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Marit Sijbrandij - One of the best experts on this subject based on the ideXlab platform.

  • Problem Management Plus (PM+) for Syrian refugees in the Netherlands
    European Journal of Public Health, 2020
    Co-Authors: Marit Sijbrandij, A. M. De Graaff, Pim Cuijpers, Barbara Kieft
    Abstract:

    Abstract Background Refugees are at considerable risk to develop common mental disorders and related somatic health symptoms. In order to meet the mental health needs of individuals affected by crisis worldwide, the World Health Organization has developed a set of transdiagnostic low-intensity psychological interventions. These interventions, including Problem Management Plus (PM+) and its variants, are delivered by trained non-professional counsellors under supervision of local clinicians. The EU H2020 STRENGTHS project evaluates the effectiveness of these interventions across refugee settings in Europe and the Middle East. This presentation will present the results of a pilot randomized controlled trial (RCT) on individual PM+ in the Netherlands. Methods Syrian refugees (N = 60) with elevated levels of psychological distress (10 item-Kessler Psychological Distress Scale >15) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 >16) were randomized into PM + (N=30)) or care-as-usual control (CAU; N = 30). The main outcomes were symptoms of depression and anxiety at 3 months. Secondary outcomes were functioning, symptoms of posttraumatic stress disorder, service utilisation and health costs. Results At 3 months follow-up, the PM+ group had significantly lower scores than control for depression (d=.52?) and anxiety (d=.48), symptoms of posttraumatic stress disorder (d=.66, p = .006?), functional impairment (d=.73, p = .009) and self-identified Problems (d=.81, p = .005). PM+ potentially may be cost effective with an ICER of €5,047, (95% CI €0, €19773) per additional recovery achieved. Conclusions PM+ delivered by non-specialist peer-refugee helpers has the potential be effective in reducing depression, anxiety, improving functioning, and reducing health costs. Larger RCTs on the effects of PM+ are currently conducted within the EU STRENGTHS project.

  • Peer-provided Problem Management Plus (PM+) for adult Syrian refugees: a pilot randomised controlled trial on effectiveness and cost-effectiveness
    Epidemiology and Psychiatric Sciences, 2020
    Co-Authors: A. M. De Graaff, Pim Cuijpers, Barbara Kieft, Richard A Bryant, Daniela C. Fuhr, David Mcdaid, A-la Park, Aniek Woodward, E. Minkenberg, Marit Sijbrandij
    Abstract:

    Abstract Aims Common mental disorders are highly prevalent among Syrian refugees. Problem Management Plus (PM+) is a brief, transdiagnostic, non-specialist helper delivered, psychological intervention targeting psychological distress. This single-blind pilot randomised controlled trial (RCT) on PM+ delivered by peer-refugees examined trial procedures in advance of a definitive RCT, evaluated PM+ 's acceptability and feasibility, and investigated its likely effectiveness and cost-effectiveness among Syrian refugees in the Netherlands. Methods Adult Syrian refugees ( N = 60) with elevated psychological distress (Kessler Psychological Distress Scale (K10) score >15) and reduced pychosocial functioning (WHO Disability Assessment Schedule 2.0 (WHODAS) score >16) were randomised into PM+ in addition to care as usual (CAU) (PM+/CAU; n = 30) or CAU alone ( n = 30). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes were pychosocial functioning (WHO Disability Assessment Schedule; WHODAS 2.0), symptoms of posttraumatic stress disorder (PTSD) (PTSD Checklist for DSM 5; PCL-5) and self-identified Problems (Psychological Outcomes Profiles; PSYCHLOPS). Changes in service utilisation and time out of employment and/or adult education were estimated (adapted version of the Client Service Receipt Inventory; CSRI). Semi-structured interviews on the implementation of PM+ were conducted with stakeholders (i.e. six PM+ participants, five non-specialist helpers and five key informants). Results Recruitment, randomization and blinding procedures were successful. PM+ was generally perceived positively by stakeholders, especially regarding the intervention strategies, accommodation of the intervention and the helpers. Two serious adverse events not attributable to the trial were reported. At 3-month follow-up, the HSCL-25 total score was significantly lower for the PM+/CAU group ( n = 30) than CAU group ( n = 30) ( p = 0.004; d = 0.58). Significant differences in favour of PM+/CAU were also found for WHODAS psychosocial functioning ( p = 0.009, d = 0.73), PCL-5 symptoms of PTSD ( p = 0.006, d = 0.66) and PSYCHLOPS self-identified Problems ( p = 0.005, d = 0.81). There were no significant differences in mean health service costs ( p = 0.191) and the mean costs of lost productive time ( p = 0.141). This suggests PM+ may potentially be cost-effective with an incremental cost from a health system perspective of €5047 (95% CI €0–€19 773) per additional recovery achieved. Conclusions Trial procedures and PM+ delivered by non-specialist peer-refugee helpers seemed acceptable, feasible and safe. Analyses indicate that PM+ may be effective in improving mental health outcomes and psychosocial functioning, and potentially cost-effective. These results support the development of a definitive RCT with a larger sample of refugees and a longer follow-up period.

