1
|
Kaminer D, Booysen D, Ellis K, Kristensen CH, Patel AR, Robjant K, Sardana S. Improving access to evidence-based interventions for trauma-exposed adults in low- and middle-income countries. J Trauma Stress 2024; 37:563-573. [PMID: 38459223 DOI: 10.1002/jts.23031] [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: 02/02/2024] [Revised: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 03/10/2024]
Abstract
In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.
Collapse
Affiliation(s)
- Debra Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Duane Booysen
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Kate Ellis
- Department of Psychology, American University in Cairo, New Cairo, Egypt
| | - Christian Haag Kristensen
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Anushka R Patel
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Katy Robjant
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Srishti Sardana
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Nakkash R, Ghandour L, Brown G, Panter-Brick C, Bomar H, Tleis M, Al Masri H, Fares M, Al Halabi F, Najjar Y, Louis B, Hodroj M, Chamoun Y, Zarzour M, Afifi RA. Syrian refugee young adults as community mental health workers implementing problem management plus: Protocol for a pilot randomized controlled trial to measure the mechanisms of effect on their own wellbeing, stress and coping. Contemp Clin Trials Commun 2024; 40:101325. [PMID: 39045391 PMCID: PMC11263753 DOI: 10.1016/j.conctc.2024.101325] [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: 02/15/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/25/2024] Open
Abstract
This pilot randomized controlled trial protocol aims to (1) assess the impact on the wellbeing of Syrian refugee young adults (18-24 years) of being a community mental health worker (CMHW) implementing WHO's evidence-based psychosocial intervention - Problem Management Plus (PM+) - with adults in their community, and (2) identify the mechanisms associated with the outcomes of enhanced wellbeing and coping, and reduced stress among these CMHWs. Over 108 million people have been forcibly displaced as of the end of 2022. Mental health consequences of these displacements are significant, yet human resources for health are not sufficient to meet the needs. A large proportion of refugee populations are youth and young adults (YA). Evidence indicates their engagement in supporting their communities leads to their own enhanced wellbeing and that of their community. This trial trains Syrian refugees to serve their communities as CMHW (n=19) or tutors (n=19) and compare wellbeing, stress and coping outcomes between these two groups and a control group (n = 40). We will also assess 7 mechanisms as potential pathways for the interventions to influence outcomes. Surveys will assess outcomes and mechanisms, hair samples will measure stress cortisol. The primary analysis will use a Bayesian Hierarchical Model approach to model the trajectories of the mechanisms and primary study endpoints over time for individuals in each of the arms. Our results will elucidate critical mechanisms in which engagement of young adults to support their community enhances their own wellbeing. Trial registration National Institutes of Mental Health, NCT05265611, Registered prospectively in 2021. Lebanon clinical trials registry # LBCTR2023015206, Registered in 2023.
Collapse
Affiliation(s)
- Rima Nakkash
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Lilian Ghandour
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Grant Brown
- Biostatistics Department, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Catherine Panter-Brick
- Anthropology Department, Yale University, New Haven, CT, USA
- Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Hailey Bomar
- Community and Behavioral Health Department, College of Public Health, Iowa City, IA, USA
| | - Malak Tleis
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hanan Al Masri
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | - Maha Hodroj
- Lebanese National Mental Health Program, Lebanon Ministry of Public Health, Beirut, Lebanon
| | - Yara Chamoun
- Saint Joseph University of Beirut, Beirut, Lebanon
| | | | - Rima A. Afifi
- Community and Behavioral Health Department, College of Public Health, Iowa City, IA, USA
| |
Collapse
|
3
|
Marchetti M, Ceccarelli C, Muneghina O, Stockner M, Lai C, Mazzoni G. Enhancing mental health and well-being in adults from lower-resource settings: A mixed-method evaluation of the impact of problem management plus. Glob Ment Health (Camb) 2024; 11:e56. [PMID: 38751726 PMCID: PMC11094550 DOI: 10.1017/gmh.2024.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/27/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Mental health conditions, recognised as a global crisis, were further exacerbated by the COVID-19 pandemic. Access to mental health services remains limited, particularly in low-income regions. Task-sharing interventions, exemplified by Problem Management Plus (PM+), have emerged as potential solutions to bridge this treatment gap. This study presents an evaluation of the PM+ scale-up in Sub-Saharan Africa (Ethiopia and Benin) and Eastern Europe (Croatia and Bosnia and Herzegovina) as part of a mental health and psychosocial support programming including 87 adult participants. A mixed-method approach assesses the impact of the intervention. Quantitative analyses reveal significant reductions in self-reported problems, depression, anxiety and improved functioning. Qualitative data highlight four main themes: general health, family relationships, psychosocial problems and daily activities. These thematic areas demonstrate consistent improvements across clients, irrespective of the region. The findings underscore the impact of PM+ in addressing a broad spectrum of client issues, demonstrating its potential as a valuable tool for mitigating mental health challenges in diverse settings. This study contributes to the burgeoning body of evidence supporting PM+ and highlights its promise in enhancing mental health outcomes on a global scale, particularly for vulnerable populations.
