CoChat
Sign Up
Cited by 165Mental Health Treatment and AccessMaternal Mental Health During Pregnancy and PostpartumPosttraumatic Stress Disorder Research

Effectiveness of a brief group psychological intervention for women in a post-conflict setting in Pakistan: a single-blind, cluster, randomised controlled trial

Open access
Rahman, Atif, Khan, Muhammad Naseem, Hamdani, Syed Usman, Chiumento, Anna, Akhtar, Parveen, Nazir, Huma, Nisar, Anum, Masood, Aqsa +7 more·2019·The Lancet
DOI 10.1016/s0140-6736(18)32343-2
Open this paper in CoChat — free account

Abstract

Background Many women are affected by anxiety and depression after armed conflict in low-income and middle-income countries, yet few scalable options for their mental health care exist. We aimed to establish the effectiveness of a brief group psychological intervention for women in a conflict-affected setting in rural Swat, Pakistan.Methods In a single-blind, cluster, randomised, controlled trial, 34 community clusters in two union councils of rural Swat, Pakistan, were randomised using block permutation at a 1:1 ratio to intervention (group intervention with five sessions incorporating behavioural strategies facilitated by non-specialists) or control (enhanced usual care) groups. Researchers responsible for identifying participants, obtaining consent, enrolment, and outcome assessments were masked to allocation. A community cluster was defined as neighbourhood of about 150 households covered by a lady health worker. Women aged 18-60 years who provided written informed consent, resided in the participating cluster catchment areas, scored at least 3 on the General Health Questionnaire-12, and at least 17 on the WHO Disability Assessment Schedule were recruited. The primary outcome, combined anxiety and depression symptoms, was measured 3 months after the intervention with the Hospital Anxiety and Depression Scale (HADS). Modified intention-to-treat analyses were done using mixed models adjusted for covariates and clusters defined a priori. The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12616000037404, and is now closed to new participants.Findings From 34 eligible community clusters, 306 women in the intervention group and 306 women in the enhanced usual care (EUC) group were enrolled between Jan 11, 2016, and Aug 21, 2016, and the results of 288 (94%) of 306 women in the intervention group and 290 (95%) of 306 women in the EUC group were included in the primary endpoint analysis. At 3 months, women in the intervention group had significantly lower mean total scores on the HADS than women in the control group (10·01 [SD 7·54] vs 14·75 [8·11]; adjusted mean difference [AMD] -4·53, 95% CI -7·13 to -1·92; p=0·0007). Individual HADS anxiety scores were also significantly lower in the intervention group than in the control group (5·43 [SD 4·18] vs 8·02 [4·69]; AMD -2·52, 95% CI -4·04 to -1·01), as were depression scores (4·59 [3·87] vs 6·73 [3·91]; AMD -2·04, -3·19 to -0·88). No adverse events were reported in either group.Interpretation Our group psychological intervention resulted in clinically significant reductions in anxiety and depressive symptoms at 3 months, and might be a feasible and effective option for women with psychological distress in rural post-conflict settings.Funding WHO through a grant from the Office for Foreign Disaster Assistance.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(18)32343-2

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

The text we found for this paper looks like another document, so its claims and self-check weren’t run. The registry and citation checks still apply.

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The text we found for this paper looks like another document, so the self-check wasn’t run.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Rahman, A., Khan, M. N., Hamdani, S. U., Chiumento, A., Akhtar, P., Nazir, H., Nisar, A., Masood, A., Din, I. U., Khan, N. A., Bryant, R. A., Dawson, K. S., Sijbrandij, M., Wang, D., & van Ommeren, M.
Affiliations
  • Khyber Medical University (PK)
  • Human Development Research Foundation (PK)
  • University of Liverpool (GB)
  • Bacha Khan Medical College (PK)
  • UNSW Sydney (AU)
  • Vrije Universiteit Amsterdam (NL)
  • Liverpool School of Tropical Medicine (GB)
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2019-04
Volume
393
Issue
10182
Pages
1733-1744
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(18)32343-2
OpenAlex
W2925468400
Cited by
165
References
28
Citations by year
2026: 14 · 2025: 19 · 2024: 23 · 2023: 21 · 2022: 36 · 2021: 29 · 2020: 16 · 2019: 7
FWCI
27.63
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion, other-oa)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
World Health Organization
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
group psychological intervention, post-conflict mental health, women's mental health, anxiety, depression, armed conflict, SWAT, community health workers, brief psychotherapy, rural Pakistan, disability, community-based intervention, intervention effectiveness, enhanced usual care, Lady Health Workers, GHQ-12, WHO Disability Assessment Schedule
MeSH terms
Armed Conflicts, Exposure to Violence, Adolescent, Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Middle Aged, Pakistan, Psychotherapy, Brief, Rural Health, Cluster Analysis, Single-Blind Method, Treatment Outcome, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review