  • Pathways towards scaling up Problem Management Plus in Turkey: a theory of change workshop.
    Conflict and health, 2020
    Co-Authors: Daniela C. Fuhr, Marit Sijbrandij, Ceren Acarturk, Ersin Uygun, Michael Mcgrath, Zeynep Ilkkursun, Sadaf Kaykha, Egbert Sondorp, Peter Ventevogel, Pim Cuijpers
    Abstract:

    Background A considerable evidence base has been produced in recent years highlighting the effectiveness of brief scalable psychological interventions for people living in communities exposed to adversity. However, practical guidance on how to scale up these interventions to wider populations does not exist. In this paper we report on the use of Theory of Change (ToC) to plan the scale up of the World Health Organization's flagship low intensity psychological intervention "Problem Management Plus" (PM+) for Syrian refugees in Turkey. Methods We conducted a one-day ToC workshop in Istanbul. ToC is a participatory planning process used in the development, implementation and evaluation of projects. It is similar to driver diagrams or logic models in that it offers a tool to visually present the components needed to reach a desired long-term outcome or impact. The overall aim of ToC is to understand the change process of a complex intervention and to map out causal pathways through which an intervention or strategy has an effect. Results Twenty-four stakeholders (including governmental officials, mental health providers, officials from international/national non-governmental organisations, conflict and health researchers) participated in the ToC workshop. A ToC map was produced identifying three key elements of scaling up (the resource team; the innovation and the health system; and the user organisation) which are represented in three distinct causal pathways. Context-specific barriers related to the health system and the political environment were identified, and possible strategies for overcoming these challenges were suggested. Conclusion ToC is a valuable methodology to develop an integrated framework for scaling up. The results highlight that the scaling up of PM+ for Syrian refugees in Turkey needs careful planning and investment from different stakeholders at the national level. Our paper provides a theoretical foundation of the scaling up of PM+, and exemplifies for the first time the use of ToC in planning the scaling up of an evidence-based psychological intervention in global mental health.

  • group Problem Management plus gpm in the treatment of common mental disorders in syrian refugees in a jordanian camp study protocol for a randomized controlled trial
    BMC Public Health, 2020
    Co-Authors: Marit Sijbrandij, Aemal Akhtar, Luana Giardinelli, Ahmad Bawaneh, Manar Awwad, Hadeel Naser, Claire Whitney, Mark J D Jordans, Richard A Bryant
    Abstract:

    Accessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce. To mitigate this, the World Health Organization has developed group Problem Management plus (gPM+), a low-intensity psychological intervention for adults experiencing psychological distress. gPM+ is a group-based intervention consisting of five-sessions, and can be delivered by non-specialist providers. This paper outlines the study protocol for a trial of gPM+ in Jordan. We will conduct a single-blind, two-arm, randomized controlled trial in a Syrian refugee camp in Jordan. We aim to enrol 480 adults into the trial. Participants will be eligible for the trial if they screen positive for levels of psychological distress. Following screening, those eligible will be randomly assigned to receive the gPM+ intervention or enhanced treatment as usual. The primary outcome is reduction in levels of psychological distress at 3-months post-treatment. Secondary outcomes include anxiety, depression, prodromal psychotic symptoms, posttraumatic stress disorder, prolonged grief, daily functioning, economic effectiveness, and change in parenting behaviour. Secondary outcomes also include the reduction in psychological distress of the participant’s child. The trial aims to deliver a template for affordable and scalable psychosocial interventions that can readily be implemented in refugee settings, and that can benefit both the participant and their child. Australian New Zealand Clinical Trials Registry, ACTRN12619001386123. Registered prospectively on 10/10/2019.

  • Protocol for a randomized controlled trial: peer-to-peer Group Problem Management Plus (PM+) for adult Syrian refugees in Turkey.
    Trials, 2020
    Co-Authors: Ersin Uygun, Marit Sijbrandij, A. M. De Graaff, Pim Cuijpers, Richard A Bryant, Daniela C. Fuhr, Zeynep Ilkkursun, A Tamer Aker, Joop T. V. M. De Jong, David Mcdaid
    Abstract:

    Background: A large proportion of Syrians have been exposed to potentially traumatic events, multiple losses, and breakdown of supportive social networks and many of them have sought refuge in host countries where they also face post-migration living difficulties such as discrimination or integration Problems or both. These adversities may put Syrian refugees at high risk for common mental disorders. In response to this, the World Health Organization (WHO) developed a trans-diagnostic scalable psychological intervention called Problem Management Plus (PM+) to reduce psychological distress among populations exposed to adversities. PM+ has been adapted for Syrian refugees and can be delivered by non-specialist peer lay persons in the community. Methods: A randomized controlled trial (RCT) will be conducted with 380 Syrian refugees in Turkey. After providing informed consent, participants with high levels of psychological distress (scoring above 15 on the Kessler-10 Psychological Distress Scale (K10)) and functional impairment (scoring above 16 on the WHO Disability Assessment Schedule 2.0, or WHODAS 2.0) will be randomly assigned to Group PM+/enhanced care as usual (Group PM+/E-CAU) (n = 190) or E-CAU (n = 190). Outcome assessments will take place 1 week after the fifth session (post-assessment), 3 months after the fifth session and 12 months after baseline assessment. The primary outcome is psychological distress as measured by the Hopkins Symptom Checklist (HSCL-25). Secondary outcomes include functional impairment, post-traumatic stress symptoms, self-identified Problems, and health system and productivity costs. A process evaluation will be conducted to explore the feasibility, challenges and success of the intervention with 25 participants, including participants, facilitators, policy makers and mental health professionals. Discussion: The treatment manual of the Syrian-Arabic Group PM+ and training materials will be made available through the WHO once the effectiveness and cost-effectiveness of Group PM+ have been established. Trial registration: Clinical Trial Registration: ClinicalTrials.gov Identifier NCT03960892. Unique protocol ID: 10/2017. Prospectively registered on 21 May 2019.

Richard A Bryant - One of the best experts on this subject based on the ideXlab platform.