Collapse
Affiliation(s)
- Michela Marchetti
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Caterina Ceccarelli
- SOS Children’s Villages Italy, Global Expert Group on Mental Health and Psychosocial Support (GPEG in MHPSS), Milan, Italy
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Orso Muneghina
- SOS Children’s Villages Italy, Global Expert Group on Mental Health and Psychosocial Support (GPEG in MHPSS), Milan, Italy
| | - Mara Stockner
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Giuliana Mazzoni
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
4
|
Mwangala PN, Makandi M, Kerubo A, Nyongesa MK, Abubakar A. A scoping review of the literature on the application and usefulness of the Problem Management Plus (PM+) intervention around the world. BJPsych Open 2024; 10:e91. [PMID: 38650067 PMCID: PMC11060090 DOI: 10.1192/bjo.2024.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Given the high rates of common mental disorders and limited resources, task-shifting psychosocial interventions are needed to provide adequate care. One such intervention developed by the World Health Organization is Problem Management Plus (PM+). AIMS This review maps the evidence regarding the extent of application and usefulness of the PM+ intervention, i.e. adaptability, feasibility, effectiveness and scalability, since it was introduced in 2016. METHOD We conducted a scoping review of seven literature databases and grey literature from January 2015 to February 2024, to identify peer-reviewed and grey literature on PM+ around the world. RESULTS Out of 6739 potential records, 42 met the inclusion criteria. About 60% of the included studies were from low- and middle-income countries. Findings from pilot/feasibility trials demonstrated that PM+ is feasible, acceptable and safe. Results from definitive randomised controlled trials at short-term follow-up also suggested that PM+ is effective, with overall moderate-to-large effect sizes, in improving symptoms of common mental health problems. Although PM+ was more effective in reducing symptoms of common mental disorders, it was found to be costlier compared to usual care in the only study that evaluated its cost-effectiveness. CONCLUSIONS Our findings indicate that PM+, in its individual and group formats, can be adapted and effectively delivered by trained helpers to target a wide range of common mental health concerns. More effectiveness and implementation evidence is required to understand the long-term impact of PM+, its cost-effectiveness and scalability, and moderators of treatment outcomes such as gender and delivery formats.
Collapse
Affiliation(s)
- Patrick N. Mwangala
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and School of Public Health, University of the Witwatersrand, South Africa
| | | | - Anita Kerubo
- Institute for Human Development, Aga Khan University, Kenya
| | | | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and Department of Psychiatry, University of Oxford, UK
| |
Collapse
|
5
|
Keyan D, Hadzi-Pavlovic D, Akhtar A, Dawson K, Koyiet PN, Bryant R. Dimensionality of the Swahili version of the General Health Questionnaire (GHQ-12) in a Kenyan population: A confirmatory factor analysis. Glob Ment Health (Camb) 2024; 11:e48. [PMID: 38690570 PMCID: PMC11058525 DOI: 10.1017/gmh.2024.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 12/05/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
The current study evaluated the Kiswahili version of General Health Questionnaire (GHQ-12) in a Kenyan context comprising of women exposed to gender-based violence. Participants were randomly drawn from community sampling using household screening methods in peri-urban areas in Nairobi. A total of 1,394 participants with varying levels of literacy (years of education: mean [M] = 9.42; standard deviation [SD] = 3.73) and aged between 18 and 89 years were recruited for the study. The observed factor structure of the GHQ-12 was evaluated using six most tested models querying the dimensionality of the instrument insofar as the impacts of positive and negative wording effects in driving multidimensionality. Results from the confirmatory factor analysis supported a bifactor model, consisting of a general distress factor and two separate factors representing common variance due to the positive and negative wording of items. Overall, the findings support the use of the Kiswahili version of the GHQ-12 as a unidimensional construct with method-specific variance owing to wording effects. Importantly, GHQ-12 responses from a sample of Kenyan women with relatively low levels of literacy are congruent with the factor structure observed in other cross-cultural settings in low- and-middle-income countries.
Collapse
Affiliation(s)
- Dharani Keyan
- School of Psychology, Science, UNSW Sydney, Sydney, NSW, Australia
| | | | - Aemal Akhtar
- School of Psychology, Science, UNSW Sydney, Sydney, NSW, Australia
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Sweden
| | - Katie Dawson
- School of Psychology, Science, UNSW Sydney, Sydney, NSW, Australia
| | | | - Richard Bryant
- School of Psychology, Science, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
6
|
Keynejad RC, Bitew T, Sorsdahl K, Myers B, Honikman S, Mulushoa A, Demissie M, Deyessa N, Howard LM, Hanlon C. Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia. Psychother Res 2024; 34:538-554. [PMID: 37384929 DOI: 10.1080/10503307.2023.2222899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE To adapt an evidence-based psychological intervention for pregnant women experiencing depressive symptoms and intimate partner violence (IPV) in rural Ethiopia. METHOD We conducted a desk review of contextual factors in Sodo, Ethiopia, followed by qualitative interviews with 16 pregnant women and 12 antenatal care (ANC) providers. We engaged stakeholders through participatory theory of change (ToC) workshops, to select the intervention and articulate a programme theory. We used "ADAPT" guidance to adapt the intervention to the context, before mapping potential harms in a "dark logic model". RESULTS Brief problem-solving therapy developed for South Africa was the most contextually relevant model. We adapted the delivery format (participants prioritised confidentiality and brevity) and training and supervision (addressing IPV). Consensus long-term outcomes in our ToC were ANC providers skilled in detecting and responding to emotional difficulties and IPV, women receiving appropriate support, and emotional difficulties improving. Our dark logic model highlighted the risk of more severe IPV and mental health symptoms not being referred appropriately. CONCLUSION Although intervention adaptation is recommended, the process is rarely reported in depth. We comprehensively describe how contextual considerations, stakeholder engagement, programme theory, and adaptation can tailor psychological interventions for the target population in a low-income, rural setting.
Collapse
Affiliation(s)
- Roxanne C Keynejad
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, College of Education and Behavioural Sciences, Injibara University
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Division of Addiction Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Bentley, Western Australia
- Mental health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Simone Honikman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Adiyam Mulushoa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekdes Demissie
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Pacella BJ, Cowlishaw S, Gibbs L, Bryant RA, Brady K, Gallagher C, Molyneaux R, Gibson K, Block K, Harms L, Forbes D, O'Donnell ML. Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study. BJPsych Open 2024; 10:e57. [PMID: 38433588 PMCID: PMC10951843 DOI: 10.1192/bjo.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/19/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events. AIMS This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure. METHOD The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode). RESULTS Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors. CONCLUSIONS Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.
