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Cited by 49Mental Health Treatment and AccessMigration, Health and TraumaPosttraumatic Stress Disorder Research

Problem Management Plus (PM+) for common mental disorders in a humanitarian setting in Pakistan; study protocol for a randomised controlled trial (RCT)

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Sijbrandij, Marit, Farooq, Saeed, Bryant, Richard A., Dawson, Katie, Hamdani, Syed Usman, Chiumento, Anna, Minhas, Fareed, Saeed, Khalid +2 more·2015·BMC Psychiatry
DOI 10.1186/s12888-015-0602-yPMC PMC4591562
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Abstract

BACKGROUND: In 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. METHODS: A 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). DISCUSSION: If proven effective, PM+ will be rolled out to other areas for further adaptation and testing in diverse humanitarian settings. TRIAL REGISTRATION: ACTRN12614001235695. Registered 26 November 2014. Australian New Zealand Clinical Trials Registry.

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  • Research in Pakistan showed that the treatment arm (PM+) had significant reduction in anxiety and depression symptoms, with a moderate to large effect relative to EUC.

    “The treatment arm (PM+) showed significant reduction in the primary outcome, anxiety and depression symptoms (assessed with the Hospital Anxiety and Depression Scale, or HADS), with a moderate to large effect relative to EUC.”

    From A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: A randomized controlled trial (2020) · cites this paper as [34]

    The Methods (Design and Primary outcomes; page not provided) identify anxiety and depression measured by HADS as primary outcomes in a Pakistan trial of PM+. But this paper is a protocol: its Sample size section gives projected reductions, not observed results, and it reports no significant reduction or moderate-to-large effect. Its comparator is treatment as usual (TAU), not EUC. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • The secondary outcomes (PTSD symptoms, functional impairment, and symptoms of depressive disorder) in the Pakistan study also showed significant reductions; these effects were moderate relative to EUC.

    “The secondary outcomes (PTSD symptoms, functional impairment, and symptoms of depressive disorder) also showed significant reductions; these effects were moderate relative to EUC.”

    From A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: A randomized controlled trial (2020) · cites this paper as [34]

    The Methods sections on Design and Secondary outcomes identify functional disability, PTSD symptoms, and depression measures, but this paper is a study protocol. Its Analysis plan describes how changes will be tested; it does not report significant reductions or moderate effects. The planned comparator is treatment as usual (TAU), not EUC. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • These findings are consistent with evidence from LMICs on the cost-effectiveness of a task-shifting approach to delivering psychological interventions for the treatment of common mental disorders compared with EUC delivered by primary healthcare physicians.

    “These findings are consistent with evidence from LMICs on the cost-effectiveness of a task-shifting approach to delivering psychological interventions for the treatment of common mental disorders compared with EUC delivered by primary healthcare physicians. 30,31”

    From Cost-effectiveness of WHO Problem Management Plus for adults with mood and anxiety disorders in a post-conflict area of Pakistan: randomised controlled trial (2020) · cites this paper as [31]

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2 of the 33 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [14]WHO mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings 2010 Geneva WHO 23741783

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Authors
Sijbrandij, M., Farooq, S., Bryant, R. A., Dawson, K., Hamdani, S. U., Chiumento, A., Minhas, F., Saeed, K., Rahman, A., & van Ommeren, M.
Affiliations
  • Amsterdam Public Health (NL)
  • Lady Reading Hospital (PK)
  • UNSW Sydney (AU)
  • University of Liverpool (GB)
  • Rawalpindi Medical University (PK)
  • World Health Organization Regional Office for the Eastern Mediterranean (EG)
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2015-10-01
Volume
15
Issue
1
Pages
232-232
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-015-0602-y
PMC
PMC4591562
OpenAlex
W2179336238
Cited by
48
References
33
Citations by year
2026: 2 · 2025: 4 · 2024: 9 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 9 · 2019: 8 · 2018: 1 · 2017: 2 · 2016: 5
FWCI
4.37
Type
journal article
Language
en
Update notices
correction (2018-10-15)
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
  • VU Research Portal (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • R2HC (ᅟ)
  • United States Agency for International Development (ᅟ)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
Problem Management Plus, common mental disorders, depression, anxiety disorders, post-traumatic stress disorder, humanitarian settings, primary care, psychological distress, functional disability, cost-effectiveness, Peshawar district
MeSH terms
Adolescent, Adult, Altruism, Anxiety Disorders, Cost-Benefit Analysis, Counseling, Depressive Disorder, Female, Humans, Male, Pakistan, Primary Health Care, Psychotherapy, Stress Disorders, Post-Traumatic, Stress, Psychological

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