Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal of Mental Health Systems
Published in: International Journal of Mental Health Systems 1/2017

Open Access 01-12-2017 | Study Protocol

Problem Management Plus (PM+) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial

Authors: Syed Usman Hamdani, Zainab Ahmed, Marit Sijbrandij, Huma Nazir, Aqsa Masood, Parveen Akhtar, Hania Amin, Richard A. Bryant, Katie Dawson, Mark van Ommeren, Atif Rahman, Fareed Aslam Minhas

Published in: International Journal of Mental Health Systems | Issue 1/2017

Login to get access

Abstract

Background

The World Health Organization (WHO) has developed Problem Management Plus (PM+), a 5-session, psychological intervention program delivered by trained non-specialist that addresses common mental disorders. The objectives of this study are to evaluate effectiveness and cost-effectiveness of PM+ in a specialized mental health care facility in Pakistan.

Methods

A single blind individual randomized controlled trial (RCT) will be carried out in the outpatient department of a specialized mental healthcare facility in Rawalpindi, Pakistan. After informed consent, patients with high psychological distress (General Health Questionnaire-12 (score >2) and functional impairment (WHO Disability Assessment Schedule 2.0 score >16) will be randomised to PM+ plus treatment as usual (n = 96) or TAU only (n = 96). The primary outcome is the psychological distress, measured by levels of anxiety and depression on the Hospital Anxiety and Depression Scale and improvement in functioning as measured by WHODAS at 20 weeks after baseline. Secondary outcomes include improvement in symptoms of depression, post-traumatic stress disorder, levels of social support and cost effectiveness evaluation. Qualitative interviews will be conducted to evaluate the process of implementing PM+ including barriers and facilitators in implementation and possibility of integration of PM+ program in specialized mental health care facilities in Pakistan.