Collapse
Affiliation(s)
- Belinda J. Pacella
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Sean Cowlishaw
- Turner Institute for Brain and Mental Health, Monash School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lisa Gibbs
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Kate Brady
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Colin Gallagher
- Centre for Transformative Innovation, Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia
| | - Robyn Molyneaux
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kari Gibson
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Karen Block
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Louise Harms
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - David Forbes
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Meaghan L. O'Donnell
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| |
Collapse
|
9
|
Keyan D, Habashneh R, Akhtar A, El-Dardery H, Faroun M, Abualhaija A, Aqel IS, Dardas LA, Bryant R. Evaluating a stepped care model of psychological support for adults affected by adversity: study protocol for a randomised controlled trial in Jordan. BMJ Open 2024; 14:e078091. [PMID: 38413156 PMCID: PMC10900353 DOI: 10.1136/bmjopen-2023-078091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The burden of common mental disorders in low and middle-income countries (LMICs) is growing with little known about how to allocate limited resources to reach the greatest number of people undergoing instances of significant psychological distress. We present a study protocol for a multicentre, parallel-group, superiority, randomised controlled trial. METHODS AND ANALYSIS Adults with significant psychological distress (K10 score ≥20) will be randomised to receive a stepped care programme involving a self-guided course (Doing What Matters) followed by a more intensive group programme (Problem Management Plus) or the self-guided course alone, both of which will take place in addition to enhanced treatment as usual comprising of a follow-up referral session to available services within the community. We will include 800 participants. An intent-to-treat and completer analysis will explore the impact of the stepped model of care on anxiety and depression symptoms (as measured by the Hopkins Symptom Checklist; HSCL-25) at 24 weeks from baseline. Secondary outcomes include positive psychological well-being, agency, changes in patient-identified problems, quality of life and cost-effectiveness. Linear mixed models will be used to assess the differential impact of the conditions over time. Analyses will focus on the primary outcome (HSCL-25) and secondary outcomes (agency subscale, WHO Well-Being Index, WHO Disability Assessment Schedule V.2.0, EQ-5D, Psychological Outcomes Profiles Scale) for both conditions, with the main outcome time point being the 3-month follow-up, relative to baseline. ETHICS AND DISSEMINATION This will be the first randomised controlled trial to assess the benefits of a stepped model of care to addressing psychological distress in a LMIC setting. Results will provide important insights for managing limited resources to mental healthcare in these settings and will be accordingly disseminated to service providers and organisations via professional training and meetings, and via publication in relevant journals and conference presentations. We will also present these findings to the Jordanian Ministry of Health, where this institute will guide us on the most appropriate format for communication of findings, including written reports, verbal presentations and/or brochures. Ethical approval was obtained from the University of Jordan School of Nursing Research Ethics Committee (number: PF.22.10). TRIAL REGISTRATION NUMBER ACTRN12621000189820p; Australian New Zealand Clinical Trials Registry.
Collapse
Affiliation(s)
- Dharani Keyan
- School of Psychology, UNSW, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | - Richard Bryant
- School of Psychology, UNSW, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Deuba K, Shrestha R, Koju R, Jha VK, Lamichhane A, Mehra D, Ekström AM. Assessing the Nepalese health system's readiness to manage gender-based violence and deliver psychosocial counselling. Health Policy Plan 2024; 39:198-212. [PMID: 38300229 PMCID: PMC10883662 DOI: 10.1093/heapol/czae003] [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: 05/05/2023] [Revised: 12/26/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors' physical, sexual and mental health care needs. However, there is a notable lack of evidence regarding such readiness in Nepal. This study, utilizing a concurrent triangulation design, evaluated the readiness of public health facilities in Nepal's Madhesh Province in managing VAW, focusing on providers' motivation to offer psychosocial counselling to survivors. A cross-sectional study was conducted across 11 hospitals and 17 primary health care centres, where 46 health care providers were interviewed in February-April 2022. The study employed the World Health Organization's tools for policy readiness and the Physician Readiness to Manage IPV Survey for data collection. Quantitative and qualitative data were collected via face-to-face interviews and analysed using descriptive and content analysis, respectively. Only around 28% of health facilities had trained their staff in the management of VAW. Two out of 11 hospitals had a psychiatrist, and a psychosocial counsellor was available in four hospitals and two out of 17 primary health care centres. Two-thirds of all health facilities had designated rooms for physical examinations, but only a minority had separate rooms for counselling. Though a few health facilities had guidelines for violence management, the implementation of these guidelines and the referral networks were notably weak. Hospitals with one-stop crisis management centres demonstrated readiness in VAW management. Health providers acknowledged the burden of IPV or domestic violence and expressed motivation to deliver psychosocial counselling, but many had limited knowledge. This barrier can only be resolved through appropriate training and investment in violence management skills at all tiers of the health system.
Collapse
Affiliation(s)
- Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Widerströmska Huset Tomtebodavägen 18 A, Plan 3, Solna 17165, Sweden
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Rachana Shrestha
- Department of Global Public Health, Karolinska Institutet, Stockholm, Widerströmska Huset Tomtebodavägen 18 A, Plan 3, Solna 17165, Sweden
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Reena Koju
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Vijay Kumar Jha
- Health Directorate, Ministry of Social Development, Sapahi, Dhanusha, Janakpur, Madhesh Province 45600, Nepal
| | - Achyut Lamichhane
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Devika Mehra
- MAMTA Health Institute for Mother and Child, New Delhi 110048, India
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Box 117, Lund 221 00, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Widerströmska Huset Tomtebodavägen 18 A, Plan 3, Solna 17165, Sweden
| |
Collapse
|
11
|
Melchior M, Figueiredo N, Roversi A, Dubanchet A, Bui E, Vadell-Martínez J, Barbui C, Purgato M, Ayuso-Mateos JL, Mediavilla R, McDaid D, Park AL, Petri-Romão P, Kalisch R, Nicaise P, Lorant V, Sijbrandij M, Witteveen AB, Bryant R, Felez M, Underhill J, Pollice G, Tortelli A. Addressing mental health problems among persons without stable housing in the context of the COVID-19 pandemic: study protocol for a randomised trial. RESPOND - France. BMC Public Health 2023; 23:2275. [PMID: 37978577 PMCID: PMC10656934 DOI: 10.1186/s12889-023-17238-7] [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: 05/02/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had an impact on population-wide mental health and well-being. Although people experiencing socioeconomic disadvantage may be especially vulnerable, they experience barriers in accessing mental health care. To overcome these barriers, the World Health Organization (WHO) designed two scalable psychosocial interventions, namely the web-based Doing What Matters in Times of Stress (DWM) and the face-to-face Problem Management Plus (PM+), to help people manage stressful situations. Our study aims to test the effectiveness of a stepped-care program using DWM and PM + among individuals experiencing unstable housing in France - a majority of whom are migrant or have sought asylum. METHODS This is a randomised controlled trial to evaluate the effectiveness and cost effectiveness of a stepped-care program using DWM and PM + among persons with psychological distress and experiencing unstable housing, in comparison to enhanced care as usual (eCAU). Participants (N = 210) will be randomised to two parallel groups: eCAU or eCAU plus the stepped-care program. The main study outcomes are symptoms of depression and anxiety measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). DISCUSSION This randomised controlled trial will contribute to a better understanding of effective community-based scalable strategies that can help address the mental health needs of persons experiencing socioeconomic disadvantage, whose needs are high yet who frequently have limited access to mental health care services. TRIAL REGISTRATION this randomised trial has been registered at ClinicalTrials.gov under the number NCT05033210.
