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Surkan PJ, Rayes D, Bertuzzi L, Figueiredo N, Melchior M, Tortelli A. A qualitative evaluation of the use of Problem Management Plus (PM+) among Arabic-speaking migrants with psychological distress in France - The APEX study. Eur J Psychotraumatol 2024; 15:2325243. [PMID: 38501438 PMCID: PMC10953778 DOI: 10.1080/20008066.2024.2325243] [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: 05/13/2023] [Accepted: 12/21/2023] [Indexed: 03/20/2024] Open
Abstract
ABSTRACTBackground: Feasibility studies with non-French speaking migrants in France are needed to inform appropriate adaptation of psychosocial intervention procedures.Objective: To test the WHO Problem Management Plus (PM+) intervention protocol for Arabic-speaking migrants in the Paris metropolitan region.Methods: Between 2019 and 2021 we recruited participants from three accommodation centres receiving asylum seekers or migrants experiencing social and economic difficulties. Participants experiencing psychological distress underwent five PM + sessions with trained helpers. Feasibility was evaluated through 15 interviews with 8 participants, 4 helpers, and 3 study supervisors. Interview topics covered PM + implementation in general and for each component. We also sought to understand problems with delivery and gathered suggestions for improvement. Data were analysed thematically using a deductive approach.Results: We found implementation of PM + to be feasible, with predominantly positive reactions from participants, helpers and study staff. All intervention components were considered beneficial, with breathing exercises considered easy to implement and often sustained. Selection of problems and strategies to address them were described as challenging to execute. Psychosocial support from and rapport with helpers and the use of the native language were considered key strengths of the programme. However, we observed the need for complementary or higher intensity psychological support in some cases. Findings also highlighted the importance of addressing distress among non-specialist helpers delivering PM + . Finally, local guidance to social resources were suggested to be added in the protocol.Conclusion: PM + was well-liked and feasible, with cultural adjustments and increased access to community resources for migrants needed.
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Affiliation(s)
- P. J. Surkan
- Social and Behavioral Interventions Program, Department of International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institut d’Etudes Avancées de Paris, Paris, France
| | - D. Rayes
- Social and Behavioral Interventions Program, Department of International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L. Bertuzzi
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
| | - N. Figueiredo
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
| | - M. Melchior
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
| | - A. Tortelli
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
- GHU Paris, Psychiatrie & Neurosciences – Pôle Psychiatrie Précarité, Paris, France
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Woodward A, Sondorp E, Barry AS, Dieleman MA, Fuhr DC, Broerse JEW, Akhtar A, Awwad M, Bawaneh A, Bryant R, Sijbrandij M, Cuijpers P, Roberts B. Scaling up task-sharing psychological interventions for refugees in Jordan: a qualitative study on the potential barriers and facilitators. Health Policy Plan 2023; 38:310-320. [PMID: 36631951 PMCID: PMC10019561 DOI: 10.1093/heapol/czad003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
Training nonspecialists in providing evidence-based psychological interventions (i.e. task-sharing) can effectively increase community access to psychological support. However, task-sharing interventions for this purpose are rarely used at scale. The aim of this study was to examine the factors influencing the potential for scaling up (i.e. scalability) of a task-sharing psychological intervention called Problem Management Plus (PM+) for Syrian refugees in Jordan. Semi-structured individual (n = 17) and group interviews (n = 20) were conducted with stakeholders knowledgeable about PM+ and the mental health system for Syrian refugees in Jordan. Using 'system innovation perspective', this study conceptualized the context as landscape developments, and systemic considerations were divided into culture (shared ways of thinking) and structure (ways of organizing). Political momentum was identified as a landscape trend likely facilitating scaling up, while predicted reductions in financial aid was regarded as a constraint. In terms of culture, the medicalized approach to mental health, stigma and gender were reported barriers for scaling up PM+. Using non-stigmatizing language and offering different modalities, childcare options and sessions outside of working hours were suggestions to reduce stigma, accommodate individual preferences and increase the demand for PM+. In relation to structure, the feasibility of scaling up PM+ largely depends on the ability to overcome legal barriers, limitations in human and financial resources and organizational challenges. We recommend sustainable funding to be made available for staff, training, supervision, infrastructure, coordination, expansion and evaluation of 'actual' scaling up of PM+. Future research may examine the local feasibility of various funding, training and supervision models. Lessons learned from actual scaling up of PM+ and similar task-sharing approaches need to be widely shared.
