Aims Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal. Methods In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8–8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC). Results We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5–3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm. Conclusion The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.

中文翻译：

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Group Problem Management Plus (PM+) 改善尼泊尔受地震影响社区成年人心理健康和功能的可行性

目标 简短、可接受、有效且可由非专家提供的心理干预在低收入和中等收入国家尤为必要，因为那里的精神卫生系统无法满足高水平的社会心理需求。问题管理增强版 (PM+) 是一项为期五次的干预措施，专为那些生活在受逆境影响的社区而受到心理困扰的人设计。在肯尼亚和巴基斯坦，个人 PM+ 已证明在减轻痛苦方面有效，而 PM+ 的团体版本（Group PM+）对巴基斯坦受冲突影响的妇女有效。本文描述了在尼泊尔农村受地震影响地区进行的针对女性和男性的当地适应组 PM+ 的可行性和可接受性试验。方法 在这项可行性整群随机对照试验中，实验组的参与者接受了五次 PM+ 组会议，对照组的参与者接受了强化常规护理 (EUC)，这需要进行简短的心理教育，并为初级保健服务提供转诊选择，并由接受过心理健康差距行动培训的卫生工作者提供项目干预指南 (mhGAP-IG)。混合方法设计用于评估 PM+ 组的可行性和可接受性。可行性评估标准包括参与者的忠诚度和保留率。通过与参与者、家庭成员、项目工作人员和其他利益相关者的深入访谈来评估可接受性。主要临床结果是使用患者健康问卷 (PHQ-9) 在基线和基线后 8-8.5 周（即 组 PM+ 或 EUC 完成后）。结果 我们招募了 121 名参与者（83% 的女性和 17% 的男性），PM+ 组和 EUC 组的分配均等 (1:1)。小组 PM+ 由经过培训和监督的、性别匹配的当地非专家进行了 5 次 2.5-3 小时的会议，平均有五次会议出席。定量和定性结果证明了非专业人员交付 Group PM+ 的可行性和可接受性。尽管该研究无法评估有效性，但对于包括主要临床结果在内的所有五项关键结果指标，PM+ 组的估计平均改善幅度大于 EUC 组。结论 参与者、家庭成员和项目工作人员可以接受干预和试验程序。社区和参与者发现干预是有益的。由于在该试验中确立了可行性和可接受性，将进行一项全功率随机对照试验以进行更大规模的实施，以确定尼泊尔干预措施的有效性。