Problem Management Plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial

Marit Sijbrandij; Richard A Bryant; Alison Schafer; Katie S Dawson; Dorothy Anjuri; Lincoln Ndogoni; Jeannette Ulate; Syed Usman Hamdani; Mark van Ommeren

doi:10.1186/s13033-016-0075-5

Problem Management Plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial

Int J Ment Health Syst. 2016 May 31:10:44. doi: 10.1186/s13033-016-0075-5. eCollection 2016.

Authors

Marit Sijbrandij¹, Richard A Bryant², Alison Schafer³, Katie S Dawson², Dorothy Anjuri⁴, Lincoln Ndogoni⁴, Jeannette Ulate⁵, Syed Usman Hamdani⁶, Mark van Ommeren⁷

Affiliations

¹ Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
² School of Psychology, University of New South Wales, Sydney, Australia.
³ World Vision International and World Vision Australia, Burwood East, Australia.
⁴ World Vision Kenya, Nairobi, Kenya.
⁵ World Vision Canada, Mississauga, Canada.
⁶ University of Liverpool, Liverpool, UK ; Human Development Research Foundation, Islamabad, Pakistan.
⁷ Department of Mental Health and Substance Abuse, World Health Organization (WHO), Geneva, Switzerland.

Abstract

Background: Women affected by adversity, including gender-based violence, are at increased risk for developing common mental disorders such as depression, anxiety and posttraumatic stress disorder (PTSD). The World Health Organization (WHO) has developed Problem Management Plus (PM+), a 5-session, individual psychological intervention program, that can be delivered by non-specialist counsellors that addresses common mental disorders in people affected by adversity. The objectives of this study are to evaluate effectiveness of PM+ among women who have been affected by adversity, including gender-based violence, and to perform a process evaluation.

Methods: Informed by community consultations, the PM+ manual has been translated and adapted to the local context. A randomized controlled trial will be carried out in the catchment areas of three local health care facilities in Dagoretti Sub County, Nairobi. After informed consent, females with high psychological distress (General Health Questionnaire-12 (score >2) and functional impairment (WHO Disability Assessment Schedule 2.0 score >16) will be randomised to PM+ (n = 247) or enhanced treatment as usual (n = 247). Post-treatment and 3-months post-treatment follow-up assessments include psychological distress, functional disability, PTSD symptoms, perceived problems for which the person seeks help, health care use and health costs. For evaluating the process of implementing PM+ within local communities in Nairobi 20 key informant interviews will be carried out in participants, PM+ providers, decision makers, clinical staff.

Discussion: If PM+ is proven effective, it will be rolled out to other low and middle income areas and other populations for further adaptation and testing. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000032459. Registered prospectively on January 18, 2016.

Keywords: Anxiety; Cognitive behavioural therapy; Common mental disorders; Depression; Gender-based violence; Intimate partner violence; Low- and middle income countries; Non-specialist counsellors; Posttraumatic stress disorder; Task-shifting; Trauma.

Grants and funding

001/WHO_/World Health Organization/International