In a study published online by JAMA, Atif Rahman, Ph.D., of the University of Liverpool, England, and colleagues evaluated the effectiveness of a multicomponent behavioral intervention delivered in primary care centers in Peshawar, Pakistan by lay health workers to adults with psychological distress. The study is being released to coincide with its presentation at the International Society for Traumatic Stress Studies annual meeting.
More than 125 million people today are directly affected by armed conflict, the highest number since World War II. Although reported rates of mental disorders vary, a meta-analysis of a subset of relatively rigorous post-conflict surveys showed that mood and anxiety disorders were common, with rates of 17 percent for depression and 15 percent for posttraumatic stress disorder. Scalable interventions to address a range of mental health problems are needed.
In this study, 346 adult primary care attendees with high levels of both psychological distress and functional impairment were randomly assigned to receive 5 weekly 90-minute individual sessions, administered by lay health workers, that included empirically supported strategies of problem solving, behavioral activation, strengthening social support, and stress management (n = 172); or enhanced usual care (n= 174). The trial was conducted from November 2014 through January 2016 in 3 primary care centers in Peshawar, Pakistan.
Among the patients, 146 (intervention) and 160 (enhanced usual care) completed the study. After 3 months of treatment, the intervention group had significantly lower average scores than the control group on measures of anxiety and depression. At 3 months, there were also significant differences in scores of posttraumatic stress, functional impairment, problems for which the person sought help, and symptoms of depressive disorder.
"This randomized clinical trial tested the effectiveness of a brief lay health worker-administered multicomponent intervention in Peshawar, Pakistan, a low-income setting affected by ongoing conflict and insecurity," the authors write. "Improvement across all dimensions of anxiety, depression, trauma-related symptoms, and functioning demonstrated the effectiveness of the transdiagnostic feature of the intervention."
(doi:10.1001/jama.2016.17165; the study is available pre-embargo at the For the Media website)
Editor's Note: This work was supported by Enhanced Learning and Research for Humanitarian Assistance's Research for Health in Humanitarian Crises initiative funded by the UK Department for International Development and the Wellcome Trust. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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