Syed Usman Hamdani1,2,3, Zill-E- Huma4,5, Aqsa Masood5, Kaina Zhou6, Zainab Ahmed7, Huma Nazir5, Hania Amin7, Parveen Akhtar5, Richard A Bryant8, Katie Dawson8, Mark van Ommeren9, Duolao Wang6, Atif Rahman4, Fareed Aslam Minhas7. 1. University of Liverpool, Liverpool, UK. syedusmanhamdani@gmail.com. 2. Human Development Research Foundation, Islamabad, Pakistan. syedusmanhamdani@gmail.com. 3. Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan. syedusmanhamdani@gmail.com. 4. University of Liverpool, Liverpool, UK. 5. Human Development Research Foundation, Islamabad, Pakistan. 6. Liverpool School of Tropical Medicine, Liverpool, UK. 7. Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan. 8. University of New South Wales, Sydney, Australia. 9. World Health Organization, Geneva, Switzerland.
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.
RCT Entities:
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.
Entities:
Keywords:
Anxiety; Cognitive behavioral therapy; Common mental disorders; Depression; Low intensity psychological intervention; Specialized mental health facility
Authors: Pim Cuijpers; Marit Sijbrandij; Sander L Koole; Gerhard Andersson; Aartjan T Beekman; Charles F Reynolds Journal: World Psychiatry Date: 2014-02 Impact factor: 49.548
Authors: Atif Rahman; Fareed Aslam Minhas; Syed Usman Hamdani; Zainab Ahmed; Marit Sijbrandij; Huma Nazir; Aqsa Masood; Parveen Akhtar; Hania Amin; Richard A Bryant; Katie Dawson; Mark van Ommeren Journal: Int J Ment Health Syst Date: 2017-06-08