Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial
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 no...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | International Journal of Mental Health Systems |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13033-020-00434-y |
| _version_ | 1818392823960961024 |
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| author | Syed Usman Hamdani Zill-e- Huma Aqsa Masood Kaina Zhou Zainab Ahmed Huma Nazir Hania Amin Parveen Akhtar Richard A. Bryant Katie Dawson Mark van Ommeren Duolao Wang Atif Rahman Fareed Aslam Minhas |
| author_facet | Syed Usman Hamdani Zill-e- Huma Aqsa Masood Kaina Zhou Zainab Ahmed Huma Nazir Hania Amin Parveen Akhtar Richard A. Bryant Katie Dawson Mark van Ommeren Duolao Wang Atif Rahman Fareed Aslam Minhas |
| author_sort | Syed Usman Hamdani |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-14T05:35:33Z |
| format | Article |
| id | doaj.art-3dce3bc6b1c748b7841667b8d3acd3c1 |
| institution | Directory Open Access Journal |
| issn | 1752-4458 |
| language | English |
| last_indexed | 2024-12-14T05:35:33Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Mental Health Systems |
| spelling | doaj.art-3dce3bc6b1c748b7841667b8d3acd3c12022-12-21T23:15:11ZengBMCInternational Journal of Mental Health Systems1752-44582021-01-0115111210.1186/s13033-020-00434-yEffect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trialSyed Usman Hamdani0Zill-e- Huma1Aqsa Masood2Kaina Zhou3Zainab Ahmed4Huma Nazir5Hania Amin6Parveen Akhtar7Richard A. Bryant8Katie Dawson9Mark van Ommeren10Duolao Wang11Atif Rahman12Fareed Aslam Minhas13University of LiverpoolUniversity of LiverpoolHuman Development Research FoundationLiverpool School of Tropical MedicineInstitute of Psychiatry, WHO Collaborating Center for Mental Health Research and TrainingHuman Development Research FoundationInstitute of Psychiatry, WHO Collaborating Center for Mental Health Research and TrainingHuman Development Research FoundationUniversity of New South WalesUniversity of New South WalesWorld Health OrganizationLiverpool School of Tropical MedicineUniversity of LiverpoolInstitute of Psychiatry, WHO Collaborating Center for Mental Health Research and TrainingAbstract 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/ ACTRN12616000381482https://doi.org/10.1186/s13033-020-00434-yLow intensity psychological interventionCognitive behavioral therapySpecialized mental health facilityCommon mental disordersDepressionAnxiety |
| spellingShingle | Syed Usman Hamdani Zill-e- Huma Aqsa Masood Kaina Zhou Zainab Ahmed Huma Nazir Hania Amin Parveen Akhtar Richard A. Bryant Katie Dawson Mark van Ommeren Duolao Wang Atif Rahman Fareed Aslam Minhas Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial International Journal of Mental Health Systems Low intensity psychological intervention Cognitive behavioral therapy Specialized mental health facility Common mental disorders Depression Anxiety |
| title | Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial |
| title_full | Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial |
| title_fullStr | Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial |
| title_full_unstemmed | Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial |
| title_short | Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial |
| title_sort | effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in pakistan a randomized controlled trial |
| topic | Low intensity psychological intervention Cognitive behavioral therapy Specialized mental health facility Common mental disorders Depression Anxiety |
| url | https://doi.org/10.1186/s13033-020-00434-y |
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