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Evaluating feasibility and acceptability of a group WHO trans-diagnostic intervention for women with common mental disorders in rural Pakistan: a cluster randomised controlled feasibility trial

Published online by Cambridge University Press:  10 July 2017

M. N. Khan ,
S. U. Hamdani ,
A. Chiumento ,
K. Dawson ,
R. A. Bryant ,
M. Sijbrandij ,
H. Nazir ,
P. Akhtar ,
A. Masood  and
D. Wang
...Show all authors
M. N. Khan*
Affiliation:
Khyber Medical University, Institute of Public Health & Social Sciences (IPH&SS), 10-B, Near ICMS, Phase V, Hayatabad, Peshawar, Pakistan
S. U. Hamdani
Affiliation:
Human Development Research Foundation, Islamabad, Pakistan University of Liverpool, Liverpool, UK
A. Chiumento
Affiliation:
University of Liverpool, Liverpool, UK
K. Dawson
Affiliation:
University of New South Wales, Sydney, Australia
R. A. Bryant
Affiliation:
University of New South Wales, Sydney, Australia
M. Sijbrandij
Affiliation:
VU University Amsterdam, Amsterdam, The Netherlands
H. Nazir
Affiliation:
Human Development Research Foundation, Islamabad, Pakistan
P. Akhtar
Affiliation:
Human Development Research Foundation, Islamabad, Pakistan
A. Masood
Affiliation:
Human Development Research Foundation, Islamabad, Pakistan
D. Wang
Affiliation:
Liverpool School of Tropical Medicine, Liverpool, UK
E. Wang
Affiliation:
Queen Mary University of London, UK
I. Uddin
Affiliation:
Bacha Khan Medical College, Mardan, Pakistan
M. van Ommeren
Affiliation:
Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
A. Rahman
Affiliation:
Human Development Research Foundation, Islamabad, Pakistan University of Liverpool, Liverpool, UK
*
*Address for correspondence: M. N. Khan, Khyber Medical University, Institute of Public Health & Social Sciences (IPH&SS), 10-B, Near ICMS, Phase V, Hayatabad, Peshawar, Pakistan. (Email: drnasim@kmu.edu.pk)
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Abstract

Aims:

The aim of this feasibility trial was to evaluate the feasibility and acceptability of the locally adapted Group Problem Management Plus (PM+) intervention for women in the conflict affected settings in Swat, Pakistan.

Methods:

This mixed-methods study incorporated a quantitative component consisting of a two arm cluster randomised controlled feasibility trial, and qualitative evaluation of the acceptability of the Group PM+ to a range of stakeholder groups. For the quantitative component, on average from each of the 20 Lady Health Workers (LHWs) catchment area (20 clusters), six women were screened and recruited for the trial with score of >2 on the General Health Questionnaire and score of >16 on the WHO Disability Assessment Schedule. These LHW clusters were randomised on a 1 : 1 allocation ratio using a computer-based software through a simple randomisation method to the Group PM+ intervention or Enhanced Usual Care. The Group PM+ intervention consisted of five weekly sessions of 2 h duration delivered by local non-specialist females under supervision. The primary outcome was individual psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale at 7th week after baseline. Secondary outcomes include symptoms of depression, post-traumatic stress disorder (PTSD), general psychological profile, levels of functioning and generalised psychological distress. Intervention acceptability was explored through in-depth interviews.

Results:

The results show that lay-helpers with no prior mental health experience can be trained to achieve the desired competency to successfully deliver the intervention in community settings under supervision. There was a good intervention uptake, with Group PM+ considered useful by participants, their families and lay-helpers. The outcome evaluation, which was not based on a large enough study to identify statistically significant results, indicated statistically significant improvements in depression, anxiety, general psychological profile and functioning. The PTSD symptoms and depressive disorder scores showed a trend in favour of the intervention.

Conclusion:

This trial showed robust acceptance in the local settings with delivery by non-specialists under supervision by local trained females. The trial paves the way for further adaptation and exploration of the outcomes through larger-scale implementation and definitive randomised controlled trials in the local settings.

Keywords

Depressiongroup therapyother psychosocial techniques/treatmentsrandomised controlled trialswomen
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 28 , Issue 1 , February 2019 , pp. 77 - 87
Copyright
Copyright © Cambridge University Press 2017 

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