Rahman 2016a.

Methods	Single‐blind, individual RCT
Participants	Adults from Peshawar (a conflict‐affected area of Pakistan) currently experiencing emotional distress. The study was conducted between November 2014 and Juanuary 2016 To be included, participants need to score both 3 or higher on a screening questionnaire for common mental disorders (12‐item General Health Questionnaire (GHQ‐12)) and 17 or higher on a questionnaire for functional impairments (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)) Age range: 18‐65 years
Interventions	Problem management plus (based on problem‐solving and behavioural techniques): 172 participants Enhanced usual care: 174 participants
Outcomes	Primary outcomes: anxiety and depressive symptoms measured by the Hospital Anxiety and Depression Scale (HADS‐A; HADS‐D; HADS total score) Secondary outcomes: Post‐traumatic stress disorder symptoms were measured by the 20‐item Posttraumatic Stress Disorder Checklist for DSM‐5 (PCL‐5). Functional impairment was measured by the WHODAS 2.0. The Psychological Outcome Profiles (PSYCHLOPS) instrument was used to measure progress on problems for which the person sought help. Participants were also assessed for symptoms of depressive disorder with the 9‐item Patient Health Questionnaire (PHQ‐9)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Randomization was performed using computerized software on 1:1 basis"
Allocation concealment (selection bias)	Low risk	Quote: "Randomization was conducted after baseline assessment by an independent research assistant located off site and not involved in any other aspect of the study (...). Allocation concealment was ensured by keeping the random assignments in sequentially numbered, opaque, sealed envelopes at the off‐site center"
Blinding of participants and personnel (performance bias) All outcomes	High risk	The trial was single blind
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "All assessments were performed by trained research assistants blind to allocation status of participants who received 2‐day training covering administration"
Incomplete outcome data (attrition bias) All outcomes	High risk	More than 20% of participants abandoned the study prematurely Study endpoint: 112/172 missing from intervention group; 97/174 missing from enhanced usual care group
Selective reporting (reporting bias)	Low risk	All outcomes stated in the "Methods" section were correctly reported. The study protocol was publicly accessible
Therapist qualification	Unclear risk	Intervention was delivered by lay health workers
Treatment fidelity	Low risk	Quote: "One in‐country supervisor directly observed a randomly selected sample of 10% of health workers' sessions (...) and used a checklist to systematically assess fidelity to the intervention. The session‐wise checklist consisted of items capturing key intervention strategies for each session. The responses were recorded as yes or no for each given strategy for the particular session. Based on this evaluation, the supervisor rated each session overall as satisfactory or unsatisfactory in terms of fidelity achieved. Identified weak areas were reinforced during supervision"
Therapist/investigator allegiance	High risk	Study authors were involved in treatment development
Other bias	Unclear risk	The study appears to be free of other sources of bias