Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus
Background The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited.Objective To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental dis...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Mental Health |
| Online Access: | https://ebmh.bmj.com/content/26/1/e300637.full |
| _version_ | 1827929455321939968 |
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| author | Pim Cuijpers Jos W R Twisk Ceren Acarturk Martha Bird Zeynep Ilkkursun Marit Sijbrandij Bayard Roberts Richard Bryant Egbert Sondorp David McDaid Christine Knaevelsrud Mark Jordans A-La Park Aemal Akhtar Theo K Bouman Ulrich Schnyder Hanspeter Moergeli Sebastian Burchert Trudy Mooren Daniela Fuhr Peter Ventevogel Anne M de Graaff Annelieke Drogendijk Daniela C Fuhr Pernille Hansen Mahmoud Hemmo Nikolai Kiselev Gülsah Kurt Saara Martinmäki Naser Morina Matthis Schick Julia Spaaij Frederik Steen Karine Taha Claire Whitney Martine van den Dool Cansu Mirzanlı Nana Wiedemann Aniek Woodward Barbara Kieft Sam Hunaidy Mariam Elsawy Noer Gorgis Miriam J J Lommen Katie S Dawson Akinçi Ahmad Bawaneh Felicity Brown Anne de Graaff Jonas Maria Hessling Monique Pfaltz |
| author_facet | Pim Cuijpers Jos W R Twisk Ceren Acarturk Martha Bird Zeynep Ilkkursun Marit Sijbrandij Bayard Roberts Richard Bryant Egbert Sondorp David McDaid Christine Knaevelsrud Mark Jordans A-La Park Aemal Akhtar Theo K Bouman Ulrich Schnyder Hanspeter Moergeli Sebastian Burchert Trudy Mooren Daniela Fuhr Peter Ventevogel Anne M de Graaff Annelieke Drogendijk Daniela C Fuhr Pernille Hansen Mahmoud Hemmo Nikolai Kiselev Gülsah Kurt Saara Martinmäki Naser Morina Matthis Schick Julia Spaaij Frederik Steen Karine Taha Claire Whitney Martine van den Dool Cansu Mirzanlı Nana Wiedemann Aniek Woodward Barbara Kieft Sam Hunaidy Mariam Elsawy Noer Gorgis Miriam J J Lommen Katie S Dawson Akinçi Ahmad Bawaneh Felicity Brown Anne de Graaff Jonas Maria Hessling Monique Pfaltz |
| author_sort | Pim Cuijpers |
| collection | DOAJ |
| description | Background The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited.Objective To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands.Methods We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019–December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat.Findings Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference −0.25; 95% CI −0.385 to −0.122; p=0.0001, Cohen’s d=0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen’s d=0.42), anxiety (p=0.001, Cohen’s d=0.27), PTSD symptoms (p=0.0005, Cohen’s d=0.39) and self-identified problems (p=0.03, Cohen’s d=0.26), but not on impairment (p=0.084, Cohen’s d=0.21).Conclusions PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit.Clinical implications Peer-provided psychological interventions should be considered for scale-up in HICs. |
| first_indexed | 2024-03-13T06:23:28Z |
| format | Article |
| id | doaj.art-333fc419cf294455b57b22248f6d80fa |
| institution | Directory Open Access Journal |
| issn | 2755-9734 |
| language | English |
| last_indexed | 2024-03-13T06:23:28Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj.art-333fc419cf294455b57b22248f6d80fa2023-06-09T12:00:07ZengBMJ Publishing GroupBMJ Mental Health2755-97342023-06-0126110.1136/bmjment-2022-300637Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management PlusPim Cuijpers0Jos W R Twisk1Ceren Acarturk2Martha BirdZeynep IlkkursunMarit Sijbrandij3Bayard Roberts4Richard Bryant5Egbert SondorpDavid McDaid6Christine Knaevelsrud7Mark Jordans8A-La Park9Aemal AkhtarTheo K Bouman10Ulrich SchnyderHanspeter Moergeli11Sebastian Burchert12Trudy MoorenDaniela FuhrPeter Ventevogel13Anne M de Graaff14Annelieke DrogendijkDaniela C Fuhr15Pernille Hansen16Mahmoud HemmoNikolai KiselevGülsah KurtSaara MartinmäkiNaser Morina17Matthis SchickJulia SpaaijFrederik SteenKarine TahaClaire WhitneyMartine van den DoolCansu MirzanlıNana Wiedemann18Aniek Woodward19Barbara Kieft20Sam Hunaidy21Mariam Elsawy22Noer Gorgis23Miriam J J Lommen24Katie S Dawson25Akinçi Ahmad BawanehFelicity BrownAnne de GraaffJonas Maria