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Nohr L, Dumke L, Klein EM, Wilker S. [Current Outpatient Psychotherapeutic Care for People with Migration and Refugee Experience in Germany - An Overview]. Psychother Psychosom Med Psychol 2024; 74:205-213. [PMID: 38865996 DOI: 10.1055/a-2304-8902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Although mental health is a human right, even in a country with a well-developed healthcare system like Germany, it is not possible to ensure non-discriminatory access to mental health care for all people, regardless of their origin. For individuals with a history of flight or migration it is particularly difficult to gain access to adequate psychotherapeutic care. This review addresses key barriers contributing to the lack of outpatient care for people with a history of flight or migration. Lack of knowledge about the treatment system, fear of stigma, structural barriers, language barriers, lack of networking of healthcare providers, lack of knowledge of mental health practitioners, as well as stereotypes, discrimination, and racism towards people with a refugee or migration history were identified as the most important barriers with sufficient evidence. Innovative concepts such as peer support can enable non-discriminatory treatment access. In addition, there is an urgent need to train the profession of psychotherapists in racism- and discrimination-sensitive work and to integrate these aspects into psychotherapeutic education and training.
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Affiliation(s)
- Laura Nohr
- Klinisch-Psychologische Intervention, Freie Universität Berlin Fachbereich Erziehungswissenschaft und Psychologie, Berlin
| | - Lars Dumke
- Klinische Psychologie und Psychotherapie, Universität Bielefeld Fakultät für Psychologie und Sportwissenschaft, Bielefeld
| | - Eva M Klein
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Freiburg
| | - Sarah Wilker
- Klinische Psychologie und Psychotherapie, Universität Bielefeld Fakultät für Psychologie und Sportwissenschaft, Bielefeld
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Della Rocca B, Bello R, Carbone M, Pezzella P, Toni C, Sampogna G, Tarsitani L, Luciano M, Fiorillo A. Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions. Int J Soc Psychiatry 2024; 70:653-666. [PMID: 38069651 DOI: 10.1177/00207640231214964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. METHODS The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review. RESULTS AND CONCLUSIONS The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.
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Affiliation(s)
- Bianca Della Rocca
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Rosaria Bello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Marco Carbone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Claudia Toni
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | | | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
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Barhoma M, Carlsson J, Sonne C. Sertraline versus venlafaxine combined with psychotherapy in trauma-affected refugees - a follow-up study on a pragmatic randomised trial. Nord J Psychiatry 2024; 78:353-361. [PMID: 38451197 DOI: 10.1080/08039488.2024.2324357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Research on long-term pharmacotherapy for trauma-affected refugees is scarce. The purpose of this follow-up study of a randomised trial was to investigate the effects of sertraline compared to venlafaxine in combination with psychotherapy, 6 and 18 months after end of trial. METHOD The primary outcome was PTSD symptoms, measured by the Harvard Trauma Questionnaire (HTQ). The secondary outcomes included: Hopkins Symptom Checklist-25 (HSCL-25), somatisation items of the Symptoms Checklist-90 (SCL), pain on a visual analogue scale, well-being on the WHO-5, Sheehan Disability Scale, Hamilton Depression and Anxiety scales and Global Assessment of Functioning. Moreover, the shorter version of the Recent Life Events (IRLE) was adopted to obtain information regarding the patients' treatment and life events between the follow-up periods. RESULTS Out of 195 patients eligible for intention-to-treat analyses during trial, 116 participated in the 6-month follow-up and 97 participated in the 18-month follow-up. The results of our intention-to-treat analyses revealed no significant long-term differences between the groups on the primary outcome assessing PTSD symptoms (HTQ). For the secondary outcomes significant differences were found at the 18-month follow-up in favour of venlafaxine assessing symptoms of anxiety, depression and somatisation (HSCL-25 and SCL), although only in intention-to-treat and not per-protocol analyses. CONCLUSIONS No conclusions could be drawn due to conflicting results between our intention-to-treat and per-protocol analyses.