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Affiliation(s)
- Aniek Woodward
- *Corresponding author. KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands. E-mail:
| | - Egbert Sondorp
- KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands
| | - Alexandra S Barry
- KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands
- NHS England, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Marjolein A Dieleman
- KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, Bremen 28359, Germany
- University of Bremen, Health Sciences, Bibliothekstrasse 1, Bremen 28359, Germany
| | - Jacqueline E W Broerse
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Kensington, Sydney NSW 2052, Australia
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Solnavägen 1, Solna 171 77, Sweden
| | - Manar Awwad
- International Medical Corps, Al Shareef Abd Al Hameed Sharaf St 9, Amman, Jordan
| | - Ahmad Bawaneh
- International Medical Corps, Al Shareef Abd Al Hameed Sharaf St 9, Amman, Jordan
| | - Richard Bryant
- School of Psychology, University of New South Wales, Kensington, Sydney NSW 2052, Australia
| | - 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, De Boelelaan 1105, Amsterdam 1081 HV, 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, De Boelelaan 1105, Amsterdam 1081 HV, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, 37 Republicii Street, Cluj-Napoca, Romania
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Arega NT. Mental Health and Psychosocial Support Interventions for Children Affected by Armed Conflict in low-and middle-income Countries: A Systematic Review. CHILD & YOUTH CARE FORUM 2023:1-26. [PMID: 37360764 PMCID: PMC9990564 DOI: 10.1007/s10566-023-09741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 06/28/2023]
Abstract
Background . Armed conflicts continue to threaten a vast number of children across the world, especially in low-and middle-income countries (LMICs). Evidence-based interventions are vital to adequately address the mental health needs in these groups. Objective . This systematic review aims to provide a comprehensive update of the most current developments in mental health and psychosocial support (MHPSS) interventions for children affected by armed conflict in LMICs, since 2016. Such an update may be useful in determining where the current focus of interventions lies and whether there are changes in types of interventions that are commonly implemented. Methods . The main medical, psychological and social sciences databases (PubMed, PsycINFO, Medline) were searched to identify interventions aimed at improving or treating mental health problems in conflict-affected children in LMICs. For the period 2016-2022, a total of 1243 records were identified. Twenty-three articles met the inclusion criteria. A bio-ecological lens was used to organize the interventions and the presentation of findings. Results . Seventeen forms of MHPSS interventions with a wide range of treatment modalities were identified in this review. The reviewed articles focused mainly on family-based interventions. Very few studies empirically evaluated community-level interventions. Conclusion . Current focus of interventions is family-based; the addition of caregiver wellbeing and parenting skills components had the potential to enhance the effects of interventions designed to improve children's mental health. Future trials for MHPSS interventions need to give more attention to community-level interventions. Community-level supports such as person-to-person support, solidarity groups, and dialogue groups stand to reach large numbers of children and families.