  • Adaptation of the Problem Management Plus programme for Syrian, Eritrean and Afghan refugee youth
    European Journal of Public Health, 2020
    Co-Authors: C Alozkan Sever, Pim Cuijpers, Richard A Bryant, Katie S Dawson, Ellenor Mittendorfer-rutz, Emily A. Holmes, M Sijbrandi
    Abstract:

    Abstract Background Common mental health Problems are prevalent among refugee minors and impair their daily functioning. Due to various barriers such as lack of culturally appropriate treatments, waiting lists, and stigma they have limited access to care. Problem Management Plus (PM+) was developed by the World Health Organization to address these barriers. PM+ is transdiagnostic, delivered by non-professional helpers, and consists of 5 sessions of Problem-solving skills, behavioural activation and stress Management. PM+ is effective in reducing adults' distress and improve functioning. We aimed to adapt PM+ for refugee minors and add an emotional processing module to target symptoms of posttraumatic stress disorder. Methods We culturally and contextually adapted PM+ for use in Syrian, Eritrean and Afghan refugee minors (age 16-18 years). Data were collected through: 1) free list interviews with Syrian, Eritrean and Afghan refugee minors (n = 30), 2) key informant interviews with knowledgeable refugees (n = 6), professionals (n = 6), policy makers (n = 6) and 3) focus group discussions (n = 24). Data were analysed in ATLAS.ti through inductive and deductive framework analysis. Results The interviews with youth revealed daily life Problems around the following themes: language, family and peers, and substance use. The overall results suggested the need for culture- and age-specific adaptations of 1) the PM+ manual content (language, metaphors, illustrations) and 2) intervention delivery (modality, content and presentation of the trauma processing module, and duration). Conclusions This study led to specific adaptations of PM+ for refugee adolescents to be used in two randomized controlled trials in the Netherlands and Sweden. Key message Refugee minors face numerous barriers reaching mental health care. Scalable, culturally adapted psychological interventions should be developed and evaluated to address common mental disorders in refugee youth.

  • Peer-provided Problem Management Plus (PM+) for adult Syrian refugees: a pilot randomised controlled trial on effectiveness and cost-effectiveness
    Epidemiology and Psychiatric Sciences, 2020
    Co-Authors: A. M. De Graaff, Pim Cuijpers, Barbara Kieft, Richard A Bryant, Daniela C. Fuhr, David Mcdaid, A-la Park, Aniek Woodward, E. Minkenberg, Marit Sijbrandij
    Abstract:

    Abstract Aims Common mental disorders are highly prevalent among Syrian refugees. Problem Management Plus (PM+) is a brief, transdiagnostic, non-specialist helper delivered, psychological intervention targeting psychological distress. This single-blind pilot randomised controlled trial (RCT) on PM+ delivered by peer-refugees examined trial procedures in advance of a definitive RCT, evaluated PM+ 's acceptability and feasibility, and investigated its likely effectiveness and cost-effectiveness among Syrian refugees in the Netherlands. Methods Adult Syrian refugees ( N = 60) with elevated psychological distress (Kessler Psychological Distress Scale (K10) score >15) and reduced pychosocial functioning (WHO Disability Assessment Schedule 2.0 (WHODAS) score >16) were randomised into PM+ in addition to care as usual (CAU) (PM+/CAU; n = 30) or CAU alone ( n = 30). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes were pychosocial functioning (WHO Disability Assessment Schedule; WHODAS 2.0), symptoms of posttraumatic stress disorder (PTSD) (PTSD Checklist for DSM 5; PCL-5) and self-identified Problems (Psychological Outcomes Profiles; PSYCHLOPS). Changes in service utilisation and time out of employment and/or adult education were estimated (adapted version of the Client Service Receipt Inventory; CSRI). Semi-structured interviews on the implementation of PM+ were conducted with stakeholders (i.e. six PM+ participants, five non-specialist helpers and five key informants). Results Recruitment, randomization and blinding procedures were successful. PM+ was generally perceived positively by stakeholders, especially regarding the intervention strategies, accommodation of the intervention and the helpers. Two serious adverse events not attributable to the trial were reported. At 3-month follow-up, the HSCL-25 total score was significantly lower for the PM+/CAU group ( n = 30) than CAU group ( n = 30) ( p = 0.004; d = 0.58). Significant differences in favour of PM+/CAU were also found for WHODAS psychosocial functioning ( p = 0.009, d = 0.73), PCL-5 symptoms of PTSD ( p = 0.006, d = 0.66) and PSYCHLOPS self-identified Problems ( p = 0.005, d = 0.81). There were no significant differences in mean health service costs ( p = 0.191) and the mean costs of lost productive time ( p = 0.141). This suggests PM+ may potentially be cost-effective with an incremental cost from a health system perspective of €5047 (95% CI €0–€19 773) per additional recovery achieved. Conclusions Trial procedures and PM+ delivered by non-specialist peer-refugee helpers seemed acceptable, feasible and safe. Analyses indicate that PM+ may be effective in improving mental health outcomes and psychosocial functioning, and potentially cost-effective. These results support the development of a definitive RCT with a larger sample of refugees and a longer follow-up period.

  • Feasibility of Group Problem Management Plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal.
    Epidemiology and psychiatric sciences, 2020
    Co-Authors: Manaswi Sangraula, Richard A Bryant, Elizabeth L. Turner, Nagendra P. Luitel, E Van 't Hof, Pragya Shrestha, Raju Ghimire, Kedar Marahatta, M Van Ommeren, Brandon A. Kohrt
    Abstract:

    Aims Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal. Methods In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8-8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC). Results We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5-3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm. Conclusion The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.

