Effectiveness of Problem-Solving Therapy on Quality of Life and prevention of Repeat Heart Attacks and strokes in Haripur, Pakistan

This study will utilize a randomized controlled trial (RCT) with a mixed-methods design, to comprehensively assess the impact of resilience and participation on quality of life (QoL) among post-myocardial infarction (MI) and post-stroke patients experiencing depression. The research will be conducted at the outpatient cardiology department of the District Headquarter Hospital in Haripur, Pakistan. Participants will be randomly assigned to either an intervention or control group. Those in the intervention group will receive structured Problem-Solving Therapy (PST) in addition to standard care, while the control group will continue receiving treatment as usual (TAU) without any added psychological intervention. The PST intervention will consist of eight weekly face-to-face group sessions, each lasting approximately 90 minutes, conducted in a semi-open group format (9–10 participants per group) over a span of two months. These sessions will be delivered by trained master-level psychologists who will undergo an 80-hour structured training program supervised by a senior clinical psychologist with at least two years of clinical experience. The PST curriculum is adapted from evidence-based models and will cover key components such as problem orientation, structured problem-solving steps, goal setting, generation and evaluation of solutions, action planning, and coping skill enhancement. Additional “booster” sessions will be provided via phone at weeks 10 and 14 post-intervention to reinforce skill retention. To monitor adherence, session attendance will be logged, homework compliance tracked through checklists, and 10% of the sessions will be audio-recorded and evaluated for fidelity. Missed sessions will be followed up by the research team within 24 hours to ensure continuity. The study will unfold in three main phases: pre-intervention (baseline screening and assessment), intervention implementation, and post-intervention follow-up. The primary aims are to evaluate the short-term effectiveness of PST in enhancing coping strategies, reducing depressive symptoms, and improving overall resilience and quality of life. A secondary objective includes monitoring the recurrence of MI and stroke during the intervention period and through a three-month follow-up. Data will be collected at baseline, immediately post-intervention, and at three-month follow-up. Data will be collected using validated instruments such as the Stroke-Specific Quality of Life Scale (SSQOL), the Short Form Health Survey (SF-36), Coping Inventory for Stressful Situations (CISS), Beck Depression Inventory (BDI), and the Center for Epidemiological Studies Depression Scale (CES-D). Physiological indicators, including blood pressure, BMI, body fat percentage, and waist circumference, will be objectively measured by the research team. Additionally, recurrence of cardiac or stroke events will be tracked through self-reports and verified by reviewing participants' medical records. The entire study is expected to span approximately seven months.