title: EVALUATING A MULTI-COMPONENT GROUP INTERVENTION FOR IMPROVING PSYCHOLOGICAL WELL-BEING OF TRAINEE CIVIL SERVANTS IN PAKISTAN: A RANDOMISED CONTROLLED STUDY
Creators: name: Ahmed, Zahoor
Publisher: name: University of Liverpool Repository
Year: 2022

description: Evaluating a multi-component group intervention for improving psychological well-being of trainee civil servants in Pakistan: a randomised controlled study Zahoor Ahmed Abstract Introduction: Mental health by its very definition is related to productivity and economic output as well. It has been termed a priority under the UN 2015 Sustainable Development Goals (SDGs). Covid-19 has further brought it into limelight with almost one billion people estimated to have a mental-health or substance-use disorder (Greenwood &amp; Krol, 2020; WHO, 2020). Work-related stress has been associated with psychological problems (Quick et al., 1997). In Pakistan, the civil service carries a disproportionally high burden of responsibility and national development depends on their performance and productivity which in turn cannot be divorced from their state of mental health. However, to the best of my knowledge, no study has so far been conducted on addressing workplace related psychological issues among the civil servants in Pakistan. The present study was conducted to fill this gap. It adapted WHO’s low intensity, group psychological intervention, Problem Management Plus (PM+) to design 5 workshops to improve psychological well-being of newly inducted civil servant trainees and evaluate its effectiveness. Methods: The study was conducted at Civil Service Academy (CSA), Lahore, Pakistan in two phases. In the first phase, a scoping review of the literature and consultations with stakeholders were conducted to inform adaptation of the PM+ to ensure effective implementation with trainee civil servants in Pakistan. In the second phase, a two-arm single blinded Randomized Controlled Trial (RCT) was conducted to evaluate the effectiveness of the adapted curriculum to reduce symptoms of psychological distress in trainee civil servants in Pakistan. 240 newly inducted civil servants, undergoing a 6 months’ induction training were randomized on a 1:1 allocation ratio into intervention and usual training curriculum arm. The intervention arm received the adapted group psychosocial intervention, consisted of 5 training workshops, integrated into their orientation sessions of trainee civil servants along with the usual training. The control arm received the usual training only. The primary outcomes were changes in the scores of psychological distresses as measured by Patient Health Questionnaire-9 (PHQ-9) and coping skills strategies as measured by Brief Cope Questionnaire at 3-months post intervention. Secondary outcomes included symptoms of anxiety, well-being, and psychological capital. Intention-to-treat analyses were done using mixed models adjusted for covariates. Ethical approval of the study was obtained from the Human Development Research Foundation, Pakistan and the University of Liverpool. The trial was registered prospectively on clinicaltrials.gov (NCT03762421). Results: Phase 1 showed that PM+ was transferable into Civil Service Academy (CSA) settings following a careful adaptation process. The adaptation retained the concepts and strategies of the intervention while making significant changes in its structure and delivery. In the RCT conducted in Phase 2, of the 240 participants enrolled, 213 completed the post assessment at 7 weeks and 3 months’ post intervention. The mixed-model analysis showed that intervention arm participants reported significantly higher scores on Brief-COPE, compared to control arm participants (m[SD], 23.42[8.86] vs. 21.92[8.55]; mean difference, 95%CI, 2.11 [0.19 to 4.04]; p&lt;0.05) at 3-months post-intervention. Similarly, lower scores on PHQ-9 at one-week post intervention were reported by intervention arm participants compared to control arm participants (m[SD], 2.61[2.98] vs. 3.64[4.72]; mean difference, 95%CI, -1.01[-1.80 to -0.22]; p&lt;0.05). Statistically significant difference on secondary outcomes at one-week and 3-months post-intervention was also observed. Conclusions: The adapted PM+ intervention has resulted in improving coping skills and reducing psychological distress in trainee civil servants. The intervention has the potential to be integrated into the curriculum of Civil Service Academy (CSA) and could be useful to equip civil servant trainees with necessary skills to cope with their forthcoming workplace challenges.