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*, Phiona Koyiet, Atif Rahman, Alison Schafer, Syed Usman Hamdani, Pim Cuijpers, Marit Sijbrandij, Richard A. Bryant

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)71-82
Number of pages12
JournalDepression and Anxiety
Issue number1
Early online date9 Nov 2021
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
The study was funded by the National Health and Medical Research Council (1073041). The funder had no role in study design, data collection or analysis, or report preparation. Kenya—this study was supported by Grand Challenges Canada #0368‐04, World Vision Australia and World Vision Canada. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of manuscript. Pakistan—this study was supported by Enhanced Learning and Research for Humanitarian Assistance's Research for Health in Humanitarian Crises initiative funded by the UK Department for International Development and the Wellcome Trust. Pakistan (SWAT)—this study was funded by USAID (AID‐OFDA‐10‐15‐00067). The funders have no influence over the study design or conduct, trial management, analysis, and interpretation of data, or the writing of reports or publications.

Publisher Copyright:
© 2021 The Authors. Depression and Anxiety published by Wiley Periodicals LLC


Dive into the research topics of 'Residual posttraumatic stress disorder symptoms after provision of brief behavioral intervention in low- and middle-income countries: An individual-patient data meta-analysis'. Together they form a unique fingerprint.

Cite this