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Meta-Analysis
. 2022 Jan;39(1):71-82.
doi: 10.1002/da.23221. Epub 2021 Nov 9.

Residual posttraumatic stress disorder symptoms after provision of brief behavioral intervention in low- and middle-income countries: An individual-patient data meta-analysis

Aemal Akhtar  1   2 , Phiona Koyiet  3 , Atif Rahman  4 , Alison Schafer  5 , Syed Usman Hamdani  4   6 , Pim Cuijpers  1 , Marit Sijbrandij  1 , Richard A Bryant  2
Affiliations
Meta-Analysis

Residual posttraumatic stress disorder symptoms after provision of brief behavioral intervention in low- and middle-income countries: An individual-patient data meta-analysis

Aemal Akhtar et al. Depress Anxiety. 2022 Jan.

Abstract

Background: To address shortages of mental health specialists in low- and middle-income countries, task-shifting approaches have been employed to train nonspecialists to deliver evidence-based scalable psychosocial interventions. Problem Management Plus (PM+) is a brief transdiagnostic nontrauma focused intervention for people affected by adversity. This study reports on the capacity of PM+ to address specific symptoms of posttraumatic stress disorder (PTSD).

Methods: Individual patient data from three randomised controlled trials were combined and analysed to observe the impacts of PM+ (n = 738) or enhanced treatment as usual (ETAU) (n = 742) interventions on specific PTSD symptoms at posttreatment and 3-month follow-up. The PTSD-Checklist for DSM-5 (PCL-5) was used to index PTSD symptoms, and presence of each symptom was defined as moderate severity (score ≥ 2 on individual items).

Results: The average PCL-5 score at baseline was 26.1 (SD: 16.8) with 463 (31.3%) scoring above 33, indicative of a diagnosis of PTSD. Following intervention, 12.5% and 5.8% of participants retained a score greater than 33 at postassessment and follow-up, respectively. There was greater symptom reduction for PM+ than for ETAU for most symptoms. Hyperarousal symptoms were the most common residual symptoms after PM+, with more than 30% of participants reporting persistent sleep disturbance, concentration difficulties, and anger.

Conclusion: PM+ led to greater reduction in symptoms relating to re-experiencing and avoidance. The evidence indicates that strategies focusing on hyperarousal symptoms including sleep, concentration, and anger difficulties, could be strengthened in this brief intervention.

Keywords: behaviour therapy; posttraumatic stress disorder; problem management plus; randomised controlled trial; residual symptoms; task-sharing.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Problem management plus—symptom presence for each posttraumatic stress disorder symptom at baseline, postintervention assessment, and 3‐month follow up
Figure 2
Figure 2
Enhanced treatment as usual—symptom presence for each posttraumatic stress disorder symptom at baseline, postintervention assessment, and 3‐month follow up
See this image and copyright information in PMC

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