Evidence of linkage of common mental disorders (CMDs) including depression and anxiety disorders with DM is sparsely reported from community-based settings. The present study aimed to study the association between CMDs and DM among adult population (>30 years) residing in a rural area of North India. A community-based case-control study was conducted in 28 villages of Ballabgarh block of Faridabad district of Haryana. Cases (diabetes) were recruited from the community with at least 1 year of diabetes. Age- and sex-matched two neighborhood controls were selected from the same community. Diabetic status was confirmed using glycated hemoglobin. CMDs such as depression and anxiety disorders were screened using PRIME-MD Hindi version. Conditional logistic regression was used to study the relationship between diabetes and CMDs. Total 211 cases (diabetic) and 273 controls (nondiabetic) were approached for the study, of which 173 cases and 175 controls were analyzed. Cases and controls were comparable with respect to age, sex, and socioeconomic status. CMDs were found more among cases as compared to controls (67.5% vs. 37.5%) (P < 0.001). On conditional logistic regression analysis, CMDs were significantly higher among diabetes cases (adjusted odds ratio - 3.2, 95% confidence interval: 1.9-5.2). Strong evidence of coexistence of CMDs and DM from this population-based study necessitates the need of incorporation of management of CMDs into diabetes control program in India.

Protocol for process evaluation of SMART Mental Health cluster randomised control trial: an intervention for management of common mental disorders in India

IntroductionIn India about 95% of individuals who need treatment for common mental disorders like depression, stress and anxiety and substance use are unable to access care. Stigma associated with help...

Prévention du suicide : comment agir ?

Although being complex, suicide is a phenomenon considered as preventable, and its prevention has been made as a public health priority. Some interventions to prevent suicide have been evaluated, such as the education of the healthcare workers, especially in the suicidal assessment (suicidal risk and suicidal emergency/dangerousness), the diagnosis and management of common mental disorders, the care provided after a suicide attempt, the restriction access to common means of suicide, the use of websites to educate the public, or the appropriate reports of suicide in media. Other interventions, even not rigorously evaluated, are implemented in France as in many parts of the world. It is the case of interventions among identified high-risk groups. To be efficient, prevention programs should simultaneously include different strategies targeting several known risk factors for suicide. Clinicians play a crucial role in the suicide prevention strategies.

Management of common mental disorders should take place in primary health or specialized care? Clinical decisions of psychiatrists from Latin American countries.

ObjectiveThe objective of our study was to explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC) in four Latin Americans countries, through the application of clinical vignettes.MethodsUsing a cross-sectional design, we conducted a self-administered online questionnaire survey of psychiatrists from Bolivia, Brazil, Cuba, and Chile. The questionnaire covered sociodemographic and professional information. The psychiatrists’ clinical decisions were assessed through three clinical vignettes representing typical PC cases of depression, anxiety, and somatization.Results230 psychiatrists completed the online survey. Psychiatrists from Brazil were less likely to recognize depression as a mental disorder than those from Cuba (odds ratio (OR) = 0.30, 95% confidence interval (CI), 0.10 to 0.91, p < 0.04). Female gender (OR = 0.19, 95% CI, 0.04 to 0.91, p < 0.02) and older age (OR = 0.92, 95% CI, 0.87 to 0.97, p < 0.01) reduced the likelihood of agreement that depression cases should be treated by a Primary Care Physician (PCP). In the somatoform symptoms vignette, longer training duration increased the likelihood of agreement that treatment should be done by a psychiatrist instead of a PCP (OR = 1.19, 95% CI, 1.04 to 1.37, p < 0.01). In the anxiety vignette, females (OR = 2.38, 95% CI, 1.10 to 5.13, p < 0.01) and participants from Bolivia (compared with Cubans, OR = 4.19, 95% CI, 1.22 to 14.42, p < 0.02) were more likely to consider that these patients should be treated by a psychiatrist instead of a PCP.DiscussionMost psychiatrist respondents agreed that patients with depression should be treated by PCPs and that somatoform and anxiety cases should be treated by psychiatrists. These results show that psychiatrists consider that they, and not PCPs, should treat patients with common mental disorders, regardless of the evidence showing that common mental disorders can be treated by primary care physicians in PC.