Collapse
Affiliation(s)
- Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France.
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Aurélia Roversi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Alexandre Dubanchet
- CHU Caen, & Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", NeuroPresage Team, Cyceron, Caen, 14000, France
| | - Eric Bui
- CHU Caen, & Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", NeuroPresage Team, Cyceron, Caen, 14000, France
| | - Julian Vadell-Martínez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - 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
| | - 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
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Papoula Petri-Romão
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Anke B Witteveen
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Mireia Felez
- Institut de recerca Sant Joan de Déu, Dr. Antoni Pujadas, Sant Boi de Llobregat (Barcelona), 4208830, Spain
| | | | - Giulia Pollice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Andrea Tortelli
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
- GHU Paris, Psychiatrie & Neurosciences - Pôle Psychiatrie Précarité, Paris, France
| |
Collapse
|
12
|
Kantor V, Weindl D, Schiess-Jokanovic J, Verginer L, Lueger-Schuster B, Knefel M. Self-perceived problems of Afghan asylum seekers and refugees and their experiences with a short psychological intervention. BMC Public Health 2023; 23:2157. [PMID: 37924097 PMCID: PMC10625214 DOI: 10.1186/s12889-023-17076-7] [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: 04/13/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The present study examined Afghan asylum seekers' and refugees' self-perceived problems, and their experiences of treatment with an adapted version of the brief transdiagnostic psychological intervention "Problem Management Plus" (aPM+). Specifically, the study explored which problems trouble them most and how these problems influence their daily functioning. Further, it examined how various standardized outcome measures correlate with these subjectively perceived problems. METHOD This study is part of a larger RCT study (PIAAS study) in which 88 Afghan asylum seekers and refugees were randomly allocated either to aPM + in addition to treatment as usual (aPM+/TAU) or TAU alone. The presented study uses a multi-method approach consisting of two parts: First, we investigated participants' self-identified problems and subjective functional impairment using quantitative and qualitative assessment in both the aPM+/TAU and TAU group (n = 88). Second, we conducted in-depth qualitative interviews with a subsample of the aPM+/TAU group (n = 24) to gain a deeper understanding of participants' personal experiences with aPM + and to obtain suggestions for improvement. Spearman correlations were applied for quantitative data, and deductive and inductive approaches of thematic analysis were used for qualitative data. RESULTS We identified six main themes of self-perceived problems (primary post-migration living difficulties, general mental health problems, interpersonal stressors, secondary post-migration living difficulties, mental health problems specifically associated with stress, and somatic problems) and their consequences, as well as subjective functional impairment. Standardized measures of general mental health, posttraumatic psychopathology, and quality of life did not correlate with the intensity of self-perceived problems. aPM + was mostly perceived positively, and few participants had recommendations for its improvement. CONCLUSION The study aimed at giving a voice to Afghan trauma survivors to inform service providers and policy makers about their needs. Based on their expertise, future interventions can be tailored to their actual needs and optimized in terms of practical use. aPM + proved to be a positively perceived intervention that reduces subjective symptom burden and facilitates daily functioning. Culture-sensitive treatments within (mental) health services should increase service utilization and improve (mental) health in the long term.
Collapse
Affiliation(s)
- Viktoria Kantor
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Dina Weindl
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria.
| | - Jennifer Schiess-Jokanovic
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Lucia Verginer
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Brigitte Lueger-Schuster
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Matthias Knefel
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Spaaij J, de Graaff AM, Akhtar A, Kiselev N, McDaid D, Moergeli H, Pfaltz MC, Schick M, Schnyder U, Bryant RA, Cuijpers P, Sijbrandij M, Morina N. The effect of a low-level psychological intervention (PM+) on post-migration living difficulties - Results from two studies in Switzerland and in the Netherlands. Compr Psychiatry 2023; 127:152421. [PMID: 37708580 DOI: 10.1016/j.comppsych.2023.152421] [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: 03/14/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS OF THE STUDY After arriving in host countries, most refugees are confronted with numerous post-migration stressors (e.g., separation from family, discrimination, and employment difficulties). Post-migration living difficulties (PMLDs) significantly contribute to the development and persistence of mental disorders. Effective treatment approaches focusing on reducing post-migration stress are urgently needed. The aim of the present study was to examine the effect of a brief psychological intervention, Problem Management Plus (PM+), on PMLDs among Syrian refugees in two European countries. METHODS We merged data from two single-blind feasibility trials with Syrian refugees experiencing elevated levels of psychological distress and impaired functioning in Switzerland (N = 59) and the Netherlands (N = 60). Participants were randomised to receive either five sessions of PM+ or an enhanced care-as-usual control condition. PMLDs were assessed at baseline and 3 months after the intervention. To estimate treatment effect on PMLD, linear mixed model analysis was performed. RESULTS Three months after the intervention, participants in the PM+ condition reported significantly fewer PMLDs compared to the control condition. Further analyses at item-level showed that interpersonal and family related PMLDs, such as "worries about family back home" significantly improved over time in the PM+ condition. CONCLUSIONS This exploratory study suggests that brief psychological interventions have the potential to reduce PMLDs in refugees and asylum seekers. The reduction of post-migration stress in turn may subsequently lead to an overall reduction in psychological distress. CLINICAL TRIAL NUMBERS BASEC Nr. 2017-0117 (Swiss trial) and NL61361.029.17, 7 September 2017 (Dutch trial).