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Affiliation(s)
- Natnael Terefe Arega
- PhD in Applied Developmental Psychology, Institute of Education and Behavioral Sciences, Ambo University, Ambo, Ethiopia
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Leung T, Okumu M, Kortenaar JL, Gittings L, Khan N, Hakiza R, Kibuuka Musoke D, Nakitende A, Katisi B, Kyambadde P, Khan T, Lester R, Mbuagbaw L. Mobile Health-Supported Virtual Reality and Group Problem Management Plus: Protocol for a Cluster Randomized Trial Among Urban Refugee and Displaced Youth in Kampala, Uganda (Tushirikiane4MH, Supporting Each Other for Mental Health). JMIR Res Protoc 2022; 11:e42342. [PMID: 36480274 PMCID: PMC9782374 DOI: 10.2196/42342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although mental health challenges disproportionately affect people in humanitarian contexts, most refugee youth do not receive the mental health support needed. Uganda is the largest refugee-hosting nation in Africa, hosting over 1.58 million refugees in 2022, with more than 111,000 living in the city of Kampala. There is limited information about effective and feasible interventions to improve mental health outcomes and mental health literacy, and to reduce mental health stigma among urban refugee adolescents and youth in low- and middle-income countries (LMICs). Virtual reality (VR) is a promising approach to reduce stigma and improve mental health and coping, yet such interventions have not yet been tested in LMICs where most forcibly displaced people reside. Group Problem Management Plus (GPM+) is a scalable brief psychological transdiagnostic intervention for people experiencing a range of adversities, but has not been tested with adolescents and youth to date. Further, mobile health (mHealth) strategies have demonstrated promise in promoting mental health literacy. OBJECTIVE The aim of this study is to evaluate the feasibility and effectiveness of two youth-tailored mental health interventions (VR alone and VR combined with GMP+) in comparison with the standard of care in improving mental health outcomes among refugee and displaced youth aged 16-24 years in Kampala, Uganda. METHODS A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomized in a 1:1:1 design. Approximately 330 adolescents (110 per cluster) are enrolled and will be followed for approximately 16 weeks. Data will be collected at three time points: baseline enrollment, 8 weeks following enrollment, and 16 weeks after enrollment. Primary (depression) and secondary outcomes (mental health literacy, attitudes toward mental help-seeking, adaptive coping, mental health stigma, mental well-being, level of functioning) will be evaluated. RESULTS The study will be conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (#40965; May 12, 2021), Mildmay Uganda Research Ethics Committee (MUREC-2021-41; June 24, 2021), and Uganda National Council for Science & Technology (SS1021ES; January 1, 2022). A qualitative formative phase was conducted using focus groups and in-depth, semistructured key informant interviews to understand contextual factors influencing mental well-being among urban refugee and displaced youth. Qualitative findings will inform the VR intervention, SMS text check-in messages, and the adaptation of GPM+. Intervention development was conducted in collaboration with refugee youth peer navigators. The trial launched in June 2022 and the final follow-up survey will be conducted in November 2022. CONCLUSIONS This study will contribute to the knowledge of youth-tailored mental health intervention strategies for urban refugee and displaced youth living in informal settlements in LMIC contexts. Findings will be shared in peer-reviewed publications, conference presentations, and with community dissemination. TRIAL REGISTRATION ClinicalTrials.gov NCT05187689; https://clinicaltrials.gov/ct2/show/NCT05187689. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42342.
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Affiliation(s)
| | - Moses Okumu
- School of Social Work, University of Illinois, Urban-Champaign, IL, United States.,School of Social Sciences, Uganda Christian University, Mukono, Uganda
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lesley Gittings
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada.,Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Naimul Khan
- Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | | | | | - Brenda Katisi
- Young African Refugees for Integral Development, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS and STI Control Programme, Ministry of Health, Kampala, Uganda.,Most At Risk Population Initiative, Mulago Hospital, Kampala, Uganda
| | - Torsum Khan
- Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Richard Lester
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada.,Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon.,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Im H, Swan LET. Trauma exposure, social functioning, and common mental health disorders in Somali refugee male and female youth: An SEM analysis. Int J Soc Psychiatry 2022; 68:1539-1551. [DOI: https:/doi.org/10.1177/00207640211037726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Background: Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy. Aims: This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains. Method: We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15–35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample ( N = 305) and then assessed gender differences by running one model for male participants ( n = 124) and another for female participants ( n = 181). Results: In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample. Conclusions: This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, Richmond, USA
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Twelve-month follow-up of a randomised clinical trial of a brief group psychological intervention for common mental disorders in Syrian refugees in Jordan. Epidemiol Psychiatr Sci 2022; 31:e81. [PMID: 36377410 PMCID: PMC9677446 DOI: 10.1017/s2045796022000658] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS There is increasing evidence that brief psychological interventions delivered by lay providers can reduce common mental disorders in the short-term. This study evaluates the longer-term impact of a brief, lay provider delivered group psychological intervention (Group Problem Management Plus; gPM+) on the mental health of refugees and their children's mental health. METHODS This single-blind, parallel, controlled trial randomised 410 adult Syrians in Azraq Refugee Camp in Jordan who screened positive for distress and impaired functioning to either five sessions of gPM+ or enhanced usual care (EUC). Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL-25; depression and anxiety scales) assessed at baseline, 6 weeks, 3 months and 12 months Secondary outcomes included disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behaviour and children's mental health. RESULTS Between 15 October 2019 and 2 March 2020, 204 participants were assigned to gPM + and 206 to EUC, and 307 (74.9%) were retained at 12 months. Intent-to-treat analyses indicated that although participants in gPM + had greater reductions in depression at 3 months, at 12 months there were no significant differences between treatment arms on depression (mean difference -0.9, 95% CI -3.2 to 1.3; p = 0.39) or anxiety (mean difference -1.7, 95% CI -4.8 to -1.3; p = 0.06). There were no significant differences between conditions for secondary outcomes except that participants in gPM + had greater increases in positive parenting. CONCLUSIONS The short-term benefits of a brief, psychological programme delivered by lay providers may not be sustained over longer time periods, and there is a need for sustainable programmes that can prolong benefits gained through gPM + .