  • Effectiveness of Group Problem Management Plus (Group-PM+) for adults affected by humanitarian crises in Nepal: study protocol for a cluster randomized controlled trial.
    Trials, 2020
    Co-Authors: Edith Van’t Hof, Richard A Bryant, Mark Van Ommeren, Manaswi Sangraula, Elizabeth L. Turner, Nagendra P. Luitel, Pragya Shrestha, Kedar Marahatta, Brandon A. Kohrt, Mark J D Jordans
    Abstract:

    Background Globally, the lack of availability of psychological services for people exposed to adversities has led to the development of a range of scalable psychological interventions with features that enable better scale-up. Problem Management Plus (PM+) is a brief intervention of five sessions that can be delivered by non-specialists. It is designed for people in communities in low- and middle-income countries (LMIC) affected by any kind of adversity. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the effectiveness of individually delivered PM+. A group version of PM+ has been developed to make the intervention more scalable and acceptable. This paper describes the protocol for a cluster randomized controlled trial (c-RCT) on locally adapted Group PM+ in Nepal. Methods/design This c-RCT will compare Group PM+ to enhanced usual care (EUC) in participants with high levels of psychological distress recruited from the community. The study is designed as a two-arm, single-blind c-RCT that will be conducted in a community-based setting in Morang, a flood affected district in Eastern Nepal. Randomization will occur at ward level, the smallest administrative level in Nepal, with 72 enrolled wards allocated to Group PM+ or to EUC (ratio 1:1). Group PM+ consists of five approximately 2.5-h sessions, in which participants are taught techniques to manage their stressors and Problems, and is delivered by trained and supervised community psychosocial workers (CPSWs). EUC consists of a family meeting with (a) basic information on adversity and mental health, (b) benefits of getting support, (c) information on seeking services from local health facilities with mhGAP-trained staff. The primary outcome measure is levels of individual psychological distress at endline (equivalent to 20 ± 1 weeks after baseline), measured by the General Health Questionnaire (GHQ-12). Secondary outcome measures include levels of functioning, depressive symptoms, post-traumatic stress disorder symptoms, levels of social support, somatic symptoms, and ways of coping. We hypothesize that skills acquired will mediate any impact of the intervention. Discussion This c-RCT will contribute to the growing evidence-base for transdiagnostic psychological interventions delivered by non-specialists for people in communities affected by adversity. If Group PM+ is proven effective, the intervention manual will be released for use, giving the opportunity for further adaptation and implementation of the intervention in diverse settings with communities that require better access to psychological interventions. Trial registration ClinicalTrials.gov, NCT03747055.

  • group Problem Management plus gpm in the treatment of common mental disorders in syrian refugees in a jordanian camp study protocol for a randomized controlled trial
    BMC Public Health, 2020
    Co-Authors: Marit Sijbrandij, Aemal Akhtar, Luana Giardinelli, Ahmad Bawaneh, Manar Awwad, Hadeel Naser, Claire Whitney, Mark J D Jordans, Richard A Bryant
    Abstract:

    Accessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce. To mitigate this, the World Health Organization has developed group Problem Management plus (gPM+), a low-intensity psychological intervention for adults experiencing psychological distress. gPM+ is a group-based intervention consisting of five-sessions, and can be delivered by non-specialist providers. This paper outlines the study protocol for a trial of gPM+ in Jordan. We will conduct a single-blind, two-arm, randomized controlled trial in a Syrian refugee camp in Jordan. We aim to enrol 480 adults into the trial. Participants will be eligible for the trial if they screen positive for levels of psychological distress. Following screening, those eligible will be randomly assigned to receive the gPM+ intervention or enhanced treatment as usual. The primary outcome is reduction in levels of psychological distress at 3-months post-treatment. Secondary outcomes include anxiety, depression, prodromal psychotic symptoms, posttraumatic stress disorder, prolonged grief, daily functioning, economic effectiveness, and change in parenting behaviour. Secondary outcomes also include the reduction in psychological distress of the participant’s child. The trial aims to deliver a template for affordable and scalable psychosocial interventions that can readily be implemented in refugee settings, and that can benefit both the participant and their child. Australian New Zealand Clinical Trials Registry, ACTRN12619001386123. Registered prospectively on 10/10/2019.

Mark Van Ommeren - One of the best experts on this subject based on the ideXlab platform.

  • Cost-effectiveness of WHO Problem Management Plus for adults with mood and anxiety disorders in a post-conflict area of Pakistan: randomised controlled trial.
    The British journal of psychiatry : the journal of mental science, 2020
    Co-Authors: Syed Usman Hamdani, Atif Rahman, Mark Van Ommeren, Zill-e Huma, Duolao Wang, Tao Chen, Dan Chisholm, Saeed Farooq
    Abstract:

    BACKGROUND With the development of evidence-based interventions for treatment of priority mental health conditions in humanitarian settings, it is important to establish the cost-effectiveness of such interventions to enable their scale-up. AIMS To evaluate the cost-effectiveness of the Problem Management Plus (PM+) intervention compared with enhanced usual care (EUC) for common mental disorders in primary healthcare in Peshawar, Pakistan. Trial registration ACTRN12614001235695 (anzctr.org.au). METHOD We randomly allocated 346 participants to either PM+ (n = 172) or EUC (n = 174). Effectiveness was measured using the Hospital Anxiety and Depression Scale (HADS) at 3 months post-intervention. Cost-effectiveness analysis was performed as incremental costs (measured in Pakistani rupees, PKR) per unit change in anxiety, depression and functioning scores. RESULTS The total cost of delivering PM+ per participant was estimated at PKR 16 967 (US$163.14) using an international trainer and supervisor, and PKR 3645 (US$35.04) employing a local trainer. The mean cost per unit score improvement in anxiety and depression symptoms on the HADS was PKR 2957 (95% CI 2262-4029) (US$28) with an international trainer/supervisor and PKR 588 (95% CI 434-820) (US$6) with a local trainer/supervisor. The mean incremental cost-effectiveness ratio (ICER) to successfully treat a case of depression (PHQ-9 ≥ 10) using an international supervisor was PKR 53 770 (95% CI 39 394-77 399) (US$517), compared with PKR 10 705 (95% CI 7731-15 627) (US$102.93) using a local supervisor. CONCLUSIONS The PM+ intervention was more effective but also more costly than EUC in reducing symptoms of anxiety, depression and improving functioning in adults impaired by psychological distress in a post-conflict setting of Pakistan.