Collapse
Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; PluSport, Umbrella Organization of Swiss Disabled Sports, Volketswil, Switzerland; Swiss Research Institute of Public Health and Addiction (ISGF), University of Zürich, Zurich, Switzerland
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Mid Sweden University, Department of Psychology and Social Work, Östersund, Sweden
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research 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 Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
15
|
Keynejad RC, Bitew T, Sorsdahl K, Myers B, Honikman S, Medhin G, Deyessa N, Mulushoa A, Fekadu E, Howard LM, Hanlon C. Problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence: A randomised, controlled feasibility trial in rural Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002054. [PMID: 37889918 PMCID: PMC10610520 DOI: 10.1371/journal.pgph.0002054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Evidence for the feasibility of brief psychological interventions for pregnant women experiencing intimate partner violence (IPV) in rural, low-income country settings is scarce. In rural Ethiopia, the prevalence of antenatal depressive symptoms and lifetime IPV are 29% and 61%, respectively. We aimed to assess the feasibility and related implementation outcomes of brief problem-solving therapy (PST) adapted for pregnant women experiencing IPV (PST-IPV) in rural Ethiopia, and of a randomised, controlled feasibility study design. We recruited 52 pregnant women experiencing depressive symptoms and past-year IPV from two antenatal care (ANC) services. Consenting women were randomised to PST-IPV (n = 25), 'standard' PST (not adapted for women experiencing IPV; n = 12) or enhanced usual care (information about sources of support; n = 15). Masked data collectors conducted outcome assessments nine weeks post-enrolment. Addis Ababa University (#032/19/CDT) and King's College London (#HR-18/19-9230) approved the study. Fidelity to randomisation was impeded by strong cultural norms about what constituted IPV. However, recruitment was feasible (recruitment rate: 1.5 per day; 37% of women screened were eligible). The intervention and trial were acceptable to women (4% declined initial screening, none declined to participate, and 76% attended all four sessions of either active intervention). PST-IPV was acceptable to ANC providers: none dropped out. Sessions lasting up to a mean 52 minutes raised questions about the appropriateness of the model to this context. Competence assessments recommended supplementary communication skills training. Fidelity assessments indicated high adherence, quality, and responsiveness but assessing risks and social networks, and discussing confidentiality needed improvement. Adjustments to optimise a future, fully powered, randomised controlled trial include staggering recruitment in line with therapist availability, more training on the types of IPV and how to discuss them, automating randomisation, a supervision cascade model, and conducting post-intervention outcome assessments immediately and three months postpartum. Registration: Pan African Clinical Trials Registry #PACTR202002513482084 (13/12/2019): https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9601.
Collapse
Affiliation(s)
- Roxanne C. Keynejad
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Section of Women’s Mental Health, King’s College London, Denmark Hill, London, United Kingdom
| | - Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, College of Education and Behavioural Sciences, Injibara University, Injibara, Ethiopia
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Bentley, Western Australia, Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simone Honikman
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, Perinatal Mental Health Project, University of Cape Town, Cape Town, South Africa
| | - Girmay Medhin
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiyam Mulushoa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshcolewyine Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise M. Howard
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, Section of Women’s Mental Health, King’s College London, Denmark Hill, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London, United Kingdom
| |
Collapse
|
16
|
O'Doherty L, Whelan M, Carter GJ, Brown K, Tarzia L, Hegarty K, Feder G, Brown SJ. Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood. Cochrane Database Syst Rev 2023; 10:CD013456. [PMID: 37795783 PMCID: PMC10552071 DOI: 10.1002/14651858.cd013456.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Exposure to rape, sexual assault and sexual abuse has lifelong impacts for mental health and well-being. Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) are among the most common interventions offered to survivors to alleviate post-traumatic stress disorder (PTSD) and other psychological impacts. Beyond such trauma-focused cognitive and behavioural approaches, there is a range of low-intensity interventions along with new and emerging non-exposure based approaches (trauma-sensitive yoga, Reconsolidation of Traumatic Memories and Lifespan Integration). This review presents a timely assessment of international evidence on any type of psychosocial intervention offered to individuals who experienced rape, sexual assault or sexual abuse as adults. OBJECTIVES To assess the effects of psychosocial interventions on mental health and well-being for survivors of rape, sexual assault or sexual abuse experienced during adulthood. SEARCH METHODS In January 2022, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also checked reference lists of included studies, contacted authors and experts, and ran forward citation searches. SELECTION CRITERIA Any study that allocated individuals or clusters of individuals by a random or quasi-random method to a psychosocial intervention that promoted recovery and healing following exposure to rape, sexual assault or sexual abuse in those aged 18 years and above compared with no or minimal intervention, usual care, wait-list, pharmacological only or active comparison(s). We classified psychosocial interventions according to Cochrane Common Mental Disorders Group's psychological therapies list. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 studies (1991 to 2021) with 3992 participants randomly assigned to 60 experimental groups (3014; 76%) and 23 inactive comparator conditions (978, 24%). The experimental groups consisted of: 32 Cognitive Behavioural Therapy (CBT); 10 behavioural interventions; three integrative therapies; three humanist; five other psychologically oriented interventions; and seven other psychosocial interventions. Delivery involved 1 to 20 (median 11) sessions of traditional face-to-face (41) or other individual formats (four); groups (nine); or involved computer-only interaction (six). Most studies were conducted in the USA (n = 26); two were from South Africa; two from the Democratic Republic of the Congo; with single studies from Australia, Canada, the Netherlands, Spain, Sweden and the UK. Five studies did not disclose a funding source, and all disclosed sources were public funding. Participants were invited from a range of settings: from the community, through the media, from universities and in places where people might seek help for their mental health (e.g. war veterans), in the aftermath of sexual trauma (sexual assault centres and emergency departments) or for problems that accompany the experience of sexual violence (e.g. sexual health/primary care clinics). Participants randomised were 99% women (3965 participants) with just 27 men. Half were Black, African or African-American (1889 participants); 40% White/Caucasian (1530 participants); and 10% represented a range of other ethnic backgrounds (396 participants). The weighted mean age was 35.9 years (standard deviation (SD) 9.6). Eighty-two per cent had experienced rape or sexual assault in adulthood (3260/3992). Twenty-two studies (61%) required fulfilling a measured PTSD diagnostic threshold for inclusion; however, 94% of participants (2239/2370) were reported as having clinically relevant PTSD symptoms at entry. The comparison of psychosocial interventions with inactive controls detected that there may be a beneficial