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Measurement-based care vs. standard care for major depressive disorder in Pakistan: protocol for a randomized control trial

Published online by Cambridge University Press:  19 July 2023

I. Husain ,
M. Umer ,
Z. Nigah ,
T. Kiran ,
A. Bukhsh ,
M. Ansari ,
M. R. Bhatia ,
O. Husain ,
H. Naqvi  and
A. Qadir
...Show all authors
I. Husain
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada
M. Umer*
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada
Z. Nigah
Affiliation:
Ishrat Husain Pakistan Institute of Living and Learning, Karachi
T. Kiran
Affiliation:
Ishrat Husain Pakistan Institute of Living and Learning, Karachi
A. Bukhsh
Affiliation:
Ishrat Husain Pakistan Institute of Living and Learning, Karachi
M. Ansari
Affiliation:
Liaquat University of Medical & Health Sciences, Cowasjee Jehangir Institute of Psychiatry, Hyderbabad
M. R. Bhatia
Affiliation:
Peoples University of Medical and Health Sciences, Nawabshah
O. Husain
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada
H. Naqvi
Affiliation:
Dow University of Health Sciences, Karachi
A. Qadir
Affiliation:
Ishrat Husain Pakistan Institute of Living and Learning, Karachi
M. Saqib
Affiliation:
Ishrat Husain Pakistan Institute of Living and Learning, Karachi
A. H. Rajput
Affiliation:
Liaquat University of Medical & Health Sciences, Cowasjee Jehangir Institute of Psychiatry, Hyderbabad
M. A. Zeb
Affiliation:
Baluchistan Institute of Psychiatry and Behavioral Sciences, Quetta
S. A. Khan
Affiliation:
North West General Hospital, Peshawar
K. M. S. Siddiqui
Affiliation:
National Psychiatric Hospital, Multan
S. Sherzad
Affiliation:
Baluchistan Institute of Psychiatry and Behavioral Sciences, Quetta
B. Mulsant
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada
N. Chaudhry
Affiliation:
Ishrat Husain Pakistan Institute of Living and Learning, Karachi
I. Chaudhry
Affiliation:
Ziauddin University, Karachi, Pakistan
N. Husain
Affiliation:
Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

Low and middle-income countries (LMICs) hold the majority of disease burden attributed to major depressive disorder (MDD). Despite this, there remains a substantial gap for access to evidence-based treatments for MDD in LMICs like Pakistan. Measurement-based care (MBC) incorporates systematic administration of validated outcome measures to guide treatment decision making and is considered a low-cost approach to optimise better clinical outcomes for individuals with MDD but there is a paucity of evidence on the efficacy of MBC in LMICs.

Objectives

This protocol highlights a randomized trial which will include Pakistani outpatients with moderate to severe major depression.

Methods

Participants will be randomised to either MBC (guided by schedule), or standard treatment (guided by clinicians’ judgement), and will be prescribed with paroxetine (10–60mg/day) or mirtazapine (7.5–45mg/day) for 24 weeks. Outcomes will be evaluated by raters blind to study protocol and treatment.

Results

National Bioethics Committee (NBC) of Pakistan has given full ethics approval. The trial is being conducted and reported as per recommendation of the CONSORT statement for RCTs.

Conclusions

With increasing evidence from high-income settings supporting the effectiveness of MBC for MDD, it is now necessary to explore its feasibility, utility. and efficacy in low-resource settings. The results of the proposed trial could inform the development of a low-cost and scalable approach to efficiently optimise outcomes for individuals with MDD in Pakistan.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S836
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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