Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda
Introduction Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usua...
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| Format: | Article |
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BMJ Publishing Group
2023-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/9/e048043.full |
| _version_ | 1827801137805262848 |
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| author | Eirini Karyotaki Pim Cuijpers Marianna Purgato Kenneth Carswell Marit Sijbrandij Federico Tedeschi Corrado Barbui Mark Van Ommeren Wietse A Tol Daniel Lakin Jura Augustinavicius Marx Ronald Leku Rashelle Musci |
| author_facet | Eirini Karyotaki Pim Cuijpers Marianna Purgato Kenneth Carswell Marit Sijbrandij Federico Tedeschi Corrado Barbui Mark Van Ommeren Wietse A Tol Daniel Lakin Jura Augustinavicius Marx Ronald Leku Rashelle Musci |
| author_sort | Eirini Karyotaki |
| collection | DOAJ |
| description | Introduction Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda.Methods This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores.Results A single factor for mental health problems was identified with all factor loadings >0.30 and acceptable internal consistency (α=0.70). We excluded 161 women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative to EUC (Risk ratio =0.16, 95% CI: 0.05 to 0.53). Participation in SH+ versus EUC was also associated with increased subjective well-being (β=2.62, 95% CI: 1.63 to 3.60) and psychological flexibility (β=4.55, 95% CI: 2.92 to 6.18) at post-intervention assessment.Conclusions These results support the use and further testing of SH+ as a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings.Trial registration number ISRCTN50148022. |
| first_indexed | 2024-03-11T20:21:34Z |
| format | Article |
| id | doaj.art-281b11e25ce34f5d85ef839d9e95866a |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-11T20:21:34Z |
| publishDate | 2023-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-281b11e25ce34f5d85ef839d9e95866a2023-10-03T03:35:07ZengBMJ Publishing GroupBMJ Open2044-60552023-09-0113910.1136/bmjopen-2020-048043Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in UgandaEirini Karyotaki0Pim Cuijpers1Marianna Purgato2Kenneth Carswell3Marit Sijbrandij4Federico Tedeschi5Corrado Barbui6Mark Van Ommeren7Wietse A Tol8Daniel Lakin9Jura Augustinavicius10Marx Ronald Leku11Rashelle Musci12WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, NetherlandsDepartment of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, NetherlandsWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, ItalyDepartment of Mental Health and Substance Use, World Health Organization, Geneve, SwitzerlandDepartment of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, NetherlandsWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, ItalyWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, ItalyDepartment of Mental Health and Substance Use, World Health Organization, Geneve, SwitzerlandGlobal Health Section, University of Copenhagen, Kobenhavn, DenmarkDepartment of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USASchool of Population and Global Health, McGill University, Montreal, Québec, CanadaHealthRight International, Arua, UgandaDepartment of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USAIntroduction Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda.Methods This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores.Results A single factor for mental health problems was identified with all factor loadings >0.30 and acceptable internal consistency (α=0.70). We excluded 161 women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative to EUC (Risk ratio =0.16, 95% CI: 0.05 to 0.53). Participation in SH+ versus EUC was also associated with increased subjective well-being (β=2.62, 95% CI: 1.63 to 3.60) and psychological flexibility (β=4.55, 95% CI: 2.92 to 6.18) at post-intervention assessment.Conclusions These results support the use and further testing of SH+ as a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings.Trial registration number ISRCTN50148022.https://bmjopen.bmj.com/content/13/9/e048043.full |
| spellingShingle | Eirini Karyotaki Pim Cuijpers Marianna Purgato Kenneth Carswell Marit Sijbrandij Federico Tedeschi Corrado Barbui Mark Van Ommeren Wietse A Tol Daniel Lakin Jura Augustinavicius Marx Ronald Leku Rashelle Musci Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda BMJ Open |
| title | Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda |
| title_full | Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda |
| title_fullStr | Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda |
| title_full_unstemmed | Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda |
| title_short | Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda |
| title_sort | prevention and promotion effects of self help plus secondary analysis of cluster randomised controlled trial data among south sudanese refugee women in uganda |
| url | https://bmjopen.bmj.com/content/13/9/e048043.full |
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