  • Effectiveness of Group Problem Management Plus (Group-PM+) for adults affected by humanitarian crises in Nepal: study protocol for a cluster randomized controlled trial.
    Trials, 2020
    Co-Authors: Edith Van’t Hof, Richard A Bryant, Mark Van Ommeren, Manaswi Sangraula, Elizabeth L. Turner, Nagendra P. Luitel, Pragya Shrestha, Kedar Marahatta, Brandon A. Kohrt, Mark J D Jordans
    Abstract:

    Background Globally, the lack of availability of psychological services for people exposed to adversities has led to the development of a range of scalable psychological interventions with features that enable better scale-up. Problem Management Plus (PM+) is a brief intervention of five sessions that can be delivered by non-specialists. It is designed for people in communities in low- and middle-income countries (LMIC) affected by any kind of adversity. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the effectiveness of individually delivered PM+. A group version of PM+ has been developed to make the intervention more scalable and acceptable. This paper describes the protocol for a cluster randomized controlled trial (c-RCT) on locally adapted Group PM+ in Nepal. Methods/design This c-RCT will compare Group PM+ to enhanced usual care (EUC) in participants with high levels of psychological distress recruited from the community. The study is designed as a two-arm, single-blind c-RCT that will be conducted in a community-based setting in Morang, a flood affected district in Eastern Nepal. Randomization will occur at ward level, the smallest administrative level in Nepal, with 72 enrolled wards allocated to Group PM+ or to EUC (ratio 1:1). Group PM+ consists of five approximately 2.5-h sessions, in which participants are taught techniques to manage their stressors and Problems, and is delivered by trained and supervised community psychosocial workers (CPSWs). EUC consists of a family meeting with (a) basic information on adversity and mental health, (b) benefits of getting support, (c) information on seeking services from local health facilities with mhGAP-trained staff. The primary outcome measure is levels of individual psychological distress at endline (equivalent to 20 ± 1 weeks after baseline), measured by the General Health Questionnaire (GHQ-12). Secondary outcome measures include levels of functioning, depressive symptoms, post-traumatic stress disorder symptoms, levels of social support, somatic symptoms, and ways of coping. We hypothesize that skills acquired will mediate any impact of the intervention. Discussion This c-RCT will contribute to the growing evidence-base for transdiagnostic psychological interventions delivered by non-specialists for people in communities affected by adversity. If Group PM+ is proven effective, the intervention manual will be released for use, giving the opportunity for further adaptation and implementation of the intervention in diverse settings with communities that require better access to psychological interventions. Trial registration ClinicalTrials.gov, NCT03747055.

  • Correction to: 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.
    International journal of mental health systems, 2018
    Co-Authors: Syed Usman Hamdani, Marit Sijbrandij, Richard A Bryant, Katie S Dawson, Zainab Ahmed, Huma Nazir, Aqsa Masood, Parveen Akhtar, Hania Amin, Mark Van Ommeren
    Abstract:

    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. 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. 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

  • Protocol for a feasibility study of group-based focused psychosocial support to improve the psychosocial well-being and functioning of adults affected by humanitarian crises in Nepal: Group Problem Management Plus (PM+).
    Pilot and feasibility studies, 2018
    Co-Authors: Manaswi Sangraula, Mark Van Ommeren, Mark J D Jordans, Elizabeth L. Turner, Nagendra P. Luitel, Kedar Marahatta, Edith Van’t Hof, Jolene H Nakao, Brandon A. Kohrt
    Abstract:

    The prevalence of common mental disorders increases in humanitarian emergencies while access to services to address them decreases. Problem Management Plus (PM+) is a brief five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies that can be delivered by non-specialist lay-providers under specialist supervision to adults impaired by distress. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the efficacy of individually delivered PM+. To make PM+ more scalable and acceptable in different contexts, it is important to develop a group version as well, with 6–8 participants in session. A study is needed to demonstrate the feasibility and acceptability of both the intervention in a new cultural context and the procedures to evaluate Group PM+ in a cluster randomized controlled trial. This protocol describes a feasibility trial to Group PM+ in Sindhuli, Nepal. This study will evaluate procedures for a cluster randomized controlled trial (c-RCT) with Village Development Committees (VDCs), which are the second smallest unit of government administration, as the unit of randomization. Adults with high levels of psychological distress and functional impairment will receive either Group PM+ (n = 60) or enhanced usual care (EUC; n = 60). Psychological distress, functional impairment, depression symptoms, posttraumatic stress disorder (PTSD) symptoms, and perceived Problems will be measured during screening, pre-treatment baseline, and 7–10 days after the intervention. Qualitative data will be collected from beneficiaries, their families, local stakeholders, and staff to support quantitative data and to identify themes reporting that those involved and/or effected by Group PM+ perceived it as being acceptable, feasible, and useful. The primary objective of this trial is to evaluate the acceptability and feasibility of the intervention; to identify issues around implementation of local adaptation methods, training, supervision, and outcomes measures; and to assure that procedures are adequate for a subsequent effectiveness c-RCT. Outcomes from this trial will contribute to optimizing feasibility and acceptability through cultural adaptation and contextualization of the intervention as well as refining the design for a c-RCT, which will evaluate the effectiveness of Group PM+ in Nepal. ClinicalTrials.gov identifier: NCT03359486

  • 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.
    International journal of mental health systems, 2017
    Co-Authors: Syed Usman Hamdani, Marit Sijbrandij, Richard A Bryant, Zainab Ahmed, Huma Nazir, Aqsa Masood, Parveen Akhtar, Hania Amin, Katie Dawson, Mark Van Ommeren
    Abstract:

    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. 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. 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.

