Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands.
School of Psychology, University of New South Wales, Sydney, Australia.
Depress Anxiety. 2022 Jan;39(1):71-82. doi: 10.1002/da.23221. Epub 2021 Nov 9.
To address shortages of mental health specialists in low- and middle-income countries, task-shifting approaches have been employed to train nonspecialists to deliver evidence-based scalable psychosocial interventions. Problem Management Plus (PM+) is a brief transdiagnostic nontrauma focused intervention for people affected by adversity. This study reports on the capacity of PM+ to address specific symptoms of posttraumatic stress disorder (PTSD).
Individual patient data from three randomised controlled trials were combined and analysed to observe the impacts of PM+ (n = 738) or enhanced treatment as usual (ETAU) (n = 742) interventions on specific PTSD symptoms at posttreatment and 3-month follow-up. The PTSD-Checklist for DSM-5 (PCL-5) was used to index PTSD symptoms, and presence of each symptom was defined as moderate severity (score ≥ 2 on individual items).
The average PCL-5 score at baseline was 26.1 (SD: 16.8) with 463 (31.3%) scoring above 33, indicative of a diagnosis of PTSD. Following intervention, 12.5% and 5.8% of participants retained a score greater than 33 at postassessment and follow-up, respectively. There was greater symptom reduction for PM+ than for ETAU for most symptoms. Hyperarousal symptoms were the most common residual symptoms after PM+, with more than 30% of participants reporting persistent sleep disturbance, concentration difficulties, and anger.
PM+ led to greater reduction in symptoms relating to re-experiencing and avoidance. The evidence indicates that strategies focusing on hyperarousal symptoms including sleep, concentration, and anger difficulties, could be strengthened in this brief intervention.
为了解决中低收入国家精神卫生专家短缺的问题，已经采用了任务转移方法来培训非专业人员提供基于证据的可扩展心理社会干预措施。问题管理加（PM+）是一种针对受逆境影响的人的简短的跨诊断非创伤性的非聚焦干预措施。本研究报告了 PM+解决创伤后应激障碍（PTSD）特定症状的能力。
对三项随机对照试验的个体患者数据进行了合并和分析，以观察 PM+（n=738）或增强的常规治疗（ETAU）（n=742）干预对治疗后和 3 个月随访时特定 PTSD 症状的影响。使用DSM-5 创伤后应激障碍检查表（PCL-5）来评定 PTSD 症状，并且将每个症状的存在定义为中度严重程度（个体项目得分为≥2）。
基线时的平均 PCL-5 得分为 26.1（标准差：16.8），有 463 人（31.3%）得分高于 33，表明存在 PTSD 诊断。干预后，分别有 12.5%和 5.8%的参与者在评估后和随访时的得分仍大于 33。与 ETAU 相比，PM+的大多数症状的症状缓解程度更大。PM+后的残留症状中以警觉性增高症状最为常见，超过 30%的参与者报告持续存在睡眠障碍、注意力困难和愤怒。
PM+导致与再体验和回避相关的症状减轻更多。证据表明，在这种简短的干预中，可能需要加强针对警觉性增高症状（包括睡眠、注意力和愤怒困难）的策略。
