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

中文翻译：

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在巴基斯坦一家专门的精神保健机构中对常见精神障碍的常规护理增加心理干预的效果：一项随机对照试验

在许多资源匮乏的环境中，政府心理保健服务的提供仅限于城市医院医疗机构中的专门精神病科，那里常见的精神障碍（CMD）最常见的治疗方法是药物疗法，有时还需要辅助的非特异性心理支持。我们旨在评估在巴基斯坦的一家专门的心理健康护理机构中，在常规护理中添加针对CMD的低强度心理干预，问题管理增强版（PM +）的有效性。对成年人（N = 192）进行了两臂单盲个人随机对照试验（RCT），由精神科医生提供了心理支持。研究参与者随机（1：1）进行PM +常规治疗（TAU）（n = 96）或仅TAU（n = 96）。主要结局是焦虑和抑郁症状，在基线后20周时，通过医院焦虑抑郁量表（HADS）进行评估，并通过WHO残疾评估表（WHODAS 2.0）进行功能损害评估。分析是按照意向性治疗原则进行的。线性混合模型分析显示，基线后20周，焦虑和抑郁症状显着减少（平均值[SD]为16.23 [8.81]对19.79 [7.77]； AMD为− 3.10； 95％CI为− 0.26至-5.76）；p = 0.03和功能改善（平均值[SD]为22.94 [9.37]，而平均值为27.37 [8.36]； AMD为− 4.35； 95％CI为− 1.45至− 7.24）；p + TAU与TAU臂的p = 0.004。主要终点的随访率为67％。中低收入国家的专门护理机构可以考虑在其常规护理中增加针对CMD的简短的，循证的心理治疗。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