Marko Jäntti - One of the best experts on this subject based on the ideXlab platform.

  • Establishing a knowledge base for Problem Management, part II
    2008
    Co-Authors: Marko Jäntti, Niko Pylkkänen
    Abstract:

    A knowledge base (KB) can be used for collecting, organizing, and searching the knowledge, such as data on software Problems. Users of IT services can search Problem solutions from the knowledge base which decreases the workload of the service desk. Although KB applications are very useful for customer support, the introduction of KB has been given very little consideration in software engineering research. In our previous paper, the first six phases (identification of stakeholders, process assessment, goal setting, process engineering, knowledge structuring and prototyping) of building a KB were described. This paper presents the final three phases (incremental enhancement and continuous evaluation, deployment and planning the next increment). The research question is: how to establish a knowledge base for a Problem Management process.

  • Difficulties in Managing Software Problems and Defects
    2008
    Co-Authors: Marko Jäntti
    Abstract:

    Many IT organizations are struggling with the increasing number of software Problems and defects. The number of software Problems and defects has increased due to complex IT systems, new technologies, and tight project schedules. Software quality Problems can rapidly increase the costs of software maintenance and development. Unfortunately, support teams of IT organizations have limited resources for resolving software Problems and defects. Often, they do not have well-defined process models for Problem Management. Additionally, traditional defect Management models are not adequate to service-oriented software business in which Problem resolution requires communication between several service providers. The process of managing Problems and defects includes a large number of difficulties and challenges but has been given little consideration in software engineering research. The research work of this thesis is organized around four goals. The first goal is to study software quality assurance methods that can be used to detect defects. The second goal is to identify the difficulties that organizations have in managing software defects and which improvements are needed to existing defect Management models. The third goal is to study the concepts of service-oriented Problem Management. The fourth goal is to study challenges and difficulties of service-oriented Problem Management methods. In this thesis, we have examined software quality assurance methods with a strong focus on UML-based testing and studied how early test case planning helps to detect defects and Problems. We have identified difficulties that IT customers and IT providers have regarding defect Management. We have introduced a service-oriented Problem Management model that describes the concepts of Problem Management, the relationships between concepts, and connections between Problem Management and other service support processes. The model has been tested and evaluated in practice with several case organizations. As a part of the model, a checklist for evaluating Problem Management was created and a knowledge base for proactive Problem Management was established. The main contributions of this thesis are 1) evaluation of a UML-based test model as a defect detection technique, 2) a documented list of challenges and difficulties regarding defect Management, 3) a systematic approach on service-oriented Problem Management with recommendations and guidelines, and 4) a list of difficulties concerning service-oriented Problem Management. These contributions can be used by Problem managers and quality managers to improve Problem Management processes. Universal Decimal Classification: 004.052.4, 004.415.5, 004.415.53, 006.015.5 Inspect Thesaurus: computer software; software quality; software process improvement; quality assurance, quality Management; software Management; errors; error detection; Unified Modeling Language; program testing

  • A checklist for evaluating the software Problem Management model: a case study
    2007
    Co-Authors: Marko Jäntti, Aki Miettinen, Kyösti Vähäkainu
    Abstract:

    Software Problem Management has four major goals: 1) collect information on software Problems, 2) identify defects related to Problems, 3) remove defects and 4) prevent Problems and defects before they occur. At present, many organizations are planning to implement a Problem Management model based on IT Infrastructure Library (ITIL) to improve support and maintenance processes. However, the ITIL framework is a heavy standard with a large number of difficult concepts. IT organizations need practical guidelines to be able to implement ITIL-based processes. The main contribution of this study is to provide a checklist for evaluating the software Problem Management model. The research question in this paper is: what are the requirements for implementing a software Problem Management model. We use the checklist to evaluate the Problem Management model of a case organization: TietoEnator, Energy, Finland.

  • Improving the software Problem Management process : A case study
    Lecture Notes in Computer Science, 2006
    Co-Authors: Marko Jäntti, Kari Kinnunen
    Abstract:

    This paper describes the results of a case study focusing on improving the software Problem Management process in TietoEnator Oyj. The research question is what kind of challenges are related to the software Problem Management process. As main findings, we show a list of challenges identified during the study. Those challenges include the increasing number of open and duplicate Problems in the Problem database, difficulties in combining existing Problem Management concepts with ITIL-based concepts, a lack of performance metrics such as incident turnaround times, and a lack of knowledge base. The main contribution of this study is to help IT organizations to identify the challenges and Problems that are related to ITIL-based Problem Management.