Mindfulness Based Interventions Framework in District Mental Health Programme in India

The management of Common Mental Disorders (CMDs) in the Indian context is a complex issue and India has constrained mental health services infrastructure in District Mental Health Programme (DMHP) setting. Mental health interventions should be specific and feasible and relevant in the Indian population. DMHP is an important tier and bridged the gap between the tertiary care centres and the primary health care centres. Mindfulness-based interventions are effective in the management of common mental disorders in the community setting. Mindfulness based Cognitive therapy would reduce depressive relapse in patients. Mindfulness skills improves effective self-regulation of anxiety related cognition, emotion, sensation and behaviour. In DMHP training framework of mindfulness skills based sub-modules, mindfulness-based stress reduction, mindfulness-based cognitive therapy, acceptance and commitment therapy (ACT) modules could be incorporated. This framework targets relationship to thoughts and feelings (both physical and emotional) via decentring. This framework which is a practical, feasible strategy in the management of CMDs in DMHP setting of various states in India. Developing a need-based mindfulness-based interventions framework would be instru-mental in guiding the planning and prioritization of mental health care in India in 21st century

Common mental disorders among women and its social correlates in an urban marginalized populace in South India.

Common mental disorders (CMD) cause a range of health, social and economic burden, and disorders like depression and anxiety are more prevalent among women. Prevalence and factors contributing to increased vulnerability for CMDs have regional variation. Identification of factors contributing to the vulnerability is essential to both psychiatric epidemiology and in addressing mental health challenges in the community. This cross-sectional study aimed at understanding the burden of CMD and its association with social determinants of mental health. Women hailing from urban slum attending the outpatient family care facility for their medical problems constituted the sample. Data was collected using a clinical research form with variables such as sociodemographic profile, health profile, and psychosocial profile. The questionnaire had specific questions on indicators of poverty, certain stressors, and support system. Presence of CMD was assessed using Clinical Interview Schedule-Revised (CIS-R), a standard tool for CMD research in primary care settings. A cut off score of 12 and above was considered for detecting CMD. Research ethical principles were adhered to and data was analyzed using SPSS 21.0. Among 172 women, 77 (44.8%) were diagnosed to have CMDs. Univariate analysis revealed a significant association between age, marital status, living arrangement, educational level, difficulty with buying food, presence of debt, chronic medical illness, husband's alcohol use, marital satisfaction, experiencing abuse, family support, religious participation, and a diagnosis of CMD. Multivariate analysis showed high burden with nuclear family arrangement, difficulty to buy food, experiencing abuse and, low burden with higher educational level, family support, and religious participation. Considering the high prevalence and the treatment gap of CMDs in primary setting, family-physician should be sensitized for detection and management of CMDs. Social interventions targeting poverty, women's education and empowerment, and support system are likely to decrease the burden of CMDs in this population.

Inequalities in the identification and management of common mental disorders in the perinatal period: An equity focused re-analysis of a systematic review.

Maternal mental health problems in the perinatal period can cause significant distress and loss of functioning, and can have lasting impact on children. People living in disadvantage are at risk of health inequalities, including for perinatal mental health. A review of current guidance found that overall implementation of the UK detection and management strategy was satisfactory, but equity was not considered in the review. Greater understanding of implementation equity is needed. We aimed to reanalyse an existing systematic review on the implementation of current guidance for the identification and management of perinatal mental health problems for equity. Studies reporting the presence or absence of variation by a social, economic or demographic group were quality appraised and the presence and direction of disparity tabled. We calculated standardised absolute prevalence estimates for overall detection and management, and absolute and relative estimates by determinants grouping. A thematic analysis of the studies that examined potential reasons for disparity was undertaken. Six studies, with no major quality concerns, provided consistent evidence of reduced identification and management for ethnic minority women, both those who do, and do not, speak English. There was less consistent evidence of inequality for other axes of social disparity and for characteristics such as age, parity and partnership status. Explanations centred on difficulties that translation and interpretation added to communication, and hesitancy related to uncertainty from healthcare providers over cultural understanding of mental health problems. The identification and management of perinatal mental health problems is likely to be inequitable for ethnic minority women. Further systems-based research should focus on clarifying whether other groups of women are at risk for inequalities, understand how mismatches in perception are generated, and design effective strategies for remediation. Inequalities should be considered when reviewing evidence that underpins service planning and policy decision-making.

