Effect of a Multicomponent Behavioral Intervention in Adults Impaired by Psychological bistress in a Conflict-Affected Area of Pakistan: A Randomized Clinical Trial

• Published in: JAMA : the journal of the American Medical Association 2016-12, Vol.316 (24), p.2609
• Main Authors: Rahman, Atif, Hamdani, Syed Usman, Awan, Naila Riaz, Bryant, Richard A, Dawson, Katie S, Khan, Muhammad Firaz, Azeemi, Mian Mukhtar-ul-Haq, Akhtar, Parveen, Nazir, Huma, Chiumento, Anna, Sijbrandij, Marit, Wang, Duolao, Farooq, Saeed, van Ommeren, Mark
• Format: Article
• Language: English
• Subjects: Adults; Behavior modification; Clinical trials; Mental disorders
• ISSN: 0098-7484; 1538-3598

Rahman et al examine the effectiveness of a multicomponent behavioral intervention delivered by lay health workers to adults with psychological distress in primary care settings. Among 346 patients (mean [SD] age, 33.0 [11.8] years; 78.9% women), 172 were randomly assigned to the intervention and 174 to enhanced usual care; among them, 146 and 160 completed the study, respectively. At baseline, the intervention and control groups had similar mean (SD) Hospital Anxiety and Depression Scale (HADS) scores on symptoms of anxiety (14.16 [3.17] vs 13.64 [3.20]; adjusted mean difference [AMD], 0.52; 95% CI, -0.22 to 1.27) and depression (12.67 [3.27] vs 12.49 [3.34]; AMD, 017,95% CI, -0.54 to 0.89). After 3 months of treatment, the intervention group had significantly lower mean (SD) HADS scores than the control group for anxiety (7.25 [3.63] vs 10.03 [3.87]; AMD, -2.77; 95% CI, -3.56 to -1.98) and depression (6.30 [3.40] vs 9.27 [3.561; AMD, -2.98; 95% CI, -3.74to -2.22). At 3 months, there were also significant differences in scores of posttraumatic stress (AMD, -5.86; 95% CI, -8.53 to -3.19), functional impairment (AMD, -417; 95% CI, -5.84 to -2.51), problems for which the person sought help (AMD, -1.58; 95% CI, -2.40 to -0.77), and symptoms of depressive disorder (AMD, -3.41; 95% CI, 4.49 to 2.34).