Project 462114

Most mental health problems begin before the age of 24 and effective treatments may prevent life-long distress and disability. In low and middle-income countries (LMICs) like Pakistan, 90% of young people do not have access to mental health care. We aim to improve outcomes in young people with first episode psychosis (FEP) by delivering culturally appropriate interventions, culturally adapted cognitive behavior therapy for individuals with psychosis (CaCBT), and culturally adapted family intervention for patients with psychosis and their caregivers (CulFI). We have carried out feasibility trials of both interventions in Pakistan and demonstrated acceptability and feasibility in this population. However, a larger study of a longer duration study is needed to assess clinical efficacy and cost-effectiveness before steps can be taken towards implementing these interventions. We will measure patient specific outcomes including symptom severity, insight, quality of life, and functioning. We will also look at carer specific outcomes including wellbeing, carer experience, illness perception as well as depression and anxiety measures. For future scale-up and implementation, we will interview participants, family members/carers, physicians, therapists, and other stakeholders. These interviews will explore stakeholder views, facilitators, and barriers to intervention delivery. Developing evidence for psychosocial interventions in low-resource settings is key to reducing global disease burden for people with psychosis. Should the results of the proposed trial confirm the findings of our pilot studies, these interventions can be scaled up for delivery across other low-resource settings. This line of research would lead to the development of culturally appropriate interventions that could be rapidly implemented in clinical practice not only in Pakistan but other low-resource settings within Canada, to improve outcomes for affected individuals.