Hamdani Syed Usman, Huma Zill-E-, Masood Aqsa, Zhou Kaina, Ahmed Zainab, Nazir Huma, Amin Hania, Akhtar Parveen, Bryant Richard A, Dawson Katie, van Ommeren Mark, Wang Duolao, Rahman Atif, Minhas Fareed Aslam
University of Liverpool, Liverpool, UK.
Human Development Research Foundation, Islamabad, Pakistan.
Int J Ment Health Syst. 2021 Jan 19;15(1):11. doi: 10.1186/s13033-020-00434-y.
In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan.
A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N = 192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM + plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS 2.0) at 20 weeks after baseline.
The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20 weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, - 3.10; 95% CI, - 0.26 to - 5.76); p = 0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, - 4.35; 95% CI, - 1.45 to - 7.24); p = 0.004 in PM + plus TAU versus TAU arm. The follow-up rate was 67% at primary end-point.
Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered March 23, 2016. Retrospectively registered, https://www.anzctr.org.au/Default.aspx/ ACTRN12616000381482.
在许多资源匮乏地区，政府提供的精神卫生保健服务仅限于城市医院护理机构中的专业精神科病房，常见精神障碍（CMDs）最常见的治疗方法是药物治疗，偶尔辅以非特异性心理支持。我们旨在评估在巴基斯坦一家专业精神卫生保健机构中，为常见精神障碍增加一种低强度心理干预——问题管理强化疗法（PM+）到常规护理中的效果。
对由精神科医生转介接受心理支持的成年人（N = 192）进行了一项双臂、单盲个体随机对照试验（RCT）。研究参与者被随机（1:1）分为PM+联合常规治疗（TAU）组（n = 96）或仅TAU组（n = 96）。主要结局指标为焦虑和抑郁症状，通过医院焦虑抑郁量表（HADS）测量，以及功能损害，通过世界卫生组织残疾评定量表（WHODAS 2.0）在基线后20周测量。
分析基于意向性分析原则。线性混合模型分析显示，在基线后20周，PM+联合TAU组与仅TAU组相比，焦虑和抑郁症状有显著减轻（均值[标准差]，16.23[8.81]对19.79[7.77]；平均差，-3.10；95%置信区间，-0.26至-5.76）；p = 0.03，功能有改善（均值[标准差]，22.94[9.37]对27.37[8.36]；平均差，-4.35；95%置信区间，-1.45至-7.24）；p = 0.004。主要终点的随访率为67%。
低收入和中等收入国家的专业护理机构可考虑在常规护理中增加针对常见精神障碍的简短、循证心理治疗。试验注册澳大利亚新西兰临床试验注册中心，ACTRN12616000381482。于2016年3月23日注册。追溯注册，https://www.anzctr.org.au/Default.aspx/ ACTRN12616000381482。