Discussion

The results of this study will be helpful in evaluating the effectiveness of the approach of training non specialists, based in the specialized mental health care facilities in delivering evidence based psychological interventions in the low resource settings.
Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered Retrospectively on March 23, 2016
Appendix
Available only for authorised users
Literature
1.
2.
Votruba N, Thornicroft G. Sustainable development goals and mental health: learnings from the contribution of the FundaMentalSDG global initiative. Global Mental Health. 2016;3. doi:10.​1017/​gmh.​2016.​20.
3.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–86.CrossRef
4.
Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, Saxena S, Scheffler RM. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–63.CrossRef
5.
Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878–89.CrossRef
6.
World Health Organization. WHO-AIMS report on mental health system in Pakistan. Geneva: World Health Organization; 2009.
7.
Group LGMH. Scale up services for mental disorders: a call for action. Lancet. 2007;370(9594):1241–52.CrossRef
8.
Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R, Ntulo C, Thornicroft G, Saxena S. Scale up of services for mental health in low-income and middle-income countries. Lancet. 2011;378(9802):1592–603.CrossRef
9.
Murray LK, Dorsey S, Bolton P, Jordans MJ, Rahman A, Bass J, Verdeli H. Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. Int J Mental Health Syst. 2011;5(1):30.CrossRef
10.
Rahman A, Malik A, Sikander S, Roberts C, Creed F. 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. 2008;372(9642):902–9.CrossRef
11.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, De Silva MJ, Bhat B, Araya R, King M. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376(9758):2086–95.CrossRef
12.
Dua T, Barbui C, Clark N, Fleischmann A, Poznyak V, van Ommeren M, Yasamy MT, Ayuso-Mateos JL, Birbeck GL, Drummond C, et al. Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Med. 2011;8(11):e1001122.CrossRef
13.
Tol WA, Barbui C, van Ommeren M. Management of acute stress, PTSD, and bereavement: WHO recommendations. JAMA. 2013;310(5):477–8.CrossRef
14.
WHO. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. Geneva: WHO; 2010.
15.
WHO. Guidelines for the management of conditions specifically related to stress. Geneva: WHO; 2013.
16.
Rahman A, Riaz N, Dawson KS, Usman Hamdani S, Chiumento A, Sijbrandij M, Minhas F, Bryant RA, Saeed K, van Ommeren M, et al. Problem Management Plus (PM+): pilot trial of a WHO transdiagnostic psychological intervention in conflict-affected Pakistan. World Psychiatry Off J World Psychiatr Assoc. 2016;15(2):182–3.
17.
Rahman A, Hamdani SU, Awan NR, Bryant RA, Dawson KS, Khan MF, Azeemi MMUH, Akhtar P, Nazir H, Chiumento A. Effect of a multicomponent behavioral intervention in adults impaired by psychological distress in a conflict-affected area of Pakistan: a randomized clinical trial. JAMA. 2016;316(24):2609–17.CrossRef
18.
Goldberg D, Williams P. A user’s guide to the General Health Questionnaire. Windsor: NFER-Nelson; 1988.
19.
Minhas FM, Mubbashar MH. Validation of General Health Questionnaire (GHQ-12) in primary care settings of Pakistan. J Coll Physicians Surg Pak. 1996;6:133–6.
20.
WHO. Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0. Geneva: WHO; 2010.
21.
22.
Naeem F, Gul M, Irfan M, Munshi T, Asif A, Rashid S, Khan MN, Ghani S, Malik A, Aslam M, et al. Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. J Affect Disord. 2015;177:101–7.CrossRef
23.
Dawson KS, Bryant RA, Harper M, Kuowei Tay A, Rahman A, Schafer A, van Ommeren M. Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry Off J World Psychiatr Assoc. 2015;14(3):354–7.
24.
WHO. Problem Management Plus (PM+): Psychological help for adults in communities exposed to adversity (Generic field-trial version 1.0). Geneva: WHO; in press.
25.
Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B. Client Socio-Demographic and Service Receipt Inventory-European Version: development of an instrument for international research EPSILON Study 5 European Psychiatric Services: inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl. 2000;177(39):s28–33.CrossRef
26.
Shoukat S, Anis M, Kella DK, Qazi F, Samad F, Mir F, Mansoor M, Parvez MB, Osmani B, Panju SA, et al. Prevalence of mistreatment or belittlement among medical students—a cross sectional survey at a private medical school in Karachi, Pakistan. PLoS ONE. 2010;5(10):e13429.CrossRef
27.
Kidwai R. Demographic factors, social problems and material amenities as predictors of psychological distress: a cross-sectional study in Karachi, Pakistan. Soc Psychiatry Psychiatr Epidemiol. 2014;49(1):27–39.CrossRef
28.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRef
29.
