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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

Information

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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References

Ahmer, S, Faruqui, RA, Aijaz, A (2007). Psychiatric rating scales in Urdu: a systematic review. BMC Psychiatry 7, 1.Google Scholar
Allden, K, Poole, C, Chantavanich, S, Ohmar, K, Aung, NN, Mollica, RF (1996). Burmese political dissidents in Thailand: trauma and survival among young adults in exile. American Journal of Public Health 86, 1561–1569.Google Scholar
Andrews, G, Kemp, A, Sunderland, M, Von Korff, M, Ustun, TB (2009). Normative data for the 12 item WHO Disability Assessment Schedule 2.0. PLoS ONE 4, e8343.Google Scholar
Applied Mental Health Research Group (2013). Design, Implementation, Monitoring, and Evaluation of Mental Health and Psychosocial Assistance Programs for Trauma Survivors in Low Resource Countries; A User's Manual for Researchers and Program Implementers. John Hopkins University Bloomberg School of Public Health: Baltimore, MA.Google Scholar
Ashworth, M, Shepherd, M, Christey, J, Matthews, V, Wright, K, Parmentier, H, Robinson, S, Godfrey, E (2004). A client-generated psychometric instrument: the development of ‘PSYCHLOPS’. Counselling and Psychotheraphy Research 4, 27–31.Google Scholar
Ashworth, M, Evans, C, Clement, S (2009). Measuring psychological outcomes after cognitive behaviour therapy in primary care: a comparison between a new patient-generated measure ‘PSYCHLOPS’ (Psychological Outcome Profiles) and ‘HADS’ (Hospital Anxiety and Depression Scale). Journal of Mental Health 18, 169–177.Google Scholar
Bhui, K, Abdi, A, Abdi, M, Pereira, S, Dualeh, M, Robertson, D, Sathyamoorthy, G, Ismail, H (2003). Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees – preliminary communication. Social Psychiatry and Psychiatric Epidemiology 38, 35–43.Google Scholar
Bile, KM, Hafeez, A (2009). Crisis in the Swat Valley of Pakistan: need for international action. Lancet 374, 23.Google Scholar
Bolton, P, Bass, J, Neugebauer, R, Verdeli, H, Clougherty, KF, Wickramaratne, P, Speelman, L, Ndogoni, L, Weissman, M (2003). Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA 289, 3117–3124.Google Scholar
Craig, G, Corden, A, Thornton, P (2000). Safety in social research. Social Research Update 29, 68–72.Google Scholar
Cuijpers, P, Van Straten, A, Warmerdam, L, Smits, N (2008). Characteristics of effective psychological treatments of depression: a metaregression analysis. Psychotherapy Research 18, 225–236.Google Scholar
Dawson, KS, Bryant, RA, Harper, M, Kuowei Tay, A, Rahman, A, Schafer, A, van Ommeren, M (2015). Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry 14, 354–357.Google Scholar
Ehlers, A, Clark, DM, Hackmann, A, McManus, F, Fennell, M (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy 43, 413–431.Google Scholar
Ellsberg, M, Jansen, HA, Heise, L, Watts, CH, Garcia-Moreno, C (2008). Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. The Lancet 371, 1165–1172.Google Scholar
George, C, Kanakamma, LG, John, J, Sunny, G, Cohen, A, De Silva, MJ (2012). Post-tsunami mental health: a cross-sectional survey of the predictors of common mental disorders in South India 9–11 months after the 2004 Tsunami. Asia-Pacific Psychiatry 4, 104–112.Google Scholar
Goldberg, D, Williams, P (1988). A User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor, Berks.Google Scholar
Green, J, Thorogood, N (2014). Qualitative Methods for Health Research. SAGE Publishing: London, UK.Google Scholar
Hafeez, A, Mohamud, BK, Shiekh, MR, Shah, SAI, Jooma, R (2011). Lady health workers programme in Pakistan: challenges, achievements and the way forward. Journal of the Pakistan Medical Association 61, 210.Google Scholar
Inter-Agency Standing Committee (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Inter-Agency Standing Committee: Geneva, Switzerland.Google Scholar
Kakuma, R, Minas, H, van Ginneken, N, Dal Poz, MR, Desiraju, K, Morris, JE, Saxena, S, Scheffler, RM (2011). Human resources for mental health care: current situation and strategies for action. Lancet 378, 1654–1663.Google Scholar
Khalily, MT, Gul, S, Mushtaq, R, Jahangir, SF (2012). To examine delayed PTSD symptomatology over time among trauma survivors in Pakistan. The Online Journal of Counselling and Education 1, 1–11.Google Scholar
Khan, MN, Chiumento, A, Dherani, M, Bristow, K, Sikander, S, Rahman, A (2015). Psychological distress and its associations with past events in pregnant women affected by armed conflict in Swat, Pakistan: a cross sectional study. Conflict and Health 9, 37.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.Google Scholar