An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme

BackgroundAround 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75–95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed.MethodsWe hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived—a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation.Expected outcomesThe primary study outcome is the difference in mean behaviour scores at 12 months in the combined ‘high-risk’ and ‘non-high-risk’ cohort and the mean difference in PHQ-9 scores at 12 months in the ‘high-risk’ cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations.SignificanceThe findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings.Trial registrationClinical Trial Registry India CTRI/2018/08/015355. Registered on 16 August 2018.

Common mental disorders among patients attending monk healers and primary health care centres in Thailand: a cross-sectional study

BackgroundThis study aimed to assess the rate of common mental disorders in patients consulting monk healers or health centres in Thailand.MethodsPatients consecutively consulting monk healers or health centres were assessed with screening measures of three common mental disorders (major depressive, general anxiety and somatization disorder).ResultsThe prevalence of any common mental disorder was significantly higher in patients attending monk healers (31.1%) than those attending primary care health centres (22.3%) (P < 0.001). Likewise, the prevalence of each common mental disorder was significantly higher in clients attending monk healers (major depressive disorder 21.0%, generalized anxiety disorder 8.1%, and somatization disorder 19.0%) than in patients attending health centres (major depressive disorder 15.8%, generalized anxiety disorder 3.5%, and somatization disorder 12.5%). In adjusted logistic regression analysis among patients of monk healers, female sex, being single, divorced, separated or widowed, and low social support were associated with any common mental disorder. Among patients of a health centre, lower education, not employed, high debt status and low social support were associated with any common mental disorder.ConclusionThe study found a higher prevalence of common mental disorders in patients consulting monk healers than primary care centre attendees, calling for integrated management of common mental disorders.

Common Mental Health Disorders among Informal Waste Pickers in Johannesburg, South Africa 2018—A Cross-Sectional Study

Background: Waste-picking is an income generating opportunity for many living in poverty and a great contributor to environmental stability. Waste pickers have most of the risk factors associated with common mental disorders (CMD), such as poverty, work related stress and poor living conditions. The aim of this study was to determine the prevalence and associated risk factors of CMD among waste pickers. Method: A cross-sectional study analysed secondary data of 365 waste pickers. A validated Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. Multivariable logistic regression was fitted to identify factors associated with CMD. Results: The overall prevalence of CMD among waste pickers was 37.3%. The odds of having CMD were 2.5 and 3.2 higher in female waste pickers and cigarette smokers, respectively (p = 0.019 and p = 0.003). Life enjoyment (Adjusted odds ratio [aOR] 0.54, p = 0.02) and a good quality of life (aOR 0.34, p≤0.001) were associated with lower odds of CMD.Conclusion: The high prevalence of CMD among waste pickers was significantly associated with cigarette smoking, being female, not enjoying life, and a poor quality of life. Mental health awareness of CMD will assist with the prevention, early detection, and comprehensive management of CMD among waste pickers.

Quality of life among patients with common mental disorders attending monk healers and primary care clinics in Thailand

PurposeCommon mental disorders are not only highly prevalent in primary health-care settings but also negatively affect patients’ quality of life (QoL). This study aims to assess the levels of QoL among patients with common mental disorders seeking care from a monk healer or primary care setting and to determine the comparative QoL of users in two different types of care settings in Thailand.Design/methodology/approachConsecutively attending clients or patients (N = 1251) of three faith healing or three health centres were assessed with measures of depression, anxiety and somatization disorder and QoL.FindingsThe overall QoL was 67.8 and among the four QoL domains, social QoL was the highest (72.3), followed by physical QoL (69.4), environmental QoL (64.8) and psychological QoL (64.6). In adjusted linear regression analyses, sociodemographic factors, such as higher educational level, being employed, having high debt and consulting a health centre, were associated with higher overall QoL. Compared to being a client with a monk healer, patients at a health centre had a higher overall QoL, environmental and psychological QoL. Having a general anxiety or major depressive disorder was negatively associated with overall QoL and all four QoL sub-domains, whereas somatization disorder was not associated with any QoL sub-domains.Originality/valueTo the best of the authors’ knowledge, this is the first study to investigate QoL in common mental disorder attenders with a monk healer in comparison with primary care patients. Primary care patients with a common mental disorder had significantly higher overall QoL (p<0.01), higher psychological QoL (p<0.001) and higher environmental QoL (p<0.001) than clients with a common mental disorder attending monk healers. This study extends previous research showing a negative association between anxiety and depressive disorders and QoL calling for integration of QoL in the management of common mental disorders in both complementary and public primary care in Thailand.