effect at post-treatment favouring psychosocial interventions in reducing PTSD (standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.22 to -0.44; 16 studies, 1130 participants; low-certainty evidence; large effect size based on Cohen's D); and depression (SMD -0.82, 95% CI -1.17 to -0.48; 12 studies, 901 participants; low-certainty evidence; large effect size). Psychosocial interventions, however, may not increase the risk of dropout from treatment compared to controls, with a risk ratio of 0.85 (95% CI 0.51 to 1.44; 5 studies, 242 participants; low-certainty evidence). Seven of the 23 studies (with 801 participants) comparing a psychosocial intervention to an inactive control reported on adverse events, with 21 events indicated. Psychosocial interventions may not increase the risk of adverse events compared to controls, with a risk ratio of 1.92 (95% CI 0.30 to 12.41; 6 studies; 622 participants; very low-certainty evidence). We conducted an assessment of risk of bias using the RoB 2 tool on a total of 49 reported results. A high risk of bias affected 43% of PTSD results; 59% for depression symptoms; 40% for treatment dropout; and one-third for adverse events. The greatest sources of bias were problems with randomisation and missing outcome data. Heterogeneity was also high, ranging from I2 = 30% (adverse events) to I2 = 87% (PTSD). AUTHORS' CONCLUSIONS Our review suggests that survivors of rape, sexual violence and sexual abuse during adulthood may experience a large reduction in post-treatment PTSD symptoms and depressive symptoms after experiencing a psychosocial intervention, relative to comparison groups. Psychosocial interventions do not seem to increase dropout from treatment or adverse events/effects compared to controls. However, the number of dropouts and study attrition were generally high, potentially missing harms of exposure to interventions and/or research participation. Also, the differential effects of specific intervention types needs further investigation. We conclude that a range of behavioural and CBT-based interventions may improve the mental health of survivors of rape, sexual assault and sexual abuse in the short term. Therefore, the needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support. The primary outcome in this review focused on the post-treatment period and the question about whether benefits are sustained over time persists. However, attaining such evidence from studies that lack an active comparison may be impractical and even unethical. Thus, we suggest that studies undertake head-to-head comparisons of different intervention types; in particular, of novel, emerging therapies, with one-year plus follow-up periods. Additionally, researchers should focus on the therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD.
Collapse
Affiliation(s)
- Lorna O'Doherty
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Maxine Whelan
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Grace J Carter
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Katherine Brown
- Department of Psychology and Sports Science, University of Hertfordshire, Hatfield, UK
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah J Brown
- Faculty of Arts, Business and Law, Law School, USC: University of the Sunshine Coast, Sippy Downs, Australia
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
17
|
Schäfer SK, Thomas LM, Lindner S, Lieb K. World Health Organization's low-intensity psychosocial interventions: a systematic review and meta-analysis of the effects of Problem Management Plus and Step-by-Step. World Psychiatry 2023; 22:449-462. [PMID: 37713578 PMCID: PMC10503931 DOI: 10.1002/wps.21129] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post-traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low-intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step-by-Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post-traumatic stress disorder symptoms; functional impairment, self-identified problems) and positive mental health outcomes (i.e., well-being, quality of life, social support/relationships). We performed random-effects multilevel meta-analyses on standardized mean differences (SMDs) at post-intervention and short-term follow-up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=-0.45, 95% CI: -0.56 to -0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14-0.47), which both remained significant at follow-up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between-study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high-quality evidence base is needed, as well as research on participant-level moderators of the effects of these interventions, their suitability for stepped-care programs, and their cost-effectiveness.
Collapse
Affiliation(s)
- Sarah K Schäfer
- Leibniz Institute for Resilience Research, Mainz, Germany
- Clinical Psychology, Psychotherapy and Psychodiagnostics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Lea M Thomas
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Saskia Lindner
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Klaus Lieb
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
18
|
Shrestha R, Sapkota D, Mehra D, Ekström AM, Deuba K. Feasibility and Effectiveness of an Intervention to Reduce Intimate Partner Violence and Psychological Distress Among Women in Nepal: Protocol for the Domestic Violence Intervention (DeVI) Cluster-Randomized Trial. JMIR Res Protoc 2023; 12:e45917. [PMID: 37581909 PMCID: PMC10466145 DOI: 10.2196/45917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) disproportionately affects people in low-and middle-income countries (LMICs), such as Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and posttraumatic stress disorder. The shortage of trained frontline health care providers, coupled with stigma related to IPV and mental health disorders, fuels low service uptake among women experiencing IPV. The Domestic Violence Intervention (DeVI) combines the Problem Management Plus counseling program developed by the World Health Organization with a violence prevention component. OBJECTIVE This study aims to implement and evaluate the feasibility, acceptability, and effectiveness of DeVI in addressing psychological distress and enabling the secondary prevention of violence for women experiencing IPV. METHODS A parallel cluster-randomized trial will be conducted across 8 districts in Madhesh Province in Nepal, involving 24 health care facilities. The study will include women aged 18-49 years who are either nonpregnant or in their first trimester, have experienced IPV within the past 12 months, have a 12-item General Health Questionnaire (GHQ-12) score of 3 or more (indicating current mental health issues), and have lived with their husbands or in-laws for at least 6 months. A total sample size of 912 was estimated at 80% power and α<.05 statistical significance level to detect a 15% absolute risk reduction in the IPV frequency and a 50% reduction in the GHQ-12 score in the intervention arm. The health care facilities will be randomly assigned to either the intervention or the control arm in a 1:1 ratio. Women visiting the health care facilities in the intervention and control arms will be recruited into the respective arms. In total, 38 participants from each health care facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-up visits after 6, 17, and 52 weeks after baseline. RESULTS This study received funding in 2019. As of December 29, 2022, over 50% of eligible women had been recruited from both intervention and control sites. In total, 269 eligible women have been enrolled in the intervention arm and 309 eligible women in the control arm. The trial is currently in the recruitment phase. Data collection is expected to be completed by December 2023, after which data analysis will begin. CONCLUSIONS If the intervention proves effective, it will provide evidence of how nonspecialist mental health care providers can address the harmful effects of IPV in resource-constrained settings with a high burden of IPV, such as Nepal. The study findings could also contribute evidence for integrating similar services into routine health programs in LMICs to prevent IPV and manage mental health problems among women experiencing IPV. TRIAL REGISTRATION ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45917.
