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Mwangala PN, Makandi M, Kerubo A, Nyongesa MK, Abubakar A. A scoping review of the literature on the application and usefulness of the Problem Management Plus (PM+) intervention around the world. BJPsych Open 2024; 10:e91. [PMID: 38650067 PMCID: PMC11060090 DOI: 10.1192/bjo.2024.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Given the high rates of common mental disorders and limited resources, task-shifting psychosocial interventions are needed to provide adequate care. One such intervention developed by the World Health Organization is Problem Management Plus (PM+). AIMS This review maps the evidence regarding the extent of application and usefulness of the PM+ intervention, i.e. adaptability, feasibility, effectiveness and scalability, since it was introduced in 2016. METHOD We conducted a scoping review of seven literature databases and grey literature from January 2015 to February 2024, to identify peer-reviewed and grey literature on PM+ around the world. RESULTS Out of 6739 potential records, 42 met the inclusion criteria. About 60% of the included studies were from low- and middle-income countries. Findings from pilot/feasibility trials demonstrated that PM+ is feasible, acceptable and safe. Results from definitive randomised controlled trials at short-term follow-up also suggested that PM+ is effective, with overall moderate-to-large effect sizes, in improving symptoms of common mental health problems. Although PM+ was more effective in reducing symptoms of common mental disorders, it was found to be costlier compared to usual care in the only study that evaluated its cost-effectiveness. CONCLUSIONS Our findings indicate that PM+, in its individual and group formats, can be adapted and effectively delivered by trained helpers to target a wide range of common mental health concerns. More effectiveness and implementation evidence is required to understand the long-term impact of PM+, its cost-effectiveness and scalability, and moderators of treatment outcomes such as gender and delivery formats.
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Affiliation(s)
- Patrick N. Mwangala
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and School of Public Health, University of the Witwatersrand, South Africa
| | | | - Anita Kerubo
- Institute for Human Development, Aga Khan University, Kenya
| | | | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and Department of Psychiatry, University of Oxford, UK
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Mutahi J, Kangwana B, Khasowa D, Muthoni I, Charo O, Muli A, Kumar M. Integrating Mental Health Management into Empowerment Group Sessions for Out-of-School Adolescents in Kenyan Informal Settlements: A Process Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:223. [PMID: 38397712 PMCID: PMC10888709 DOI: 10.3390/ijerph21020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024]
Abstract
This article presents processes for developing contextualized training procedures to better appreciate partnership, capacity-building experiences, and specific implementation challenges and opportunities for mental and public health teams. The program enrolled 469 out-of-school adolescents to participate in the integration of youth mental health into health and life-skill safe spaces. The teams utilized various methods to achieve process outcomes of restructuring and adapting curricula, training youth mentors, and assessing their self-efficacy before integrating the intervention for 18 months. The Coronavirus (COVID-19) pandemic became an additional unique concern in the preliminary and the 18-month implementation period of the program. This necessitated innovation around hybrid training and asynchronous modalities as program teams navigated the two study locations for prompt training, supervision, evaluation, and feedback. In conclusion, out-of-school adolescents face a myriad of challenges, and a safe space program led by youth mentors can help promote mental health. Our study demonstrated how best this can be achieved. We point to lessons such as the importance of adapting the intervention and working cohesively in teams, building strong and trusting partnerships, learning how to carry out multidisciplinary dialogues, and continuous supervision and capacity building. This article aimed to document the processes around the design and implementation of this innovative intervention and present a summary of lessons learned.
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Affiliation(s)
- Joan Mutahi
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Beth Kangwana
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Dorcas Khasowa
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Irene Muthoni
- Integrated Education for Community Empowerment, Nairobi P.O. Box 7631-00300, Kenya;
| | - Oliver Charo
- Rapid Effective Participatory Action in Community Theatre Education and Development, Nakuru P.O. Box 15614-20100, Kenya;
| | - Alfred Muli
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Manasi Kumar
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, US-550 First Avenue New York, New York, NY 10016, USA
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Falgas-Bague I, Melero-Dominguez M, de Vernisy-Romero D, Tembo T, Chembe M, Lubozha T, Paul R, Parkerson D, Rockers PC, Sikazwe D, Fink G. Testing the feasibility, acceptability, and exploring trends on efficacy of the problem management plus for moms: Protocol of a pilot randomized control trial. PLoS One 2024; 19:e0287269. [PMID: 38181004 PMCID: PMC10769019 DOI: 10.1371/journal.pone.0287269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/24/2023] [Indexed: 01/07/2024] Open
Abstract
Mental health disorders are one of the most common causes that limit the ability of mothers to care for themselves and for their children. Recent data suggest high rates of distress among women in charge of young children in Zambia. Nevertheless, Zambia's public healthcare offers very limited treatment for common mental health distress. To address this treatment gap, this study aims to test the feasibility, acceptability, and potential efficacy of a context-adapted psychosocial intervention. A total of 265 mothers with mental health needs (defined as SRQ-20 scores above 7) were randomly assigned with equal probability to the intervention or control group. The intervention group will receive a locally adapted version of the Problem-Management Plus and "Thinking Healthy" interventions developed by the World Health Organization (WHO), combined with specific parts of the Strong Minds-Strong Communities intervention. Trained and closely supervised wellbeing-community health workers will provide the psychosocial intervention. Mental health distress and attendance to the intervention will be assessed at enrollment and 6 months after the intervention. We will estimate the impact of the intervention on mental health distress using an intention-to-treat approach. We previously found that there is a large necessity for interventions that aim to address mother anxiety/depression problems. In this study, we tested the feasibility and efficacy of an innovative intervention, demonstrating that implementing these mental health treatments in low-income settings, such as Zambia, is viable with an adequate support system. If successful, larger studies will be needed to test the effectiveness of the intervention with increased precision. Trial registration: This study is registered at clinicaltrials.gov as NCT05627206.