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Affiliation(s)
- Maria Barhoma
- Department of Psychology, University of Leiden, Leiden, The Netherlands
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
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Xu M, Tian C, Liang S, Tong B, Wu Y, Zhou L, Nian T, Wang Y, Yang K, Li X. Comparative efficacy of exercise modalities on sleep quality in populations with sleep disorders: A systematic review and network meta-analysis. Sleep Med Rev 2024; 73:101877. [PMID: 38006755 DOI: 10.1016/j.smrv.2023.101877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/27/2023]
Abstract
The effect of various exercise modalities on people with sleep disorders remains unclear. This network meta-analysis aims to explore the effects of various exercise modalities in improving sleep quality in people with sleep disorders. Four electronic databases were searched from inception to April 8, 2023. We conducted pairwise meta-analyses and frequentist network meta-analyses with random effects models. A total of 17 randomized controlled trials enrolled 1090 participants were included. Compared with passive control, with moderate-to-low certainty of evidence, mind-body exercise combined with treatment as usual [standard mean difference (SMD) = -2.26, 95% confidence interval (CI) (-3.29, -1,24)], moderate aerobic exercise combined with light strength exercise [SMD = -1.26, 95% CI (-2.22, -0.31)], mind-body exercise [SMD = -0.81, 95% CI (-1.37, -0.25)] and moderate aerobic exercise [SMD = -0.75, 95% CI (-1.38, -0.13)] were more effect in improving sleep disorders. Various exercise modalities have favorable effects on sleep quality for people with sleep disorders compared with passive control. However, due to the low quality of evidence, well-designed trials should be conducted to elucidate these promising findings in the future.
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Affiliation(s)
- Meng Xu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Chen Tian
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Shanshan Liang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Bo Tong
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yanan Wu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Liying Zhou
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Tao Nian
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Yongsheng Wang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
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Smaik N, Simmons LA, Abdulhaq B, Dardas LA. The feasibility and preliminary efficacy of narrative exposure therapy on post-traumatic stress disorder among Syrian refugees in Jordan. Int J Nurs Sci 2023; 10:518-526. [PMID: 38020837 PMCID: PMC10667293 DOI: 10.1016/j.ijnss.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 09/01/2023] [Accepted: 09/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Post-traumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders among refugees, and all require immediate mental health support to prevent short- and long-term detrimental health outcomes. The purpose of this study was to evaluate the feasibility and preliminary efficacy of narrative exposure therapy (NET) in reducing symptoms of PTSD, depression, and anxiety among Syrian refugees residing in Jordan. Methods A two-arm randomized control trial was utilized. A total of 40 Syrian refugees aged 18 to 64 diagnosed with PTSD were randomly allocated to either the NET intervention group (n = 20) or the waitlist control group (n = 20) using a computer-generated allocation list with 1:1 allocation. PTSD symptoms were evaluated using the Arabic rendition of the Harvard Trauma Questionnaire, while depression and anxiety symptoms were appraised using the Arabic adaptation of the Hopkins Symptoms Checklist-25. Descriptive statistics were employed to characterize the sample and survey data. Independent t-tests were conducted to assess mean score differences in PTSD, anxiety, and depression between the intervention and control groups. Results Post NET intervention, significant reductions in PTSD (t = -10.00, P < 0.001), anxiety (t = -9.46, P < 0.001), and depression (t = -6.00, P < 0.001) scores were observed in the intervention group compared to the control group. Effect sizes were moderate for the trauma (Cohen's d = 0.73) and depression (Cohen's d = 0.79) symptoms and notably large for anxiety symptoms (Cohen's d = 0.97). There were no adverse events related to study participation. The intervention achieved a 100% participant retention rate. Conclusions The results pertaining to retention rate, adherence to the study protocol, data completeness, cultural congruence, and participants' satisfaction provided strong support for the future implementation of the full-scale RCT. NET may be a feasible and helpful approach for refugees and other patients with PTSD, anxiety, and depression.