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Dowrick C, Rosala-Hallas A, Rawlinson R, Khan N, Winrow E, Chiumento A, Burnside G, Aslam R, Billows L, Eriksson-Lee M, Lawrence D, McCluskey R, Mackinnon A, Moitt T, Orton L, Roberts E, Rahman A, Smith G, Tudor Edwards R, Uwamaliya P, White R. The Problem Management Plus psychosocial intervention for distressed and functionally impaired asylum seekers and refugees: the PROSPER feasibility RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/nzxa0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background
The prevalence of psychological morbidity among asylum seekers and refugees is high, but these groups encounter extensive barriers to accessing health and social care. The aim of the PROSPER study was to assess the feasibility of conducting a randomised controlled trial in the UK of Problem Management Plus (PM+), an evidence-based psychosocial intervention delivered by lay therapists for distressed and functionally impaired asylum seekers and refugees.
Design
We undertook a feasibility study of PM+, which included a pilot study of the design features of a future definitive randomised controlled trial and economic evaluation. The feasibility study involved the adaptation of PM+ based on evidence drawn from literature synthesis and local stakeholder engagement, and a two-stage training procedure for lay therapists. These were followed by a pilot trial designed to assess the feasibility of conducting a three-arm randomised controlled trial of five 90-minute sessions of PM+, delivered individually or in groups, with 105 participants randomised 1 : 1 : 1 to individual PM+, group PM+ or a control intervention. Primary health outcomes were anxiety and depressive symptoms at 3 months; other outcomes included post-traumatic stress disorder symptoms, quality of life, progress with identified goals and service use.
Findings
We demonstrated that the form and content of PM+ could be adapted to meet the needs of asylum seekers and refugees. Twelve people with lived experience of the asylum process were successfully trained as lay therapists to deliver this targeted, low-intensity psychosocial intervention in local asylum seeker and refugee communities. The pilot trial was affected by governance issues. It began in December 2019 and was cut short by the COVID-19 pandemic. We were not able to complete recruitment and follow-up as planned; 11 out of 105 (10%) participants were recruited to the pilot trial (individual PM+, n = 4; group PM+, n = 3; control, n = 4); 8 out of 11 participants were followed up at 13 weeks and 7 out of 11 participants were followed up at 26 weeks. (Preliminary data were gathered on recruitment and retention, intervention fidelity and acceptability of study measures, including service use measures.)
Limitations
Protracted delays due to governance issues, followed by the COVID-19 pandemic, meant that we were unable to complete the pilot trial or to provide evidence regarding the feasibility of group PM+. The complexities of working with multiple languages and cultural groups were noted. There were mixed views on how successful PM+ might prove, and we had insufficient evidence to provide clear conclusions.
Future work
Future research could explore how technology can be used to improve the acceptability, feasibility, efficacy and potential cost-effectiveness of scalable mental health interventions and well-being support for distressed asylum seekers and refugees. The use of mobile phone and/or app-based forms of support may help to increase asylum seekers’ and refugees’ willingness to engage in research of this type.