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Affiliation(s)
- Irene Falgas-Bague
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Economics, University of Basel, Basel, Switzerland
- Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine. Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maria Melero-Dominguez
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Daniela de Vernisy-Romero
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Global Health. Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Mpela Chembe
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Theresa Lubozha
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Ravi Paul
- Department of Psychiatry, University of Zambia, Lusaka, Zambia
| | - Doug Parkerson
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Peter C. Rockers
- Department of Global Health. Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Günther Fink
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Economics, University of Basel, Basel, Switzerland
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Zhang L, Ni Z, Liu Y, Chen H. The effectiveness of e-health on reducing stigma, improving social support and quality of life among people living with HIV: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2023; 148:104606. [PMID: 37801937 DOI: 10.1016/j.ijnurstu.2023.104606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Many people living with HIV reported poor quality of life, which was primarily due to HIV-related stigma and the lack of social support. Compared with face-to-face interventions, e-health interventions are reported to have potential to help people living with HIV improve their adherence to antiretroviral therapy, promote their management of HIV and depressive symptoms. However, in the literature, the effectiveness of e-health interventions in helping people living with HIV reduce stigma, improve social support and quality of life is unclear. OBJECTIVE To examine the effectiveness of e-health interventions in reducing stigma and improving social support and quality of life among people living with HIV. DESIGN This study is a systematic review and meta-analysis of randomized controlled trials following the Cochrane Handbook guidelines and PRISMA2020. METHODS A comprehensive search was conducted from inception to 1st December 2022 in six databases: PubMed, CINAHL Plus with Full Text, PsycINFO (Ovid), Embase, Web of Science, and CENTRAL (Ovid), and an updated search took place on 11st June 2023. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95 % confidence interval (CI) using Review Manager 5.3. A sensitivity analysis was conducted to test the rigor of the pooled results using one-study-out method. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS Nine studies met eligibility criteria and were included in this review. The results of the meta-analysis showed that e-health interventions could statistically significantly reduce stigma (SMD: -0.29, 95 % CI: [-0.48, -0.10], p = 0.002) and improve quality of life (SMD = 0.49, 95 % CI: [0.30, 0.68], P < 0.001), but had no significant effects on social support (SMD = -0.01, 95 % CI: [-0.48, 0.46] P = 0.96). CONCLUSIONS E-health interventions could reduce stigma and improve quality of life among people living with HIV. More studies are needed to further explore if e-health interventions can improve the social support for people living with HIV and investigate how to integrate e-health interventions into the existing health models to help people living with HIV treat and manage HIV/AIDS. REGISTRATION The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42022373299).
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Affiliation(s)
- Liao Zhang
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China
| | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA; School of Nursing, Yale University, New Haven, CT, USA
| | - Ying Liu
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China
| | - Hong Chen
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China.
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Schäfer SK, Thomas LM, Lindner S, Lieb K. World Health Organization's low-intensity psychosocial interventions: a systematic review and meta-analysis of the effects of Problem Management Plus and Step-by-Step. World Psychiatry 2023; 22:449-462. [PMID: 37713578 PMCID: PMC10503931 DOI: 10.1002/wps.21129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post-traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low-intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step-by-Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post-traumatic stress disorder symptoms; functional impairment, self-identified problems) and positive mental health outcomes (i.e., well-being, quality of life, social support/relationships). We performed random-effects multilevel meta-analyses on standardized mean differences (SMDs) at post-intervention and short-term follow-up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=-0.45, 95% CI: -0.56 to -0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14-0.47), which both remained significant at follow-up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between-study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high-quality evidence base is needed, as well as research on participant-level moderators of the effects of these interventions, their suitability for stepped-care programs, and their cost-effectiveness.
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Affiliation(s)
- Sarah K Schäfer
- Leibniz Institute for Resilience Research, Mainz, Germany
- Clinical Psychology, Psychotherapy and Psychodiagnostics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Lea M Thomas
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Saskia Lindner
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Klaus Lieb
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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