Collapse
Affiliation(s)
- Rachana Shrestha
- Public Health and Environment Research Center, Lalitpur, Nepal
- Knowledge to Action, Lalitpur, Nepal
| | | | - Devika Mehra
- Mamta Health Institute for Mother and Child, New Delhi, India
- Medeon Science Park, Malmo, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Frankova I, Klymchuck V, Nickerson A, Sijbrandij M, Amstadter AB. A summary of the 38th Annual International Society for Traumatic Stress Studies Presidential Panel: How the traumatic stress community can assist individuals affected by the war in Ukraine. J Trauma Stress 2023; 36:682-690. [PMID: 37339112 DOI: 10.1002/jts.22945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 06/22/2023]
Abstract
As the premier global traumatic stress society, the International Society for Traumatic Stress Studies (ISTSS) has an important role to play in educating and raising awareness about the consequences of traumatic events, such as the war in Ukraine. On November 12, 2022, during its 38th annual meeting, the ISTSS hosted an invited Presidential Panel, chaired by Ananda Amstadter during her term as ISTSS President, that brought together trauma experts Peter Ventevogel, Marit Sijbrandij, Vitalii Klymchuck, Iryna Frankova, and Angela Nickerson to highlight how traumatic stress professionals can assist individuals affected by the war in Ukraine. The present paper summarizes the key points from the panel and discusses future challenges anticipated for people affected by the war.
Collapse
Affiliation(s)
- Iryna Frankova
- 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, The Netherlands
- Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, Bogomolets National Medical University, Kyiv, Ukraine
| | - Vitalii Klymchuck
- Mental Health for Ukraine Project, Lviv, Ukraine
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, 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, The Netherlands
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
20
|
Keith T, Hyslop F, Richmond R. A Systematic Review of Interventions to Reduce Gender-Based Violence Among Women and Girls in Sub-Saharan Africa. TRAUMA, VIOLENCE & ABUSE 2023; 24:1443-1464. [PMID: 35057674 DOI: 10.1177/15248380211068136] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sub-Saharan Africa (SSA) is disproportionately affected by gender-based violence (GBV). We systematically reviewed English language, peer-reviewed, quantitative evaluations of interventions to reduce violence against women and girls (VAWG) in SSA that involved a comparison group and reported GBV incidence, or GBV-related attitudes, norms and symptoms as an outcome. We identified 53 studies published between January 2000 and April 2020 and classified these programmes from an empowerment perspective using the following categories: social, economic, combined social and economic and psychological empowerment interventions. Our review found social empowerment interventions effective for transforming gender attitudes and norms and reducing GBV, and psychological empowerment interventions effective for managing GBV-related symptoms. The evidence for economic empowerment interventions was equivocal. Key elements of successful interventions included participatory group learning, engaging male partners, engaging the community, longer duration and utilising existing platforms. Promising approaches for further research included gender specific programmes, psychological empowerment interventions delivered by lay workers and psychological empowerment interventions focused on GBV reduction.
Collapse
Affiliation(s)
- Thi Keith
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Fran Hyslop
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Robyn Richmond
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| |
Collapse
|
21
|
Abrahams N, Chirwa E, Mhlongo S, Seedat S, Myers B, Peer N, Kengne AP, Garcia-Moreno C, Lombard C, Jewkes R. Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study. Arch Womens Ment Health 2023; 26:341-351. [PMID: 37032357 PMCID: PMC10191987 DOI: 10.1007/s00737-023-01312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/23/2023] [Indexed: 04/11/2023]
Abstract
Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care.
Collapse
Affiliation(s)
- N Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa.
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7935, Cape Town, South Africa.
| | - E Chirwa
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - S Mhlongo
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - S Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Dr, Parow, Cape Town, 7505, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, South African Research Chair in Posttraumatic Stress Disorder, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, 6102, Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - N Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - A P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - C Garcia-Moreno
- HRP (The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), 1211, Geneva, Switzerland
| | - C Lombard
- Biostatistics Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, 0001, South Africa
| |
Collapse
|
22
|
Spaaij J, Fuhr DC, Akhtar A, Casanova L, Klein T, Schick M, Weilenmann S, Roberts B, Morina N. Scaling-up problem management plus for refugees in Switzerland - a qualitative study. BMC Health Serv Res 2023; 23:488. [PMID: 37189160 DOI: 10.1186/s12913-023-09491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Refugees are at an increased risk of developing symptoms of mental disorders but face various structural and socio-cultural barriers to accessing mental health care. The SPIRIT project (Scaling-up Psychological Interventions in Refugees In SwiTzerland) seeks to promote the resilience of refugees and improve their access to mental health care. For this purpose, Problem Management Plus (PM+), an evidence-based low-intensity psychological intervention delivered by trained non-specialist "helpers", is being scaled-up in Switzerland. OBJECTIVE To identify factors influencing the process of the large-scale implementation of PM + for refugees in Switzerland and to develop recommendations to guide the implementation process. METHODS 22 semi-structured interviews were conducted with key informants (Syrian refugees who previously participated in PM+, PM + helpers, health professionals working with refugees and decision-makers from the migration, integration, social, and health sectors). The data were analyzed using thematic analysis, combining an inductive and deductive approach. RESULTS The data revealed three major themes, which might have an impact for the longer-term implementation of PM + in Switzerland. First, preconditions for successful integration in the health system prior to scaling-up such as sustainable funding or the introduction of a stepped care approach. Second, the requirements for the PM + intervention supporting scale-up such as quality control during PM + delivery, PM + modality, time and setting when PM + is offered or the views on task sharing. Third, the perceived benefits of scaling-up PM + in Switzerland. CONCLUSIONS Our results have shown that PM + must be scaled-up within a stepped care approach, including a functioning triage system and sustainable funding. Rather than selecting one modality or setting, it seemed preferable to offer a variety of formats and settings to achieve maximum reach and benefits. A successful scale-up of PM + in Switzerland might have various benefits. Communicating them to policy-makers and health providers, might enhance their acceptability of the intervention and their willingness to adopt PM + in regulatory structure and promote it.