HesslingMonique Pfaltz2 International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania3 Department of Epidemiology and Data Science, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands7 Department of Psychology, Koc Universitesi, Istanbul, Turkey1 Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands10 Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK8 School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia16 Department of Health Policy, The London School of Economics and Political Science, London, UK9 Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany14 Research and Development Department, War Child Holland, Amsterdam, The Netherlands16 Department of Health Policy, The London School of Economics and Political Science, London, UK6 Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands17 Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland9 Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany18 Public Health Section, UNHCR, Geneva, Switzerland1 Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands11 Health Sciences, University of Bremen, Bremen, Bremen, Germany13 Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark17 Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland13 Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark19 KIT Health, KIT Royal Tropical Institute, Amsterdam, Noord-Holland, The Netherlands4 ARQ National Psychotrauma Centre, Amsterdam, The Netherlands1 Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands1 Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands5 i-Psy, Parnassia Groep, The Hague, South Holland, The Netherlands6 Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands8 School of Psychology, UNSW Sydney, Sydney, New South Wales, AustraliaBackground The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited.Objective To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands.Methods We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019–December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat.Findings Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference −0.25; 95% CI −0.385 to −0.122; p=0.0001, Cohen’s d=0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen’s d=0.42), anxiety (p=0.001, Cohen’s d=0.27), PTSD symptoms (p=0.0005, Cohen’s d=0.39) and self-identified problems (p=0.03, Cohen’s d=0.26), but not on impairment (p=0.084, Cohen’s d=0.21).Conclusions PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit.Clinical implications Peer-provided psychological interventions should be considered for scale-up in HICs.https://ebmh.bmj.com/content/26/1/e300637.full |
| spellingShingle | Pim Cuijpers Jos W R Twisk Ceren Acarturk Martha Bird Zeynep Ilkkursun Marit Sijbrandij Bayard Roberts Richard Bryant Egbert Sondorp David McDaid Christine Knaevelsrud Mark Jordans A-La Park Aemal Akhtar Theo K Bouman Ulrich Schnyder Hanspeter Moergeli Sebastian Burchert Trudy Mooren Daniela Fuhr Peter Ventevogel Anne M de Graaff Annelieke Drogendijk Daniela C Fuhr Pernille Hansen Mahmoud Hemmo Nikolai Kiselev Gülsah Kurt Saara Martinmäki Naser Morina Matthis Schick Julia Spaaij Frederik Steen Karine Taha Claire Whitney Martine van den Dool Cansu Mirzanlı Nana Wiedemann Aniek Woodward Barbara Kieft Sam Hunaidy Mariam Elsawy Noer Gorgis Miriam J J Lommen Katie S Dawson Akinçi Ahmad Bawaneh Felicity Brown Anne de Graaff Jonas Maria Hessling Monique Pfaltz Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus BMJ Mental Health |
| title | Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus |
| title_full | Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus |
| title_fullStr | Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus |
| title_full_unstemmed | Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus |
| title_short | Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus |
| title_sort | peer provided psychological intervention for syrian refugees results of a randomised controlled trial on the effectiveness of problem management plus |
| url | https://ebmh.bmj.com/content/26/1/e300637.full |
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