Effectiveness of Group Problem Management Plus, a brief psychological intervention for adults affected by humanitarian disasters in Nepal: A cluster randomized controlled trial

• Published in: PLoS medicine 2021-06, Vol.18 (6), p.e1003621-e1003621
• Main Authors: Jordans, Mark J D, Kohrt, Brandon A, Sangraula, Manaswi, Turner, Elizabeth L, Wang, Xueqi, Shrestha, Pragya, Ghimire, Renasha, Van't Hof, Edith, Bryant, Richard A, Dawson, Katie S, Marahatta, Kedar, Luitel, Nagendra P, van Ommeren, Mark
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adolescent; Adult; Adverse events; Aged; Aged, 80 and over; Aggression; Alcohol use; Biology and Life Sciences; Clinical trials; Community; Coronaviruses; COVID-19; Depression - diagnosis; Depression - etiology; Depression - psychology; Depression - therapy; Depression, Mental; Disasters; Female; Functional Status; Gender identity; Group counseling; Health aspects; Health services; Humanitarianism; Humans; Intervention; Male; Management; Medicine and Health Sciences; Mental depression; Mental disorders; Mental Health; Middle Aged; Natural Disasters; Nepal; Pandemics; People and Places; Post traumatic stress disorder; Prevention; Problem Solving; Psychological aspects; Psychotherapy, Brief; Psychotherapy, Group; Questionnaires; Relief Work; Risk factors; Skills; Social interactions; Social Sciences; Social support; Stress (Psychology); Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - etiology; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Stress, Psychological - diagnosis; Stress, Psychological - etiology; Stress, Psychological - psychology; Stress, Psychological - therapy; Suicide; Time Factors; Training; Treatment Outcome; Young Adult
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003621

Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (9