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.

A scoping review of the literature on the application and usefulness of the Problem Management Plus (PM+) intervention around the world.

Internally displaced persons (IDPs), refugees, returnees and host communities in conflict settings experience high rates of mental health problems associated with prolonged and repeated exposure to multiple exposure to distress, as is the case in Iraq. We sought to highlight the outcomes and complementarity of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) in addressing the mental health and psychosocial support needs of IDPs, returnees and host community teens and adults in Zummar, Iraq. A total of 290 adults were included in the PM+ intervention, while DWM included 648 adults and 282 teens. DWM was delivered to adults with accessibility barriers to receiving PM+ and to all teens in the study due to security reasons and COVID-19 restrictions. The Patient Health Questionnaire (PHQ-9) and World Health Organization Disability Assessment Schedule (WHODAS 2.0) were used to measure psychological distress and functioning in adults, respectively. The Revised Children Anxiety and Depression Scale (RCADS) was also used to measure symptoms of depression and anxiety in teens pre and postintervention. Personally identified problems were measured using the Psychological Outcome Profiles (PSYCHLOPS) for adults and teens. Psychological and emotional challenges were the main problem faced by both teens and adults at baseline. For PM+ and DWM interventions in adults, the mean difference in PSYCHLOPS, WHODAS and PHQ-9 scores between preintervention and postintervention assessment were significant (P < 0.001). For DWM teens, the paired mean difference for pre and postintervention RCADS and PSYCHLOPS teens was 55.9 (SD = 8.0) and 4.8 (SD = 2.40), respectively (P < 0.001, Cohen’s d > 2). There was a significant reduction in the number of days off work and increased ability to carry out usual activities after both interventions. The study findings highlight the applicability of PM+ and DWM in conflict settings of Iraq when there are barriers to applying one.

Highlighting Complementary Benefits of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) Interventions Delivered Alongside Broader Community MHPSS Programming in Zummar, Ninewa Governorate of Iraq

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Highlighting Complementary Benefits of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) Interventions Delivered Alongside Broader Community MHPSS Programming in Zummar, Ninewa Governorate of Iraq