  • EuroSPI - Improving the software Problem Management process: a case study
    Lecture Notes in Computer Science, 2006
    Co-Authors: Marko Jäntti, Kari Kinnunen
    Abstract:

    This paper describes the results of a case study focusing on improving the software Problem Management process in TietoEnator Oyj. The research question is what kind of challenges are related to the software Problem Management process. As main findings, we show a list of challenges identified during the study. Those challenges include the increasing number of open and duplicate Problems in the Problem database, difficulties in combining existing Problem Management concepts with ITIL-based concepts, a lack of performance metrics such as incident turnaround times, and a lack of knowledge base. The main contribution of this study is to help IT organizations to identify the challenges and Problems that are related to ITIL-based Problem Management.

Katie S Dawson - One of the best experts on this subject based on the ideXlab platform.

  • Adaptation of the Problem Management Plus programme for Syrian, Eritrean and Afghan refugee youth
    European Journal of Public Health, 2020
    Co-Authors: C Alozkan Sever, Pim Cuijpers, Richard A Bryant, Katie S Dawson, Ellenor Mittendorfer-rutz, Emily A. Holmes, M Sijbrandi
    Abstract:

    Abstract Background Common mental health Problems are prevalent among refugee minors and impair their daily functioning. Due to various barriers such as lack of culturally appropriate treatments, waiting lists, and stigma they have limited access to care. Problem Management Plus (PM+) was developed by the World Health Organization to address these barriers. PM+ is transdiagnostic, delivered by non-professional helpers, and consists of 5 sessions of Problem-solving skills, behavioural activation and stress Management. PM+ is effective in reducing adults' distress and improve functioning. We aimed to adapt PM+ for refugee minors and add an emotional processing module to target symptoms of posttraumatic stress disorder. Methods We culturally and contextually adapted PM+ for use in Syrian, Eritrean and Afghan refugee minors (age 16-18 years). Data were collected through: 1) free list interviews with Syrian, Eritrean and Afghan refugee minors (n = 30), 2) key informant interviews with knowledgeable refugees (n = 6), professionals (n = 6), policy makers (n = 6) and 3) focus group discussions (n = 24). Data were analysed in ATLAS.ti through inductive and deductive framework analysis. Results The interviews with youth revealed daily life Problems around the following themes: language, family and peers, and substance use. The overall results suggested the need for culture- and age-specific adaptations of 1) the PM+ manual content (language, metaphors, illustrations) and 2) intervention delivery (modality, content and presentation of the trauma processing module, and duration). Conclusions This study led to specific adaptations of PM+ for refugee adolescents to be used in two randomized controlled trials in the Netherlands and Sweden. Key message Refugee minors face numerous barriers reaching mental health care. Scalable, culturally adapted psychological interventions should be developed and evaluated to address common mental disorders in refugee youth.

  • Correction to: 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.
    International journal of mental health systems, 2018
    Co-Authors: Syed Usman Hamdani, Marit Sijbrandij, Richard A Bryant, Katie S Dawson, Zainab Ahmed, Huma Nazir, Aqsa Masood, Parveen Akhtar, Hania Amin, Mark Van Ommeren
    Abstract:

    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. 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. 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

  • 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
    International Journal of Mental Health Systems, 2017
    Co-Authors: Syed Usman Hamdani, Marit Sijbrandij, Richard A Bryant, Katie S Dawson, Zainab Ahmed, Huma Nazir, Aqsa Masood, Parveen Akhtar, Hania Amin, Mark Van Ommeren
    Abstract:

    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. 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. 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

  • Problem Management plus pm pilot trial of a who transdiagnostic psychological intervention in conflict affected pakistan
    Worlds Poultry Science Journal, 2016
    Co-Authors: Atif Rahman, Marit Sijbrandij, Richard A Bryant, Katie S Dawson, Syed Usman Hamdani, Anna Chiumento, Fareed Minhas, Khalid Saeed, Naila Riaz, Mark Van Ommeren
    Abstract:

