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Effectiveness of Group Problem Management Plus, a brief psychological intervention for adults affected by humanitarian disasters in Nepal: A cluster randomized controlled trial.
Jordans, Mark J D; Kohrt, Brandon A; Sangraula, Manaswi; Turner, Elizabeth L; Wang, Xueqi; Shrestha, Pragya; Ghimire, Renasha; Van't Hof, Edith; Bryant, Richard A; Dawson, Katie S; Marahatta, Kedar; Luitel, Nagendra P; van Ommeren, Mark.
  • Jordans MJD; Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
  • Kohrt BA; Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
  • Sangraula M; Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
  • Turner EL; Division of Global Mental Health, Department of Psychiatry & Behavioral Sciences, The George Washington University, Washington, DC, United States of America.
  • Wang X; Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
  • Shrestha P; Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
  • Ghimire R; Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
  • Van't Hof E; Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
  • Bryant RA; Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
  • Dawson KS; World Health Organization, Geneva, Switzerland.
  • Marahatta K; University of New South Wales, Sydney, Australia.
  • Luitel NP; University of New South Wales, Sydney, Australia.
  • van Ommeren M; World Health Organization Country Office for Nepal, Kathmandu, Nepal.
PLoS Med ; 18(6): e1003621, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315878
Semantic information from SemMedBD (by NLM)
1. Brief Interventions TREATS Adult
Subject
Brief Interventions
Predicate
TREATS
Object
Adult
2. Health care facility LOCATION_OF Psychoeducation
Subject
Health care facility
Predicate
LOCATION_OF
Object
Psychoeducation
3. General health questionnaire MEASURES Psychological Distress
Subject
General health questionnaire
Predicate
MEASURES
Object
Psychological Distress
4. Chronic disease PROCESS_OF Woman
Subject
Chronic disease
Predicate
PROCESS_OF
Object
Woman
5. AKR1A1 wt Allele compared_with AKR1A1 wt Allele
Subject
AKR1A1 wt Allele
Predicate
compared_with
Object
AKR1A1 wt Allele
6. HEART PROBLEM PROCESS_OF Participant
Subject
HEART PROBLEM
Predicate
PROCESS_OF
Object
Participant
7. physical illness CAUSES Cessation of life
Subject
physical illness
Predicate
CAUSES
Object
Cessation of life
8. Adverse event ASSOCIATED_WITH AKR1A1 wt Allele
Subject
Adverse event
Predicate
ASSOCIATED_WITH
Object
AKR1A1 wt Allele
9. Group Therapies PREVENTS Depressive Symptoms
Subject
Group Therapies
Predicate
PREVENTS
Object
Depressive Symptoms
10. Group Therapies PREVENTS Psychological Distress
Subject
Group Therapies
Predicate
PREVENTS
Object
Psychological Distress
11. Brief Interventions TREATS Adult
Subject
Brief Interventions
Predicate
TREATS
Object
Adult
12. Health care facility LOCATION_OF Psychoeducation
Subject
Health care facility
Predicate
LOCATION_OF
Object
Psychoeducation
13. General health questionnaire MEASURES Psychological Distress
Subject
General health questionnaire
Predicate
MEASURES
Object
Psychological Distress
14. Chronic disease PROCESS_OF Woman
Subject
Chronic disease
Predicate
PROCESS_OF
Object
Woman
15. AKR1A1 wt Allele compared_with AKR1A1 wt Allele
Subject
AKR1A1 wt Allele
Predicate
compared_with
Object
AKR1A1 wt Allele
16. HEART PROBLEM PROCESS_OF Participant
Subject
HEART PROBLEM
Predicate
PROCESS_OF
Object
Participant
17. physical illness CAUSES Cessation of life
Subject
physical illness
Predicate
CAUSES
Object
Cessation of life
18. Adverse event ASSOCIATED_WITH AKR1A1 wt Allele
Subject
Adverse event
Predicate
ASSOCIATED_WITH
Object
AKR1A1 wt Allele
19. Group Therapies PREVENTS Depressive Symptoms
Subject
Group Therapies
Predicate
PREVENTS
Object
Depressive Symptoms
20. Group Therapies PREVENTS Psychological Distress
Subject
Group Therapies
Predicate
PREVENTS
Object
Psychological Distress
ABSTRACT

BACKGROUND:

Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. METHODS AND

FINDINGS:

We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of -0.4 (95% CI -0.5, -0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI 0.3, 2.5, p = 0.014), with SMD of -0.2 (95% CI -0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have "heart-mind" problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information.

CONCLUSIONS:

In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. TRIAL REGISTRATION ClinicalTrials.gov NCT03747055.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Problem Solving / Psychotherapy, Brief / Psychotherapy, Group / Relief Work / Stress Disorders, Post-Traumatic / Stress, Psychological / Mental Health / Depression / Natural Disasters Type of study: Controlled clinical trial / Diagnostic study / Etiology study / Qualitative research / Randomized controlled trials Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Asia Language: English Journal: PLoS Med Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pmed.1003621

Full text: Available Collection: International databases Database: MEDLINE Main subject: Problem Solving / Psychotherapy, Brief / Psychotherapy, Group / Relief Work / Stress Disorders, Post-Traumatic / Stress, Psychological / Mental Health / Depression / Natural Disasters Type of study: Controlled clinical trial / Diagnostic study / Etiology study / Qualitative research / Randomized controlled trials Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Asia Language: English Journal: PLoS Med Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pmed.1003621