Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus

Anne M de Graaff; Pim Cuijpers; Jos W R Twisk; Barbara Kieft; Sam Hunaidy; Mariam Elsawy; Noer Gorgis; Theo K Bouman; Miriam J J Lommen; Ceren Acarturk; Richard Bryant; Sebastian Burchert; Katie S Dawson; Daniela C Fuhr; Pernille Hansen; Mark Jordans; Christine Knaevelsrud; David McDaid; Naser Morina; Hanspeter Moergeli; A-La Park; Bayard Roberts; Peter Ventevogel; Nana Wiedemann; Aniek Woodward; Marit Sijbrandij; STRENGTHS Consortium; STRENGTHS consortium

doi:10.1136/bmjment-2022-300637

Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus

BMJ Ment Health. 2023 Feb;26(1):e300637. doi: 10.1136/bmjment-2022-300637. Epub 2023 Feb 8.

Authors

Anne M de Graaff¹, Pim Cuijpers^{2

3}, Jos W R Twisk⁴, Barbara Kieft⁵, Sam Hunaidy², Mariam Elsawy², Noer Gorgis⁶, Theo K Bouman⁷, Miriam J J Lommen⁷, Ceren Acarturk⁸, Richard Bryant⁹, Sebastian Burchert¹⁰, Katie S Dawson⁹, Daniela C Fuhr^{11

12

13}, Pernille Hansen¹⁴, Mark Jordans^{15

16}, Christine Knaevelsrud¹⁰, David McDaid¹⁷, Naser Morina¹⁸, Hanspeter Moergeli¹⁸, A-La Park¹⁷, Bayard Roberts¹¹, Peter Ventevogel¹⁹, Nana Wiedemann¹⁴, Aniek Woodward²⁰, Marit Sijbrandij²; STRENGTHS Consortium; STRENGTHS consortium

Collaborators

Affiliations

¹ Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands a.m.de.graaff@vu.nl.
² Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands.
³ International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
⁴ Department of Epidemiology and Data Science, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands.
⁵ ARQ National Psychotrauma Centre, Amsterdam, The Netherlands.
⁶ i-Psy, Parnassia Groep, The Hague, South Holland, The Netherlands.
⁷ Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
⁸ Department of Psychology, Koc Universitesi, Istanbul, Turkey.
⁹ School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia.
¹⁰ Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
¹¹ Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
¹² Health Sciences, University of Bremen, Bremen, Bremen, Germany.
¹³ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
¹⁴ Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark.
¹⁵ Research and Development Department, War Child Holland, Amsterdam, The Netherlands.
¹⁶ Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands.
¹⁷ Department of Health Policy, The London School of Economics and Political Science, London, UK.
¹⁸ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
¹⁹ Public Health Section, UNHCR, Geneva, Switzerland.
²⁰ KIT Health, KIT Royal Tropical Institute, Amsterdam, Noord-Holland, The Netherlands.

Abstract

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.

Keywords: Adult psychiatry; Anxiety disorders; Depression & mood disorders.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Depression / therapy
Female
Humans
Male
Psychosocial Intervention*
Refugees* / psychology
Single-Blind Method
Syria