Establishing Context to Build Capacity: A Qualitative Study to Determine the Feasibility, Utility, and Acceptability of a Complex Trauma Training for Psychologists Working in Urban Migrant Communities in Northern Peru.

Across Latin America, increasing access to mental health care has become a priority. Management of common mental disorders is shifting to primary care, and community mental health centers (CMHCs) are being established to treat severe needs. In urban migrant communities on the outskirts of Trujillo, Peru, five new CMHCs have been built to treat complex mental health concerns, partially in response to high rates of domestic violence and child maltreatment. However, psychologists have no training in the treatment of interpersonal trauma. This study sought to determine the utility of such a training and identify areas for cultural adaptation. Six focus groups were conducted with CMHC psychologists. Findings revealed that, while a culturally-adapted training in trauma-focused treatment is desired, sociocultural barriers to ensuring the physical and psychological safety of the service user must be considered, as well as provider barriers including short treatment packages, insufficient physical infrastructure, and unstable work conditions.

Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study

BackgroundIn recent years, there have been increasing calls for integrating late-life mental health services into primary care in China, but data on the epidemiology of depressive disorders in older adults receiving primary care are very limited. This study examined prevalence, correlates and recognition of depressive disorders among Chinese older adults receiving primary care. MethodsA total of 752 older patients (65+ years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. ResultsOne–fifth (20.3%) of the older adults met DSM-IV criteria for depressive disorders during the month prior to the interview: 10.2% had major depression, 4.8% had dysthymia, and 5.3% had minor depressive disorder. The recognition rate of older patients with depressive disorders was 1.3% only. In multiple logistic regression analysis, factors significantly associated with depressive disorders included female gender (OR = 1.61), an education of primary school and below (OR = 1.69), poor financial status (OR = 2.44), poor or fair family relationship (OR = 1.66), loneliness (OR = 1.77), hypertension (OR = 1.91), heart disease (OR = 2.02), chronic gastric ulcer (OR = 6.01), and arthritis (OR = 3.55). LimitationsOlder adults from primary care clinics of economically underdeveloped regions of China were not included. ConclusionsDepressive disorders are prevalent but poorly recognized in Chinese older adults receiving treatment in primary care clinics. In order to improve the emotional well-being and health of older adults, it is time to integrate the management of common mental disorders into primary healthcare in China.

Common Mental Health Disorders among Informal Waste Pickers in Johannesburg, South Africa 2018-A Cross-Sectional Study.

Waste-picking is an income-generating opportunity for individuals living in poverty. Waste picking is associated with a range of risk factors for common mental disorders (CMD). This study aimed to determine the prevalence and factors associated with CMD among waste pickers in Johannesburg. A cross-sectional study analyzed secondary data for 365 waste pickers. A validated Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. Multivariable logistic regression was fitted to identify factors associated with CMD. The overall prevalence of CMD among waste pickers was 37.3%. The odds of having CMD were 2.5 and 3.2 higher in females and cigarette smokers, respectively (p = 0.019 and p = 0.003). Life enjoyment (Adjusted odds ratio [aOR] 0.54, p = 0.02) and a good quality of life (aOR 0.34, p ≤ 0.001) were associated with lower odds of CMD. The high prevalence of CMD among waste pickers was significantly associated with cigarette smoking, being female, not enjoying life, and a poor quality of life. Mental health awareness of CMD will assist with the prevention, early detection, and comprehensive management of CMD among waste pickers.

Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study

BackgroundDepression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas.MethodsThe Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person’s primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village’s Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects’ electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention.DiscussionThe COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life.Trial registrationClinicalTrials.gov ID: NCT01938963; First posted: September 10, 2013.