Leon, AC, Davis, LL, Kraemer, HC (2011). The role and interpretation of pilot studies in clinical research. Journal of Psychiatric Research 45, 626–629.Google Scholar
Minhas, F, Mubbashar, M (1996). Validation of General Health Questionnaire (GHQ-12) in primary care settings of Pakistan. Journal of the College of Physicians and Surgeons Pakistan 6, 133–136.Google Scholar
Mohmand, S, Gazdar, H (2007). Social structures in rural Pakistan. In Determinants and Drivers of Poverty Reduction and ADB's Contribution in Rural Pakistan, p. 56. Asian Development Bank: Islamabad, Pakistan.Google Scholar
Mollica, RF, Caspi-Yavin, Y, Bollini, P, Truong, T, Tor, S, Lavelle, J (1992). The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease 180, 111–116.Google Scholar
Mumford, D, Tareen, I, Bajwa, M, Bhatti, M, Karim, R (1991). The translation and evaluation of an Urdu version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 83, 81–85.Google Scholar
Murray, LK, Dorsey, S, Bolton, P, Jordans, MJ, Rahman, A, Bass, J, Verdeli, H (2011). Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. International Journal of Mental Health Systems 5, 1.Google Scholar
Pakistan Bureau of Statistics (2016). District at a glance Swat. http://www.pbs.gov.pk/content/district-glance-swat. Accessed 20th July 2016.Google Scholar
Rachman, S, Radomsky, AS, Shafran, R (2008). Safety behaviour: a reconsideration. Behaviour Research and Therapy 46, 163–173.Google Scholar
Rahman, A, Iqbal, Z, Harrington, R (2003). Life events, social support and depression in childbirth: perspectives from a rural community in the developing world. Psychological Medicine 33, 1161–1167.Google Scholar
Rahman, A, Malik, A, Sikander, S, Roberts, C, Creed, F (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372, 902–909.Google Scholar
Rahman, A, Fisher, J, Bower, P, Luchters, S, Tran, T, Yasamy, MT, Saxena, S, Waheed, W (2013). Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bulletin of the World Health Organization 91, 593–601I.Google Scholar
Ritchie, J, Spencer, L, Bryman, A, Burgess, R (1994). Analysing Qualitative Data. Routledge: London.Google Scholar
Rome, S (2010). Crisis and reconciliation in Swat. Pakistaniaat a Journal of Pakistan Studies 3, 53–79.Google Scholar
Singla, D, Lazarus, A, Atif, N, Sikander, S, Bhatia, U, Ahmad, I, Nisar, A, Khan, S, Fuhr, D, Patel, V (2014). ‘Someone like us’: delivering maternal mental health through peers in two South Asian contexts. Journal of Affective Disorders 168, 452–458.Google Scholar
Sousa, RM, Dewey, ME, Acosta, D, Jotheeswaran, A, Castro-Costa, E, Ferri, CP, Guerra, M, Huang, Y, Jacob, K, Pichardo, JGR (2010). Measuring disability across cultures—the psychometric properties of the WHODAS II in older people from seven low-and middle-income countries. The 10/66 Dementia Research Group population-based survey. International Journal of Methods in Psychiatric Research 19, 1–17.Google Scholar
Steel, Z, Chey, T, Silove, D, Marnane, C, Bryant, RA, van Ommeren, M (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302, 537–549.Google Scholar
Tol, WA, Barbui, C, Galappatti, A, Silove, D, Betancourt, TS, Souza, R, Golaz, A, van Ommeren, M (2011). Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet 378, 1581–1591.Google Scholar
Tol, WA, Barbui, C, van Ommeren, M (2013). Management of acute stress, PTSD, and bereavement: WHO recommendations. JAMA 310, 477–478.Google Scholar
Ventevogel, P, van Ommeren, M, Schilperoord, M, Saxena, S (2015). Improving mental health care in humanitarian emergencies. Bulletin of the World Health Organization 93, 666–666a.Google Scholar
Weathers, FW, Litz, BT, Keane, TM, Palmieri, P, Marx, B, Schnurr, P (2013) The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. http://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp. Accessed June 23 2016.Google Scholar
World Health Organization (2007). Mental health assistance to the populations affected by the Tsunami in Asia. http://www.who.int/mental_health/resources/tsunami/en/index1.html. Accessed 20th July 2016.Google Scholar
World Health Organization (2010). Measuring health and disability: Manual for WHO disability assessment schedule WHODAS 2.0. World Health Organization: Geneva, Switzerland.Google Scholar
Yalom, ID, Leszcz, M (2005). The Theory and Practice of Group Psychotherapy. Basic books, A Member of the Perseus Books Group: New York.Google Scholar
Zigmond, AS, Snaith, RP (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361–370.Google Scholar
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