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.

Hamdani, Syed Usman, Huma, Zill-E-, Masood, Aqsa, Zhou, Kaina, Ahmed, Zainab, Nazir, Huma, Amin, Hania, Akhtar, Parveen, Bryant, Richard A, Dawson, Katie, van Ommeren, Mark, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Rahman, Atif and Minhas, Fareed Aslam (2021) '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.'. International journal of mental health systems, Vol 15, p. 11.

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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.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WM Psychiatry > WM 140 Mental disorders (General)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s13033-020-00434-y
Depositing User:	Julie Franco
Date Deposited:	27 Jan 2021 12:27
Last Modified:	27 Jan 2021 12:27
URI:	https://archive.lstmed.ac.uk/id/eprint/16772

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