In areas of Pakistan affected by recent conflict, epidemiological studies have shown a high prevalence of psychological distress in women. In the setting of conflict with poor access to care, as well as role restrictions, there is a large population of women that are particularly vulnerable to anxiety and depression. As such, there is a need for culturally-appropriate and scalable psychological interventions in these settings. The WHO recommends a range of interventions for non-specialized healthcare settings, including cognitive behavioral therapy (CBT), interpersonal therapy, and stress management delivered in individual or group formats. In this cluster randomized controlled trial, individuals from 34 community clusters in rural Swat, Pakistan were randomized 1:1 to receive either a group intervention, including five sessions facilitated by non-specialists that teach behavioral strategies, or usual care to establish the effectiveness of this new WHO group intervention in a conflict-affected setting. Women between the ages of 18 and 60 years were eligible if they scored at least 3 on the General Health Questionnaire-12 and at least 17 on the WHO Disability Assessment Schedule (n=712). Researchers found that the intervention arm had a significantly lower mean Hospital Anxiety and Depression Scale (HADS) score at 3 months, with an adjusted mean difference of -4.53 (95% CI -7.13 to -1.92, p=0.0007). Both HADS depression and anxiety scores, when taken alone, were also significantly lower in the treatment arm. No adverse events were noted. Investigators concluded that this group intervention administered by female non-specialists resulted in significantly lower depression and anxiety symptoms at 3 months in a post-conflict setting, as compared to standard care.
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