    The mental health consequences of conflict and natural disaster are substantial and wide‐ranging1, 2. There is an urgent need for interventions by non‐specialist workers that can address a range of mental health Problems3. The World Health Organization (WHO)'s Problem Management Plus (PM+) is a brief transdiagnostic psychological intervention employing evidence‐based strategies of Problem solving, behavioural activation, strengthening social support, and stress Management4. We adapted the individual treatment format of this intervention for conflict‐affected Peshawar in Pakistan. It consisted of five face‐to‐face sessions, with a key feature of being affordable in most settings, because it can be offered not only by specialists but also by supervised non‐specialists with no prior training or experience in mental health care delivery. We used an apprenticeship (on‐the‐job learning) model for training and supervising the non‐specialists5, which involved an initial 6‐day training programme by a master trainer to local mental health specialists, who in turn provided an 8‐day training programme to six non‐specialists. Training of both supervisors and non‐specialists was followed by four weeks of practice under supervision of the local trainers. The local trainers themselves were supervised 3‐weekly through audio calls by the master trainer, building skills in the intervention as well as in training and supervision. All non‐specialists were evaluated for their competency by independent assessors using a competency rating tool evaluating basic helping skills and use of PM+ strategies through observation of specially designed role plays. Competency was rated using a 5‐point scale. In total, four out of six achieved scores indicating competency in all basic helping skills and five out of six achieved all competency scores on PM+ strategies. Following additional training and supervision, all non‐specialists demonstrated adequate proficiency in requisite skills. We conducted a single‐blind pilot randomized controlled trial (RCT) to explore the feasibility and acceptability of the intervention in Peshawar. PM+ was compared to enhanced treatment as usual, consisting of Management by primary care physician who received one day of basic training in treatment of common mental disorders. The study was conducted from March to May 2014 in two primary care centres in Gulbahar Union Council, a low‐income peri‐urban locality in Peshawar district. Participants were primary care attenders aged 18 or above, referred for screening by the primary care physician. Screening was conducted by trained members of the research team following informed consent to recruit persons with both marked distress and impairment. Invited participants scored: a) 2 or above on the General Health Questionnaire (GHQ‐12)6, a 12 item questionnaire of general psychological distress with a 4‐point scale ranging from 0 to 3 scored bi‐modally when used as a screener (possible range 0‐12), and b) 17 or above on the WHO Disability Assessment Schedule (WHODAS 2.0)7, a screener for functional impairment with 12 items measured on a scale ranging from 1 to 5 (possible range 12‐60). We excluded individuals with imminent suicide risk, severe cognitive impairment (e.g., severe intellectual disability or dementia) or with expressed acute needs/protection risks (e.g., recent abandonment by husband and his family). We also excluded individuals who reported having experienced a major traumatic event during the past month and individuals with severe mental disorder (psychotic disorders, substance dependence). Individuals meeting the exclusion criteria were referred to specialist centres depending upon their needs. Ethical approvals were obtained from the Ethics Review Board at the Lady Reading Hospital, Peshawar, and WHO's Ethical Review Committee. Approval was also obtained from the district primary care administration. Participants were interviewed after voluntary written consent. Out of 1,286 people seen by a physician during the study period, 94 were referred for screening, 85 met study criteria, 81 were accessible, and 60 consented to participate in the trial. Randomization to the PM+ intervention or enhanced treatment as usual was performed by an independent researcher not involved in the project using computerized software on a 1:1 basis, stratified for gender. Nine out of 60 (15%) – five from the intervention arm and four from the control arm – were lost to follow‐up. The groups were well‐balanced at baseline for demographic and clinical variables. The primary outcome, assessed by independent raters, was psychological distress, measured by GHQ‐12 with scores being the total sum across 12 items (possible range 0‐36). Other outcomes included: functioning, measured using the 12‐item interviewer‐administered screener version of the WHODAS 2.0; and post‐traumatic stress symptoms, measured using the PTSD Checklist for DSM‐5 (PCL‐5)8, which is a 20‐item checklist corresponding to the twenty DSM‐5 PTSD symptoms in the last week, with items rated on a 0‐4 scale (possible range 0‐80). The intervention had high uptake, with 22/30 (73%) completing all sessions. The intervention arm showed improvement in functioning (mean WHODAS 2.0 scores reduced from 17.7 ± 9.2 to 6.6 ± 6.1 vs. 17.0 ± 10.5 to 11.3 ± 10.4 in controls) and in post‐traumatic stress symptoms (mean PCL‐5 scores reduced from 34.2 ± 20.1 to 9.8 ± 9.1 vs. 32.3 ± 17.1 to 19.5 ± 18.5 in controls). Due to skewed distribution and variance heterogeneity of the outcome variable, log‐linear regression was carried out. After adjustment of baseline scores, the results showed a reduction of 90% in geometric mean within the intervention group (95% CI: 90.4%‐91.7%, p=0.04) in WHODAS 2.0 scores and a reduction of 92% (95% CI: 91.2%‐92.3%, p=0.02) in post‐traumatic stress symptoms. There was no significant change in GHQ‐12 scores. On qualitative evaluation of a sub‐sample of participants and primary care staff, we found that the intervention was perceived as useful, and was successfully integrated into primary care centres. As this was a pilot study with a small sample size, recruited through primary care physician referral, and no power calculations were carried out, the findings and their generalizability warrant a cautious interpretation. However, a successful conduction in challenging settings, with adequate enrolment rate, a low drop‐out, and balanced randomization provides evidence that RCTs are feasible in such settings. The intervention delivery through non‐specialists with no prior mental health care experience and the encouraging results demonstrate the feasibility of the task shifting approach, and are consistent with previous reports9, 10. The results of this pilot study should encourage further adaptation and large‐scale fully‐powered RCTs of this new, transdiagnostic psychological intervention4. Atif Rahman1,2, Naila Riaz3, Katie S. Dawson4, Syed Usman Hamdani2, Anna Chiumento1, Marit Sijbrandij5, Fareed Minhas6, Richard A. Bryant4, Khalid Saeed7, Mark van Ommeren8, Saeed Farooq3 1University of Liverpool, Liverpool, UK; 2Human Development Research Foundation, Islamabad, Pakistan; 3Lady Reading Hospital, Peshawar, Pakistan; 4University of New South Wales, Sydney, Australia; 5VU University Amsterdam, Amsterdam, The Netherlands; 6Institute of Psychiatry, Rawalpindi, Pakistan; 7Mental Health and Substance Abuse Unit, Regional Office for the Eastern Mediterranean Region, World Health Organization, Cairo, Egypt; 8Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

  • Problem Management plus pm in the treatment of common mental disorders in women affected by gender based violence and urban adversity in kenya study protocol for a randomized controlled trial
    International Journal of Mental Health Systems, 2016
    Co-Authors: Marit Sijbrandij, Richard A Bryant, Katie S Dawson, Syed Usman Hamdani, Alison Schafer, Dorothy Anjuri, Lincoln Ndogoni, Jeannette Ulate, Mark Van Ommeren
    Abstract:

    Background Women affected by adversity, including gender-based violence, are at increased risk for developing common mental disorders such as depression, anxiety and posttraumatic stress disorder (PTSD). The World Health Organization (WHO) has developed Problem Management Plus (PM+), a 5-session, individual psychological intervention program, that can be delivered by non-specialist counsellors that addresses common mental disorders in people affected by adversity. The objectives of this study are to evaluate effectiveness of PM+ among women who have been affected by adversity, including gender-based violence, and to perform a process evaluation.