title: Provision of mental health services in resource-poor settings: a randomised trial comparing counselling with routine medical treatment in North Afghanistan (Mazar-e-Sharif).
abstract: BACKGROUND
  Psychosocial stress caused by war, ongoing conflict, lack of security, and restricted access to resources promotes mental suffering and diseases in many resource-poor countries. In an exemplary setting, the present study compares the efficacy of psychosocial counselling with routine pharmacological treatment in a randomised trial in Mazar-e-Sharif (Afghanistan).
  
  
  METHODS
  Help seeking Afghan women (N = 61), who were diagnosed with mental health symptoms by local physicians either received routine medical treatment(treatment as usual) or psychosocial counselling (5-8 sessions) following a specifically developed manualised treatment protocol. Primary outcome measures were symptoms of depression and anxiety assessed before treatment and at follow-up using the Hopkins Symptom Checklist and the Mini-International Neuropsychiatric Interview. Secondary outcome measures were psychosocial stressors and coping mechanisms.
  
  
  RESULTS
  At 3-month follow-up, psychosocial counselling patients showed high improvements with respect to the severity of symptoms of depression and anxiety. In addition, they reported a reduction of psychosocial stressors and showed an enhancement of coping strategies. At the same time, the severity of symptoms, the quantity of psychosocial stressors and coping mechanisms did not improve in patients receiving routine medical treatment.
  
  
  CONCLUSIONS
  These results indicate that psychosocial counselling can be an effective treatment for mental illnesses even for those living in ongoing unsafe environments.
authors.affiliation: Department of Psychology, University of Konstanz, 78457 Konstanz, Germany. Sarah.Ayoughi@uni-konstanz.de
authors.forename: Sarah
authors.initials: S
authors.lastname: Ayoughi
authors.forename: Inge
authors.initials: I
authors.lastname: Missmahl
authors.forename: Roland
authors.initials: R
authors.lastname: Weierstall
authors.forename: Thomas
authors.initials: T
authors.lastname: Elbert
mesh_terms: D000223:Adaptation, Psychological; D000346:Afghanistan; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D003376:Counseling; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008603:Mental Health; D008605:Mental Health Services; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000628:therapy; D016896:Treatment Outcome