Conclusions
Although it was not possible to specify the parameters for a full randomised controlled trial of PM+ for asylum seekers and refugees in the UK, our findings offer guidance on strategies that may be of value in future studies of this nature.
Trial registration
This trial is registered as ISRCTN15214107.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Christopher Dowrick
- Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Anna Rosala-Hallas
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Rebecca Rawlinson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Naila Khan
- Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Eira Winrow
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Anna Chiumento
- Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Girvan Burnside
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | | | | | | | - Daniel Lawrence
- Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | | | - Tracy Moitt
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Lois Orton
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | | | - Atif Rahman
- Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Grahame Smith
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | | | - Philomene Uwamaliya
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ross White
- Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Perera C, Aldamman K, Hansen M, Haahr-Pedersen I, Caballero-Bernal J, Caldas-Castañeda ON, Chaparro-Plata Y, Dinesen C, Wiedemann N, Vallières F. A brief psychological intervention for improving the mental health of venezuelan migrants and refugees: A mixed-methods study. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bryant RA, Bawaneh A, Awwad M, Al-Hayek H, Giardinelli L, Whitney C, Jordans MJD, Cuijpers P, Sijbrandij M, Ventevogel P, Dawson K, Akhtar A. Effectiveness of a brief group behavioral intervention for common mental disorders in Syrian refugees in Jordan: A randomized controlled trial. PLoS Med 2022; 19:e1003949. [PMID: 35298469 PMCID: PMC8929659 DOI: 10.1371/journal.pmed.1003949] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Common mental disorders are frequently experienced by refugees. This study evaluates the impact of a brief, lay provider delivered group-based psychological intervention [Group Problem Management Plus (gPM+)] on the mental health of refugees in a camp, as well as on parenting behavior and children's mental health. METHODS AND FINDINGS In this single-blind, parallel, randomized controlled trial, 410 adult Syrian refugees (300 females, 110 males) in Azraq Refugee Camp (Jordan) were identified through screening of psychological distress (≥16 on the Kessler Psychological Distress Scale) and impaired functioning (≥17 on the WHO Disability Assessment Schedule). Participants were randomly allocated to gPM+ or enhanced usual care (EUC) involving referral information for psychosocial services on a 1:1 ratio. Participants were aware of treatment allocation, but assessors were blinded to treatment condition. Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL; depression and anxiety scales) assessed at baseline, 6 weeks, and 3 months follow-up as the primary outcome time point. It was hypothesized that gPM+ would result in greater reductions of scores on the HSCL than EUC. Secondary outcomes were disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behavior, and children's mental health. Between October 15, 2019 and March 2, 2020, 624 refugees were screened for eligibility, 462 (74.0%) screened positive, of whom 204 were assigned to gPM+ and 206 to EUC. There were 168 (82.4%) participants in gPM+ and 189 (91.7%) in EUC assessed at follow-up. Intent-to-treat analyses indicated that at follow-up, participants in gPM+ showed greater reduction on HSCL depression scale than those receiving EUC (mean difference, 3.69 [95% CI 1.90 to 5.48], p = .001; effect size, 0.40). There was no difference between conditions in anxiety (mean difference -0.56, 95% CI -2.09 to 0.96; p = .47; effect size, -0.03). Relative to EUC, participants in gPM+ had greater reductions in severity of personally identified problems (mean difference 0.88, 95% CI 0.07 to 1.69; p = .03), and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < .001). There were no significant differences between conditions for changes in PTSD, disability, grief, prodromal symptoms, or childhood mental health outcomes. Mediation analysis indicated the change in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE .07; 95% CI .003 to .274) and internalizing (β = 0.08, SE .05; 95% CI .003 to 0.19) problems in children. No adverse events were attributable to the interventions or the trial. Major limitations included only one-quarter of participants being male, and measures of personally identified problems, grief, prodromal psychotic symptoms, inconsistent parenting behavior, and children's mental health have not been validated with Syrians. CONCLUSIONS In camp-based Syrian refugees, a brief group behavioral intervention led to reduced depressive symptoms, personally identified problems, and disciplinary parenting compared to usual care, and this may have indirect benefits for refugees' children. The limited capacity of the intervention to reduce PTSD, disability, or children's psychological problems points to the need for development of more effective treatments for refugees in camp settings. TRIAL REGISTRATION Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619001386123.