Mumford DB, Tareen IA, Bajwa MA, Bhatti MR, Karim R. The translation and evaluation of an Urdu version of the Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1991;83(2):81–5.CrossRef
30.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRef
31.
Husain N, Gater R, Tomenson B, Creed F. Comparison of the Personal Health Questionnaire and the Self Reporting Questionnaire in rural Pakistan. JPMA J Pak Med Assoc. 2006;56(8):366–70.PubMed
32.
Ahmer S, Faruqui RA, Aijaz A. Psychiatric rating scales in Urdu: a systematic review. BMC psychiatry. 2007;7:59.CrossRef
33.
34.
Khalily MT, Gul S, Mushtaq R, Jahangir SF. To examine delayed PTSD symptomatology over time among trauma survivors in Pakistan. Online J Couns Educ. 2012;1(1):1–11.
35.
Ashworth M, Shepherd M, Christey J, Matthews V, Wright K, Parmentier H, Robinson S, Godfrey E. A client-generated psychometric instrument: the development of “PSYCHLOPS”. Couns Psychother Res Link Res Prac. 2013;4(4):27–31.
36.
Czachowski S, Seed P, Schofield P, Ashworth M. Measuring psychological change during cognitive behaviour therapy in primary care: a polish study using ‘PSYCHLOPS’ (Psychological Outcome Profiles). PLoS ONE. 2011;6(12):e27378.CrossRef
37.
Heoinsson H, Kristjansdottir H, Olason DP, Sigurosson JF. A validation and replication study of the patient-generated measure PSYCHLOPS on an Icelandic clinical population. Eur J Psychol Assess. 2013;29(2):89–95.CrossRef
38.
Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Person Assess. 1988;52(1):30–41.CrossRef
39.
Akhtar A, Rahman A, Husain M, Chaudhry IB, Duddu V, Husain N. Multidimensional scale of perceived social support: psychometric properties in a South Asian population. J Obstet Gynaecol Res. 2010;36(4):845–51.CrossRef
40.
Buttorff C, Hock RS, Weiss HA, Naik S, Araya R, Kirkwood BR, Chisholm D, Patel V. Economic evaluation of a task-shifting intervention for common mental disorders in India. Bull World Health Organ. 2012;90(11):813–21.CrossRef
41.
Chisholm D, Sekar K, Kumar KK, Saeed K, James S, Mubbashar M, Murthy RS. Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan. Br J Psychiatry J Mental Sci. 2000;176:581–8.CrossRef
42.
Mollica RF, Caspiyavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic-stress-disorder in indo-chinese refugees. J Nerv Mental Dis. 1992;180(2):111–6.CrossRef
43.
Halepota AA, Wasif SA. Harvard Trauma Questionnaire Urdu translation: the only cross-culturally validated screening instrument for the assessment of trauma and torture and their sequelae. JPMA J Pak Med Assoc. 2001;51(8):285–90.PubMed
44.
Rahman A, Iqbal Z, Harrington R. Life events, social support and depression in childbirth: perspectives from a rural community in the developing world. Psychol Med. 2003;33(7):1161–7.CrossRef
45.
Mauro F. Task shifting may prove key to tackling infectious diseases. Health. 2007;370:2158–63.
46.
Some D, Edwards JK, Reid T, Van den Bergh R, Kosgei RJ, Wilkinson E, Baruani B, Kizito W, Khabala K, Shah S. Task shifting the management of non-communicable diseases to nurses in Kibera, Kenya: does it work? PLoS ONE. 2016;11(1):e0145634.CrossRef
47.
Bolton P, Lee C, Haroz EE, Murray L, Dorsey S, Robinson C, Ugueto AM, Bass J. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med. 2014;11(11):e1001757.CrossRef
48.
Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P, Speelman L, Ndogoni L, Weissman M. Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA. 2003;289(23):3117–24.CrossRef
49.
Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, Dimidjian S, Araya R, Hollon SD, King M. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):176–85.CrossRef
Metadata
Title
Problem Management Plus (PM+) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial
Authors
Syed Usman Hamdani
Zainab Ahmed
Marit Sijbrandij
Huma Nazir
Aqsa Masood
Parveen Akhtar
Hania Amin
Richard A. Bryant
Katie Dawson
Mark van Ommeren
Atif Rahman
Fareed Aslam Minhas
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal of Mental Health Systems / Issue 1/2017
Electronic ISSN: 1752-4458
DOI
https://doi.org/10.1186/s13033-017-0147-1

Other articles of this Issue 1/2017

International Journal of Mental Health Systems 1/2017 Go to the issue

Research

Users’ involvement in mental health services: programme logic model of an innovative initiative in integrated care

Research

Patterns of psychiatric admissions and predictors of patient’s outcome in Jimma University Teaching and Referral Hospital: a retrospective study

Research

“If there’s no stability around them”: experienced therapists’ view on the role of patients’ social world in recovery in bipolar disorder

Research

Causes of and risk factors for posttraumatic stress disorder: the beliefs of Iraqi and Afghan refugees resettled in Australia

Research

Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study

Review

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care