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Serra R, Purgato M, Tedeschi F, Acartürk C, Karyotaki E, Uygun E, Turrini G, Winkler H, Pinucci I, Wancata J, Walker L, Popa M, Sijbrandij M, Välimäki M, Kösters M, Nosè M, Anttila M, Churchill R, White RG, Lantta T, Klein T, Wochele-Thoma T, Tarsitani L, Barbui C. Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model. Eur J Psychotraumatol 2024; 15:2355828. [PMID: 38828909 PMCID: PMC11149571 DOI: 10.1080/20008066.2024.2355828] [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: 01/23/2024] [Accepted: 04/13/2024] [Indexed: 06/05/2024] Open
Abstract
Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.
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Affiliation(s)
- Riccardo Serra
- World Health Organization 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, Verona, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marianna Purgato
- World Health Organization 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, Verona, Italy
| | - Federico Tedeschi
- World Health Organization 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, Verona, Italy
| | - Ceren Acartürk
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ersin Uygun
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Giulia Turrini
- World Health Organization 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, Verona, Italy
| | | | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Johannes Wancata
- Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Mariana Popa
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maritta Välimäki
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- School of Public Health, University of Helsinki, Helsinki, Finland
| | - Markus Kösters
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Michela Nosè
- World Health Organization 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, Verona, Italy
| | - Minna Anttila
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross G. White
- School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Tella Lantta
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
| | - Thomas Klein
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Corrado Barbui
- World Health Organization 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, Verona, Italy
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Wright SL, Karyotaki E, Cuijpers P, Bisson J, Papola D, Witteveen A, Suliman S, Spies G, Ahmadi K, Capezzani L, Carletto S, Karatzias T, Kullack C, Laugharne J, Lee CW, Nijdam MJ, Olff M, Ostacoli L, Seedat S, Sijbrandij M. EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychol Med 2024; 54:1580-1588. [PMID: 38173121 DOI: 10.1017/s0033291723003446] [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: 01/05/2024]
Abstract
BACKGROUND This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR. METHODS This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization. RESULTS One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity (β = -0.24), achieving response (β = 0.86), attaining remission (β = 1.05), or reducing treatment dropout rates (β = -0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females. CONCLUSION The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status.
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Affiliation(s)
- Simonne Lesley Wright
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Davide Papola
- 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
| | - Anke Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sharain Suliman
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Georgina Spies
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Liuva Capezzani
- The International Institute for Psychoanalytic Research and Training of Health Professionals (IIPRTHP), Rome, Italy
- International School for Psychotherapy (SIPSI), Rome, Italy
| | - Sara Carletto
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | | | - Jonathan Laugharne
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Christopher William Lee
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Australia
| | - Mirjam J Nijdam
- Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Miranda Olff
- Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Soraya Seedat
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Roos R, Witteveen AB, Ayuso-Mateos JL, Barbui C, Bryant RA, Felez-Nobrega M, Figueiredo N, Kalisch R, Haro JM, McDaid D, Mediavilla R, Melchior M, Nicaise P, Park AL, Petri-Romão P, Purgato M, van Straten A, Tedeschi F, Underhill J, Sijbrandij M. Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial. BMC Psychiatry 2023; 23:801. [PMID: 37919694 PMCID: PMC10623706 DOI: 10.1186/s12888-023-05288-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has negatively affected the mental health of international migrant workers (IMWs). IMWs experience multiple barriers to accessing mental health care. Two scalable interventions developed by the World Health Organization (WHO) were adapted to address some of these barriers: Doing What Matters in times of stress (DWM), a guided self-help web application, and Problem Management Plus (PM +), a brief facilitator-led program to enhance coping skills. This study examines whether DWM and PM + remotely delivered as a stepped-care programme (DWM/PM +) is effective and cost-effective in reducing psychological distress, among Polish migrant workers with psychological distress living in the Netherlands. METHODS The stepped-care DWM/PM + intervention will be tested in a two-arm, parallel-group, randomized controlled trial (RCT) among adult Polish migrant workers with self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15.9). Participants (n = 212) will be randomized into either the intervention group that receives DWM/PM + with psychological first aid (PFA) and care-as-usual (enhanced care-as-usual or eCAU), or into the control group that receives PFA and eCAU-only (1:1 allocation ratio). Baseline, 1-week post-DWM (week 7), 1-week post-PM + (week 13), and follow-up (week 21) self-reported assessments will be conducted. The primary outcome is psychological distress, assessed with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes are self-reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), resilience, quality of life, and cost-effectiveness. In a process evaluation, stakeholders' views on barriers and facilitators to the implementation of DWM/PM + will be evaluated. DISCUSSION To our knowledge, this is one of the first RCTs that combines two scalable, psychosocial WHO interventions into a stepped-care programme for migrant populations. If proven to be effective, this may bridge the mental health treatment gap IMWs experience. TRIAL REGISTRATION Dutch trial register NL9630, 20/07/2021, https://www.onderzoekmetmensen.nl/en/trial/27052.
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Affiliation(s)
- Rinske Roos
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands.
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology and 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
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - 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
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Natasha Figueiredo
- Equipe de Recherche en Epidémiologie Sociale (ERES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université, Faculté de Médecine St Antoine, Paris, France
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Focus Program Translational Neuroscience (FTN), Neuroimaging Center (NIC), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria Melchior
- Equipe de Recherche en Epidémiologie Sociale (ERES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université, Faculté de Médecine St Antoine, Paris, France
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - 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
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - 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
| | | | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
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