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Affiliation(s)
- Nadeen Smaik
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Leigh Ann Simmons
- The Betty Irene Moore School of Nursing, UC Davis, Sacramento, CA, USA
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Dowllah IM, Melville C. Effectiveness of psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in low- and middle-income countries: A systematic review and meta-analysis. J Health Psychol 2023:13591053231199254. [PMID: 37728258 DOI: 10.1177/13591053231199254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Refugees and asylum seekers are more prone to posttraumatic stress disorder (PTSD) than the general population. This systematic review aims to determine which psychosocial interventions effectively treat PTSD among refugees and asylum seekers in low- and middle-income countries (LMIC). Relevant papers were retrieved from the bibliographic databases. PTSD symptoms post-intervention was the primary outcome. Ten studies were selected with 1981 participants. In meta-analyses of Randomised control trials (RCTs), psychosocial interventions for PTSD (SMD -0.60, 95% CI -0.96 to -0.23; I2 = 91%; 95% CI 75-100; nine studies, 1789 participants) were shown to be clinically effective. Also, in case of depression (SMD -0.59, 95% CI -0.95 to -0.22; I2 = 84%; 95% CI 50-90; seven studies, 1248 participants). Eye Movement Desensitization and Reprocessing (EMDR) had the greatest effect size among psychosocial therapies for this demographic. However, the number of studies is small, and their methodological rigour is limited, thus future study should concentrate on performing more rigorous trials.
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Thøgersen MH, Bager L, Bangsgaard SG, Palic S, Auning-Hansen M, Møller SB, Larsen KB, Tækker L, Jensen BS, Bothe S, Nordin L. The Danish Trauma Database for Refugees (DTD): A Multicenter Database Collaboration-Overcoming the Challenges and Enhancing Mental Health Treatment and Research for Refugees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6611. [PMID: 37623194 PMCID: PMC10454926 DOI: 10.3390/ijerph20166611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Mental health of trauma-affected refugees is an understudied area, resulting in inadequate and poorer treatment outcomes. To address this, more high-quality treatment studies that include predictive analyses, long-term evaluations, cultural adaptations, and take account for comorbidities, are needed. Moreover, given the complex intertwining of refugees' health with post-migration stressors and other social factors, it is crucial to examine the social determinants of refugee mental health. The Danish Trauma Database for Refugees (DTD) is a multicenter research database uniting six national centers that provide outpatient treatment for trauma-affected refugees. Through the database, we collect clinical and sociodemographic data from approximately 1200 refugees annually and will merge the database with Danish population register data. The purpose of the DTD is two-fold; clinical and research. The DTD offers data-driven guidance for routine clinical treatment planning of the individual patient, as well as exceptional research opportunities for testing treatment interventions in clinical settings, with larger sample sizes, and more representative heterogeneity of the population. Complex analyses of risk and protective factors, barriers, access to treatment, and societal and transgenerational aspects of trauma are possible with the DTD. This conceptual paper introduces the DTD, the historical background, the development process and implementation strategy, and the associated challenges with developing and running a multicenter database. Most importantly, it highlights the clinical and research potential of the DTD for advancing the understanding and treatment of trauma-affected refugees.
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Affiliation(s)
- Marie Høgh Thøgersen
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | - Line Bager
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
- National Center for Register-Based Research, Aarhus University, 8210 Aarhus, Denmark
| | - Sofie Grimshave Bangsgaard
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | - Sabina Palic
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | | | - Stine Bjerrum Møller
- The Clinics for Trauma and Torture Survivors (ATT), 7100 Vejle, Denmark;
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
| | | | - Louise Tækker
- Privat Treatment Center for Traumatized Refugees and Their Families, (OASIS), 1164 Copenhagen, Denmark;
| | | | - Søren Bothe
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | - Linda Nordin
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
- Department of Psychology, Lund University, 22100 Lund, Sweden
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Xu M, Guo K, Shang X, Zhou L, E F, Yang C, Wu Y, Li X, Yang K. Network Meta-Analysis of Behavioral Programs for Smoking Cessation in Healthy People. Am J Prev Med 2023; 65:327-336. [PMID: 36893951 DOI: 10.1016/j.amepre.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Smoking is a risk factor for most chronic diseases and premature death, with a global prevalence of more than 1 billion people who smoke. This network meta-analysis aimed to investigate the impact of different behavioral interventions on smoking cessation. METHODS Four electronic databases were searched for RCTs from inception to August 29, 2022. The risk of bias for the included RCTs was evaluated using the revised version of Cochrane tool for assessing risk of bias and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The network meta-analysis was performed using Stata 16SE and R 4.1.3 software. RESULTS A total of 119 included RCTs enrolled 118,935 participants. For the 7-day-point prevalence abstinence rate, video counseling had a best intervention effect than brief advice, followed by financial incentives, self-help materials plus telephone counseling, motivational interview, health education, telephone counseling, and text messages. For the 30-day-point prevalence abstinence rate, face-to-face cognitive education and financial incentives were superior to brief advice. For the continuous abstinence rate, motivational interview and financial incentives were more effective than brief advice. The certainty of evidence was very low to moderate for these studies. DISCUSSION From the results of the network meta-analysis, different behavioral interventions resulted in positive impacts on smoking cessation compared with that of brief advice, especially video counseling, face-to-face cognitive education, and motivational interviews. Owing to the poor quality of evidence, high-quality trials should be conducted in the future to provide more robust evidence.
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Affiliation(s)
- Meng Xu
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Kangle Guo
- Gansu Provincial Hospital, Lanzhou, China
| | - Xue Shang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Liying Zhou
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Fenfen E
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Chaoqun Yang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yanan Wu
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Pozuelo JR, Bradenbrink R, Stierna MF, Sterck O. Depression, violence and socioeconomic outcomes among refugees in East Africa: evidence from a multicountry representative survey. BMJ MENTAL HEALTH 2023; 26:e300773. [PMID: 37597876 PMCID: PMC10577724 DOI: 10.1136/bmjment-2023-300773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Existing research on refugee mental health is heavily skewed towards refugees in high-income countries, even though most refugees (83%) are hosted in low-income and middle-income countries. This problem is further compounded by the unrepresentativeness of samples, small sample sizes and low response rates. OBJECTIVE To present representative findings on the prevalence and correlates of depression among different refugee subgroups in East Africa. METHODS We conducted a multicountry representative survey of refugee and host populations in urban and camp contexts in Kenya, Uganda and Ethiopia (n=15 915). We compared the prevalence of depression between refugee and host populations and relied on regression analysis to explore the association between violence, depression and socioeconomic outcomes. FINDINGS We found a high prevalence of elevated depressive symptoms (31%, 95% CI 28% to 35%) and functional impairment (62%, 95% CI 58% to 66%) among the refugee population, which was significantly higher than that found in the host population (10% for depressive symptoms, 95% CI 8% to 13% and 25% for functional impairment, 95% CI 22% to 28%) (p<0·001). Further, we observed a dose-response relationship between exposure to violence and mental illness. Lastly, high depressive symptoms and functional impairment were associated with worse socioeconomic outcomes. CONCLUSION Our results highlight that refugees in East-Africa-particularly those exposed to violence and extended exile periods-are disproportionately affected by depression, which may also hinder their socioeconomic integration. CLINICAL IMPLICATIONS Given the high prevalence of depression among refugees in East Africa, our results underline the need for scalable interventions that can promote refugees' well-being.
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Affiliation(s)
- Julia R Pozuelo
- Department of Global Health and Social Medicine, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Maria Flinder Stierna
- Department of International Development, University of Oxford, Oxford, UK
- ODI (Overseas Development Institute), London, UK
| | - Olivier Sterck
- Department of International Development, University of Oxford, Oxford, UK
- Institute of Development Policy, University of Antwerp, Antwerpen, Belgium
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10
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Jiang W, Shi G, Li Y, Lu C, Guo L, Zhang W. Dynamic contributions of socioeconomic status to mental health with the resettlement process among refugees. Psychiatry Res 2023; 324:115197. [PMID: 37058795 DOI: 10.1016/j.psychres.2023.115197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
Socioeconomic status (SES) is shown to be associated with refugees' mental health, but few studies have considered that these associations may vary over time. This study aimed to examine the dynamic contributions of SES to refugees' mental health during resettlement. We used five waves of data from a cohort study in Australia; 2399 refugees completed the interview in Wave 1, and the remaining waves had 2009, 1894, 1929, and 1881 participants, respectively. SES, high risk of severe mental illness (HR-SMI), and post-traumatic stress disorder (PTSD) were assessed in each wave. Weighted multilevel regression models were performed, and analyses were stratified by sex. For both sexes, financial hardships were consistently positively associated with HR-SMI and PTSD across all five waves. However, time or sex differences were more pronounced for associations between other SES factors and mental health. For males, there were negative associations of current paid jobs with HR-SMI and PTSD in Waves 3-5. For females, the current paid job was negatively associated with HR-SMI only in Wave 5. Our findings highlight the dynamic associations and sex differences between SES and refugees' mental health. We recommend interventions focusing on increasing employment opportunities, particularly for male refugees in the later resettlement stages.
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Affiliation(s)
- Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Guangduoji Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China.
| | - Weihong Zhang
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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11
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Purgato M, Turrini G, Tedeschi F, Serra R, Tarsitani L, Compri B, Muriago G, Cadorin C, Ostuzzi G, Nicaise P, Lorant V, Sijbrandij M, Witteveen AB, Ayuso-Mateos JL, Mediavilla R, Haro JM, Felez-Nobrega M, Figueiredo N, Pollice G, McDaid D, Park AL, Kalisch R, Petri-Romão P, Underhill J, Bryant RA, Nosè M, Barbui C. Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial. Front Public Health 2023; 11:1100546. [PMID: 36761135 PMCID: PMC9905848 DOI: 10.3389/fpubh.2023.1100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems. Methods and analysis We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness. Discussion This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health. Clinical trial registration ClinicalTrials.gov, identifier: NCT04993534.
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Affiliation(s)
- Marianna Purgato
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giulia Turrini
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Federico Tedeschi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Riccardo Serra
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Beatrice Compri
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giulia Muriago
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Pablo Nicaise
- Institute of Health and Society (IRSS) - UCLouvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS) - UCLouvain, Brussels, Belgium
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria La Princesa (IIS-Princesa), Madrid, Spain
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, ERES, Paris, France
| | - Giulia Pollice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, ERES, Paris, France
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Raffael Kalisch
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | | | | | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Michela Nosè
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
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12
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Jou YC, Pace-Schott EF. Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons. Sleep Health 2022; 8:593-600. [PMID: 36511279 PMCID: PMC9757843 DOI: 10.1016/j.sleh.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 12/13/2022]
Abstract
Sleep difficulty is a recognized hallmark symptom of post-traumatic stress disorder (PTSD) yet often remains an enduring and neglected problem post-treatment. Around 4.4%- 88.0% of refugees, asylum seekers, and internally displaced persons report PTSD, of which 39%- 99% report sleep difficulties. These percentages substantially exceed those of the general population. Yet there has been a lack of research examining evidence-based stand-alone and add-on treatments for PTSD and related sleep disturbances among this population. Barriers to treatment encountered by this population often vary by their legal status or location, but generally include lack of access due to insufficient evidence-based treatments or mental health practitioner shortages, lack of psychoeducation on mental health, cultural stigma, language barriers, situational instability, and racial bias. The refugee population has been on the rise over the past 10 years, and the United Nations estimated the recent Ukraine-Russia conflict would lead to an additional 12 million people needing humanitarian assistance inside Ukraine and more than 6.9 million refugees fleeing to neighboring countries in the coming months. Given that refugees, asylum seekers, and internally displaced persons repeatedly encounter barriers to mental health care specific to their predicament, interventions designed to accommodate their situation are imperative for improving their sleep and mental health. We therefore call for there to be more research on integrative programs incorporating evidence-based treatments that allow for scalability, adaptability, and rapid dissemination to maximize impact in this population. Further, we encourage trainings among clinicians and researchers to increase knowledge and confidence in working with this population.
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Affiliation(s)
| | - Edward F Pace-Schott
- Harvard Extension School, Cambridge, Massachusetts, USA; Massachusetts General Hospital, Department of Psychiatry, Charlestown, Massachusetts, USA; Harvard Medical School, Department of Psychiatry, Charlestown, Massachusetts, USA; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA.
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13
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Barbui C, Tedeschi F, Acarturk C, Anttila M, Au T, Baumgartner J, Carswell K, Churchill R, Cuijpers P, Karyotaki E, Klein T, Koesters M, Lantta T, Nosè M, Ostuzzi G, Pasquini M, Prina E, Sijbrandij M, Tarsitani L, Turrini G, Uygun E, Välimäki M, Walker L, Wancata J, White RG, Purgato M. Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies. Int J Soc Psychiatry 2022; 69:664-674. [PMID: 36326024 DOI: 10.1177/00207640221132430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In asylum seekers and refugees, the frequency of mental disorders, such as depression, anxiety and post-traumatic stress disorder, is higher than the general population, but there is a lack of data on risk factors for the development of mental disorders in this population. AIM This study investigated the risk factors for mental disorder development in a large group of asylum seekers and refugees resettled in high- and middle-income settings. METHODS Participant-level data from two randomized prevention studies involving asylum seekers and refugees resettled in Western European countries and in Turkey were pooled. The two studies randomized participants with psychological distress, but without a diagnosis of mental disorder, to the Self-Help Plus psychological intervention or enhanced care as usual. At baseline, exposure to potentially traumatic events was measured using the Harvard Trauma Questionnaire-part I, while psychological distress and depressive symptoms were assessed with the General Health Questionnaire and the Patient Health Questionnaire. After 3 and 6 months of follow-up, the proportion of participants who developed a mental disorder was calculated using the Mini International Neuropsychiatric Interview. RESULTS A total of 1,101 participants were included in the analysis. At 3- and 6-month follow-up the observed frequency of mental disorders was 13.51% (115/851) and 24.30% (207/852), respectively, while the frequency estimates after missing data imputation were 13.95% and 23.78%, respectively. After controlling for confounders, logistic regression analysis showed that participants with a lower education level (p = .034), a shorter duration of journey (p = .057) and arriving from countries with war-related contexts (p = .017), were more at risk of developing mental disorders. Psychological distress (p = .004), depression (p = .001) and exposure to potentially traumatic events (p = .020) were predictors of mental disorder development. CONCLUSIONS This study identified several risk factors for the development of mental disorders in asylum seekers and refugees, some of which may be the target of risk reduction policies. The identification of asylum seekers and refugees at increased risk of mental disorders should guide the implementation of focused preventative psychological interventions.
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Affiliation(s)
- Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Minna Anttila
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ken Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands.,Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Germany
| | | | - Tella Lantta
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Ersin Uygun
- Trauma and Disaster Mental Health, Istanbul Bilgi University, Turkey
| | - Maritta Välimäki
- University of Turku, Department of Nursing Science, University of Turku, Finland.,Xiangya Nursing School, Central South University, Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Changsha, China
| | - Lauren Walker
- Department of Health Sciences, University of York, UK
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ross G White
- School of Psychology, Queen's University Belfast, UK
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
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14
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Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial. Epidemiol Psychiatr Sci 2022; 31:e39. [PMID: 35674122 PMCID: PMC9220789 DOI: 10.1017/s2045796022000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe. METHODS Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes. RESULTS Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389-1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180-1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001). CONCLUSIONS The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.
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15
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Knefel M, Kantor V, Weindl D, Schiess-Jokanovic J, Nicholson AA, Verginer L, Schäfer I, Lueger-Schuster B. A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: a randomized controlled trial. Eur J Psychotraumatol 2022; 13:2068911. [PMID: 35957634 PMCID: PMC9359165 DOI: 10.1080/20008198.2022.2068911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 02/03/2023] Open
Abstract
Background Afghan refugees often face hardship and traumatic experiences before, during, and after migration and frequently suffer from mental health burdens. Evidence based psychological treatments for refugees mostly focus on symptoms of posttraumatic stress disorder (PTSD), however, refugees often suffer from a variety of general health problems as well as depression and anxiety. We thus aimed to evaluate the effectiveness of a transdiagnostic psychological intervention. Objective To investigate the effectiveness of an adapted version of Problem Management Plus (aPM+) delivered by mental health professionals to adult Afghan refugees and asylum seekers. Methods We randomly allocated 88 Afghan refugees either to aPM+ in addition to treatment as usual (aPM+/TAU) or TAU alone. APM+ comprises of six weekly 90-minute individual sessions including strategies of stress management, problem solving, behavioural activation, strengthening social support and either anger regulation or increasing self-efficacy. The primary outcome was general health (GHQ-28) post intervention. Secondary outcome measures included distress by PMLD, Complex PTSD symptoms, quality of life, self-identified problems, and integration. Results Attrition was high: 42% of the randomized participants did not participate in the post-treatment assessment. A repeated measures per-protocol (completers only) ANCOVA evidenced a significant group × timepoint interaction for GHQ total scores [F(1, 47) = 14.80, p < .001, partial η2 = 0.24]. Post-hoc analyses showed significantly lower symptoms in the aPM+/TAU arm (n = 26) as compared to the TAU arm (n = 25) for the GHQ total scores (dz = 1.04). Most secondary outcomes significantly improved in the aPM+/TAU arm, but not in the TAU arm. Conclusion APM+ was effective in reducing general health problems in Afghan refugees and might be considered as a first-line intervention. High drop-out rate limit the interpretations of our results, where future investigations should focus on possibilities to reduce these rates.Trial registration: Uniform Trial Number identifier: U1111-1226-3285. HIGHLIGHTS Refugees' mental health can be strengthened with a brief psychological intervention that also focuses on skills in the context of post-migration stressors.High drop-out rates are a major challenge for future research and delivery of psychological interventions as part of health care systems to refugees and asylum seekers.
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Affiliation(s)
- Matthias Knefel
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Viktoria Kantor
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dina Weindl
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Andrew A. Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Lucia Verginer
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Barbui C, Purgato M, Acarturk C, Churchill R, Cuijpers P, Koesters M, Sijbrandij M, Välimäki M, Wancata J, White RG. Preventing the mental health consequences of war in refugee populations. Epidemiol Psychiatr Sci 2022; 31:e24. [PMID: 35438061 PMCID: PMC9069581 DOI: 10.1017/s2045796022000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 11/06/2022] Open
Abstract
The refugee experience is associated with several potentially traumatic events that increase the risk of developing mental health consequences, including worsening of subjective wellbeing and quality of life, and risk of developing mental disorders. Here we present actions that countries hosting forcibly displaced refugees may implement to decrease exposure to potentially traumatic stressors, enhance subjective wellbeing and prevent the onset of mental disorders. A first set of actions refers to the development of reception conditions aiming to decrease exposure to post-migration stressors, and a second set of actions refers to the implementation of evidence-based psychological interventions aimed at reducing stress, preventing the development of mental disorders and enhancing subjective wellbeing.
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Affiliation(s)
- Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ceren Acarturk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | | | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ross G. White
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
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17
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Purgato M, Singh R, Acarturk C, Cuijpers P. Moving beyond a 'one-size-fits-all' rationale in global mental health: prospects of a precision psychology paradigm. Epidemiol Psychiatr Sci 2021; 30:e63. [PMID: 34632978 PMCID: PMC8518023 DOI: 10.1017/s2045796021000500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Research on the effectiveness of mental health and psychosocial support interventions for common mental disorders in global mental health provides controversial results. These results are based on mean values for different groups, often without due consideration of individual-level characteristics and contextual factors. Against this background, and based on the recent development of a precision theoretical framework in clinical psychology, which is calling for a renewed perspective on the development and implementation of trial designs, we propose to develop a precision psychology paradigm in global mental health, with emphasis not only on individual clinical and socio-demographic data, but also on the social determinants of mental health. A precision psychology paradigm would require a coordinated action of academics, stakeholders and humanitarian workers in planning a global mental health research agenda, including the design of trials aimed at reliably approximate prediction of intervention response at individual level.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona,Italy
- Cochrane Global Mental Health, University of Verona, Verona,Italy
| | - Rakesh Singh
- Department of Public Health, Independent Mental Health Researcher, Visiting Faculty, KIST Medical College, Kathmandu, Nepal
| | - Ceren Acarturk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul,Turkey
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, Netherlands
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