Change in prescriptions for antidepressant drugs after flooding in England, 2011–14: a controlled, interrupted time-series study

BackgroundFloods are the most common type of natural disaster globally. Climate change and the pressures of development to accommodate increasing population sizes could increase the number of people at risk of flooding. Although the immediate risk of death and injury from flooding is small in high-income countries, reports suggest that flooding has prolonged adverse effects on mental wellbeing. However, evidence is scarce because most previous studies have used surveys or self-reports, without robust pre-flood records. This methodological limitation applies to other natural and man-made disasters. MethodsWe investigated the mental health effects of floods in England using routine prescriptions data from pre-flood and post-flood periods in flooded and non-flooded populations. We examined prescription records for drugs used in the management of common mental disorders from 930 primary care practices located within 10 km of large flood events in England in 2011–14. We conducted a controlled, interrupted time-series analysis of the number of prescribing items for antidepressant drugs in the years before and after the flood. Pre–post changes were compared by distance of the practice from the flooded boundaries. Analyses were controlled for neighbourhood deprivation and population density or the number of prescriptions for non-antidepressant drugs. FindingsAfter controlling for neighbourhood deprivation and population density, prescriptions for antidepressant drugs among practices located within 1 km of a flood increased by 0·59% (95% CI 0·24–0·94) in the year after the flood compared with practices furthest (5–10 km) from the flood. The results did not change after controlling for non-antidepressant drugs. The increase in prescriptions was greater in more socioeconomically deprived than in less socioeconomically deprived areas. InterpretationWe found that the number of prescribing items for antidepressant drugs increased in the year after a flood in primary care practices close to major floods in England in 2011–14. This small percentage increase would, if caused by flooding, reflect a much larger increase in flooded households, which made up only a small proportion of the total number of households registered with these practices. Moreover, despite the increase being small in relative terms, it, together with the well-known high prevalence of mental disorders in the UK, suggests a substantial mental health burden after flooding, which has implications for public health practices. More detailed linkage studies are required to disentangle the effect of flood exposure on individual patients from the observed increase in prescriptions for antidepressant drugs at primary care practices. We are currently extending this study to include prescribing data for individual patients in primary care practices. FundingEconomic and Social Research Council (ES/L007517/1) and the National Institute for Health Research, Health Protection Research Unit in Environmental Change and Health.

Management of common mental disorders for psychogeriatric patients in Hong Kong: comparison of two clinics after 1 year of treatment

Management of common mental disorders for psychogeriatric patients in Hong Kong: comparison of two clinics after 1 year of treatment

Management of common mental disorders for psychogeriatric patients in Hong Kong - a comparison of two clinics.

The enhanced Common Mental Disorder Clinic (CMDC) was developed by the Hospital Authority of Hong Kong in 2015 to shorten new-case waiting time at the psychiatric specialist out-patient clinic (SOPC) for adult patients with common mental disorders (CMDs).[1][1] Patients with CMDs usually have to

Problem Management Plus (PM+) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial

BackgroundThe World Health Organization (WHO) has developed Problem Management Plus (PM+), a 5-session, psychological intervention program delivered by trained non-specialist that addresses common mental disorders. The objectives of this study are to evaluate effectiveness and cost-effectiveness of PM+ in a specialized mental health care facility in Pakistan.MethodsA single blind individual randomized controlled trial (RCT) will be carried out in the outpatient department of a specialized mental healthcare facility in Rawalpindi, Pakistan. After informed consent, patients with high psychological distress (General Health Questionnaire-12 (score >2) and functional impairment (WHO Disability Assessment Schedule 2.0 score >16) will be randomised to PM+ plus treatment as usual (n = 96) or TAU only (n = 96). The primary outcome is the psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale and improvement in functioning as measured by WHODAS at 20 weeks after baseline. Secondary outcomes include improvement in symptoms of depression, post-traumatic stress disorder, levels of social support and cost effectiveness evaluation. Qualitative interviews will be conducted to evaluate the process of implementing PM+ including barriers and facilitators in implementation and possibility of integration of PM+ program in specialized mental health care facilities in Pakistan.DiscussionThe results of this study will be helpful in evaluating the effectiveness of the approach of training non specialists, based in the specialized mental health care facilities in delivering evidence based psychological interventions in the low resource settings.Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered Retrospectively on March 23, 2016