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

• Published in: BMC psychiatry Vol. 15; no. 1; p. 232
• Main Authors: Sijbrandij, Marit, Farooq, Saeed, Bryant, Richard A, Dawson, Katie, Hamdani, Syed Usman, Chiumento, Anna, Minhas, Fareed, Saeed, Khalid, Rahman, Atif, van Ommeren, Mark
• Format: Journal Article
• Language: English
• Published: England BioMed Central 01-10-2015
• Subjects: Adolescent; Adult; Altruism; Anxiety disorders; Anxiety Disorders - economics; Anxiety Disorders - etiology; Cognition & reasoning; Cost-Benefit Analysis; Counseling - economics; Depressive Disorder - economics; Depressive Disorder - etiology; Drug use; Female; Humanitarianism; Humans; Intervention; Male; Mental depression; Mental disorders; Mental health; Pakistan; Personal health; Post traumatic stress disorder; Primary care; Primary Health Care - economics; Psychiatry; Psychotherapy - economics; Psychotherapy - methods; Questionnaires; Stress Disorders, Post-Traumatic - economics; Stress Disorders, Post-Traumatic - etiology; Stress, Psychological - economics; Stress, Psychological - therapy; Study Protocol; Substance use disorder; Systematic review; Trauma; Pakistan; Karachi Pakistan; India
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-015-0602-y

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