Developing a Booster Session for Problem Management Plus in the Bahamas: A Pilot Randomized Controlled Trial

Hospital Anxiety and Depression Scale

Hospital Anxiety and Depression Scale (HADS) (Zigmond \& Snaith, 1983) is a 14-item scale, which consists of two subscales of seven items each. One subscale measures symptoms of anxiety (HADS-A) and the other measures symptoms of depression (HADS-D). Responses are reported a four-point Likert scale, from 0-3, which pertain to different levels of symptom severity, depending on the question. Responses are summed to produce a total score, where higher scores indicate greater levels of anxiety and depression. Subscale scores may also be totaled to separate depression and anxiety symptoms. This scale has been used widely throughout the world and across many cultures, including in the US and in South America (Herrmann, 1997).

PHQ-9

Patient Health Questionnaire (PHQ-9) (Kroenke et al., 1999) is a nine-item tool which measures depression severity. Responses are reported on a four-point Likert scale (from 0-3 with 0 indicating "not at all" and 3 indicating "extremely so"). Scoring is done by taking the sum of all nine items to produce a final score. Depression scores range from minimal (0-4), mild (5-9), moderate (10-18), moderately severe (19-26), to severe (≥27). While the PHQ-9 was designed as a diagnostic tool (Keoenke et al., 1999), it is frequently used to assess depression outcomes in studies of task-sharing interventions including PM+ (e.g., Rahman et al., 2016; Khan et al., 2019; Jordans et al., 2021; Nyongesa et al, 2022; Marchetti et al., 2024).

GAD-7

Generalized Anxiety Disorder Assessment (GAD-7) (Spitzer et al., 2006) is a seven-item tool designed to assess the severity of anxiety symptoms. Similar to the PHQ-9, responses are reported on a four-point Likert scale from 0-3 (with 0 indicating "not at all" and 3 indicating "nearly every day"). Responses are summed to produce a total final score. Scores indicate the severity of anxiety symptoms and range from minimal(0-4), mild (5-9), moderate (10-14), to severe (≥15). The GAD-7 is also commonly used to evaluate anxiety symptoms in studies of PM+ (Nyongesa et al., 2022; Luzano et al., 2023; Marchetti et al., 2024), despite being originally developed as a diagnostic tool (Spitzer et al., 2006)

PSYCHLOPS

Psychological Outcomes Profile (PSYCHLOPS) (Ashworth et al., 2005) measures personally identified problems and stressors. The measure is administered as an interview and consists of four questions across three domains (problems, functioning, and wellbeing). Participants are asked to identify two problems, and one area of functioning in free-form text format. A six-point Likert scale (0-5) assesses how much the respondent has been affected by each. Respondents identify the problems and area of functioning at pre-intervention and are asked to assess each item during every session of PM+. In the proposed study, participants in the intervention arm will complete the PSYCHLOPS during the booster session as well. Scores are totalled and range from 0-20 with greater scores indicating greater distress related to personally identified problems.

PCL-5

PTSD Checklist for DSM-5 (PCL-5) (Weathers et al., 2013) is a 20-item checklist used to measure symptoms of PTSD based on the diagnostic criteria of the DSM-5. Each item is rated on a 5-point Likert scale (0-4, with 0 indicating "not at all" and 4 indicating "extremely"). Scores are summed and total scores range from 0-80 with higher scores indicating greater PTSD symptom severity. Following previous PM+ studies, the measure will be adapted to ask about symptoms in the past week rather than the past month to ensure sensitivity to detect changes at three- and six-month follow-ups.