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Affiliation(s)
- Richard A. Bryant
- University of New South Wales, Sydney, Australia
- Westmead Institute of Medical Research, Sydney, Australia
| | - Ahmad Bawaneh
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Manar Awwad
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Hadeel Al-Hayek
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | | | - Claire Whitney
- International Medical Corps, Washington DC, United States of America
| | - Mark J. D. Jordans
- War Child, Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Peter Ventevogel
- United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Katie Dawson
- University of New South Wales, Sydney, Australia
| | - Aemal Akhtar
- University of New South Wales, Sydney, Australia
- Vrije Universiteit, Amsterdam, the Netherlands
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Exploratory and confirmatory factor analysis of the 12-item Arabic World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a screening tool for Syrian refugees. BJPsych Open 2021. [PMCID: PMC8517853 DOI: 10.1192/bjo.2021.1017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees. Aims The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention. Method A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0. Results The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P < 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution. Conclusions The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Problems after flight: understanding and comparing Syrians' perspectives in the Middle East and Europe. BMC Public Health 2021; 21:717. [PMID: 33849507 PMCID: PMC8045311 DOI: 10.1186/s12889-021-10498-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background Syrian refugees and asylum seekers (SRAs) face multiple stressors after flight, which may vary due to different geographic, economic, cultural and socio-political contexts in the host countries. Past research has recognised the importance of participants’ own perspectives. The aims of this multi-country study were to identify and compare self-reported problems of SRAs between various settings. Methods A semi-structured client-generated outcome measurement was used to collect data among adult SRAs in Jordan (N = 61), Turkey (N = 46) and Switzerland (N = 57) between September 2018 and November 2019. Answers were analysed following thematic analysis. Results Over half of the participants reported practical problems with an emphasis on camp-related problems (Jordan), finances (Turkey), employment (Jordan and Switzerland) and government regulations (Switzerland), followed by psychological, and social issues. Conclusion This study highlights the impact of local contextual factors on wellbeing. The findings emphasise that planning preventative procedures and mental health care services for SRAs need to consider local challenges affecting the population in specific countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10498-1.
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Akhtar A, Bawaneh A, Awwad M, Al-Hayek H, Sijbrandij M, Cuijpers P, Bryant RA. A longitudinal study of mental health before and during the COVID-19 pandemic in Syrian refugees. Eur J Psychotraumatol 2021; 12:1991651. [PMID: 34777714 PMCID: PMC8583939 DOI: 10.1080/20008198.2021.1991651] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in increased anxiety and depression around the world. Refugees may be particularly vulnerable to the mental health effects of the pandemic because of their higher rates of mental health disorders, trauma histories, and daily stressors. OBJECTIVES This study used data from a controlled trial of a brief behavioural intervention for psychological distress in Syrian refugees living in Azraq Camp in Jordan to examine the psychological effects of the pandemic on refugee mental health. METHOD A total of 410 participants were randomized to either the intervention or control arms of the trial and were assessed at baseline and 3-month follow-up. Half the sample (199; 48.5%) completed their 3-month follow-up assessment after the pandemic restrictions began in Jordan and 211 (51.5%) completed the assessment prior to the pandemic. Refugees were independently assessed for symptoms of PTSD, anxiety, and depression at baseline and follow-up, and pandemic-related worries were assessed at follow-up for those who completed their assessment during the pandemic. RESULTS The most commonly reported worries were economic difficulties (82.4%), shortage of essential supplies (71.3%), and infecting others (59.7%) or themselves (51.9%). Refugees who were assessed during the pandemic had less severe PTSD symptoms than those assessed prior to the pandemic. Significant predictors of pandemic-related worries were lower levels of depression prior to the pandemic and greater anxiety during the pandemic. CONCLUSION These findings highlight the specific needs of refugees during the pandemic and suggest that pre-existing mental health issues may not necessarily be the key risk factors for who will experience major mental health issues or worries during the pandemic.
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Affiliation(s)
- Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia.,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
| | - Ahmad Bawaneh
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Manar Awwad
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Hadeel Al-Hayek
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - 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
| | - 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
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
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