Hussain Basharat, Khalily Muhammad Tahir, Waqas Ahmed, Rahman Atif, Angelakis Ioannis, Nisar Anum, Zaman Sabir, Akhtar Tanveer
Department of Psychology, International Islamic University, Islamabad, Pakistan.
Department of Psychology and Human Development, Karakoram International University Gilgit, Gligit, Gilgit-Baltistan, Pakistan.
Front Psychiatry. 2025 Jan 30;15:1413809. doi: 10.3389/fpsyt.2024.1413809. eCollection 2024.
In Pakistan, the mental health care for persons living with disabilities is insufficient, lacking a holistic approach to address their needs. This research evaluates the adapted PM+'s (IA-PM+) initial efficacy and acceptability in improving mental health among persons living with disabilities, contributing to the integration of mental health services within primary care settings in Pakistan.
This study employed a two-arm, single-blind cluster randomized controlled trial in a community setting within Union Council Kuri Dolal, Tehsil Gujjar Khan, District Rawalpindi-Pakistan. It compared an Active Treatment group, receiving five sessions of the IA-PM+ intervention, against a Delayed Treatment Control group. A total of 148 participants were randomized. Randomization occurred at the village level, with clusters assigned to either the intervention or control group. The intervention's effectiveness and participant satisfaction were assessed using a variety of measures, including the GHQ-12, WHODAS 2.0, DASS-21, and the Client Satisfaction Questionnaire, at baseline, the 8th week, and during a 3-month follow-up. Qualitative feedback was gathered at the end of the study to assess the intervention's acceptability among the participants.
The study achieved a 100% retention rate. Baseline demographics showed a majority male participation with a variety of disabilities predominantly lower limb. Significant improvements were noted in the intervention group across WHODAS scores (Cohen's d= 0.66), PTSD symptoms (d= 0.75), and DASS scores for depression (d= 0.46), anxiety (d=0.65), and stress (d= 0.47). Similar trends were noted during the follow-up phases. However, life satisfaction scores initially higher in the control group evened out by follow-up, and perceived social support was consistently lower in the intervention group. High levels of client satisfaction were reported in the intervention group, with most participants finding the sessions beneficial and expressing willingness to recommend the service to others. The qualitative interviews revealed that the integration of religious practices, such as associating stress management techniques with Adhan, significantly enhanced the acceptability of the culturally adapted PM+ intervention. Participants reported that this cultural alignment made the coping strategies more relatable and easier to adopt, contributing to improvements in both their mental health and somatic symptoms.
https://clinicaltrials.gov/ct2/show/NCT04981522, identifier NCT04981522.
在巴基斯坦，为残疾人提供的精神卫生保健不足，缺乏全面满足其需求的方法。本研究评估了适应性巴基斯坦心理健康项目（IA-PM+）在改善残疾人心理健康方面的初步疗效和可接受性，有助于将精神卫生服务纳入巴基斯坦基层医疗环境。
本研究在巴基斯坦拉瓦尔品第区古杰尔汗乡库里多拉联合委员会的社区环境中进行了一项双臂、单盲整群随机对照试验。它将接受五节IA-PM+干预课程的积极治疗组与延迟治疗对照组进行了比较。共有148名参与者被随机分组。随机分组在村庄层面进行，整群被分配到干预组或对照组。在基线、第8周和3个月随访期间，使用多种测量方法评估干预效果和参与者满意度，包括一般健康问卷-12（GHQ-12）、世界卫生组织残疾评定量表2.0（WHODAS 2.0）、抑郁焦虑压力量表-21（DASS-21）和客户满意度问卷。在研究结束时收集定性反馈，以评估参与者对干预的可接受性。
该研究实现了100%的保留率。基线人口统计学显示，大多数参与者为男性，患有多种残疾，主要是下肢残疾。干预组在世界卫生组织残疾评定量表得分（科恩d值=0.66）、创伤后应激障碍症状（d值=0.75）以及抑郁（d值=0.46）、焦虑（d值=0.65）和压力（d值=0.47）的抑郁焦虑压力量表得分方面有显著改善。在随访阶段也观察到了类似趋势。然而，对照组最初较高的生活满意度得分在随访时趋于平稳，且干预组的感知社会支持一直较低。干预组报告了较高的客户满意度，大多数参与者认为这些课程有益，并表示愿意向他人推荐该服务。定性访谈显示，将宗教活动（如将压力管理技巧与宣礼联系起来）融入其中，显著提高了文化适应性巴基斯坦心理健康项目干预的可接受性。参与者报告说，这种文化契合使应对策略更具相关性且更容易采用，有助于改善他们的心理健康和躯体症状。
https://clinicaltrials.gov/ct2/show/NCT04981522，标识符NCT04981522。