Collapse
Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, Zurich, CH-8091, Switzerland.
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Health Sciences, University of Bremen, Bremen, Germany
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luisa Casanova
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, Zurich, CH-8091, Switzerland
| | - Tobias Klein
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, Zurich, CH-8091, Switzerland
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, Zurich, CH-8091, Switzerland
| | - Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, Zurich, CH-8091, Switzerland
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, Zurich, CH-8091, Switzerland
| |
Collapse
|
23
|
Lotzin A, Franc de Pommereau A, Laskowsky I. Promoting Recovery from Disasters, Pandemics, and Trauma: A Systematic Review of Brief Psychological Interventions to Reduce Distress in Adults, Children, and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5339. [PMID: 37047954 PMCID: PMC10094700 DOI: 10.3390/ijerph20075339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
A substantial number of survivors of disasters, pandemics, and other severe stressors develop persistent distress that impairs mental health and well-being. However, only a few brief psychological interventions target distress or subclinical symptoms. This systematic review aimed to identify and describe brief psychological interventions to reduce distress or subclinical symptoms in survivors of disasters, pandemics, and other severe stressors. Based on a systematic literature search (MEDLINE, PsycINFO, PSYNDEX, PTSDpubs, and Web of Science), we reviewed published studies and study protocols on self-help, psychosocial support, or brief psychotherapeutic interventions to reduce distress and/or subclinical symptoms following natural hazards and man-made disasters, pandemics, or other traumatic events. We included 27 published studies or study protocols (n = 15 RCTs, n = 3 controlled pre-post studies, and n = 9 uncontrolled pre-post studies) describing 22 interventions. We found evidence for reducing psychological distress and/or subclinical symptoms in 9 out of 15 RCTs, 2 out of 3 controlled pre-post studies, and 9 out of 9 uncontrolled pre-post studies. One RCT provided evidence of increasing well-being. Innovative brief interventions have been developed to reduce distress and/or subclinical symptoms that have an emerging evidence base.
Collapse
Affiliation(s)
- Annett Lotzin
- Institute for Clinical Psychology and Psychotherapy, Department of Psychology, MSH Medical School Hamburg, 20457 Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Alicia Franc de Pommereau
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Isabelle Laskowsky
- Institute for Clinical Psychology and Psychotherapy, Department of Psychology, MSH Medical School Hamburg, 20457 Hamburg, Germany
| |
Collapse
|
24
|
Brown FL, Taha K, Steen F, Kane J, Gillman A, Aoun M, Malik A, Bryant R, Sijbrandij M, El Chammay R, Servili C, van Ommeren M, Akhtar A, Zoghbi E, Jordans MJD. Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon. BMC Psychiatry 2023; 23:131. [PMID: 36858980 PMCID: PMC9979451 DOI: 10.1186/s12888-023-04571-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Globally, there is a vast mental health treatment gap, whereby the majority of adolescents living in low- and middle-income countries requiring mental health services, do not have access to adequate care. To improve access, the World Health Organization (WHO) developed a range of interventions, designed to be low-cost and delivered by non-specialists. We conducted a two-arm, individually randomised group treatment feasibility trial of a new WHO group intervention for young adolescents with emotional distress ('Early Adolescent Skills for Emotions'; EASE) in Lebanon. METHOD The aim of this study was to determine the feasibility of the intervention and study procedures. Adolescents aged 10 to 14 years were eligible to take part if they scored above a validated cut-off on the Child Psychosocial Distress Screener. Participants were randomized to EASE or enhanced treatment as usual (ETAU) control using a 1:1 ratio. EASE consisted of seven group sessions with adolescents and three sessions with caregivers. ETAU consisted of a single brief psychoeducation home visit. Child and caregiver outcomes were measured by blind assessors at baseline, endline (8 weeks post-randomisation), and three month follow-up (20 weeks post-randomisation), with the primary outcome measure being child psychological symptoms on the Pediatric Symptom Checklist. Qualitative interviews were conducted with adolescents (n = 13), caregivers (n = 17), facilitators (n = 6), trainers (n = 3), and outreach staff (n = 1) at endline to assess barriers and facilitators related to the feasibility and delivery of EASE and study procedures. RESULTS Of 154 adolescents screened, 67 (43%) were eligible, completed baseline, and were randomized. Sixty adolescents (90%) completed endline assessments (31 EASE, 29 ETAU), and fifty-nine (88%) completed three-month assessments (29 EASE, 30 ETAU). Qualitatively, participants provided overall positive feedback about the intervention. Several challenges and suggestions for improvement were raised around logistics, intervention content, and acceptability of assessment measures. Implementation data highlighted challenges with intervention uptake and attendance. Outcome measures generally had strong psychometric properties (range: α = 0.77 to α = 87), however did not demonstrate change over time in either group. CONCLUSIONS The EASE intervention and study procedures are acceptable and feasible for implementation with vulnerable adolescents in Lebanon, however several improvements are necessary prior to full-scale evaluation. TRIAL REGISTRATION #ISRCTN60799626, retrospectively registered on 04/10/2022.
Collapse
Affiliation(s)
- Felicity L Brown
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands. .,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Karine Taha
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,War Child Lebanon, Beirut, Lebanon
| | - Frederik Steen
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Jeremy Kane
- Mailman School of Public Health, Columbia University, New York, USA
| | | | - May Aoun
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,War Child Lebanon, Beirut, Lebanon
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Rabih El Chammay
- Ministry of Public Health, Beirut, Lebanon.,Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Mark J D Jordans
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands. .,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | | |
Collapse
|
25
|
de Graaff AM, Cuijpers P, Twisk JWR, Kieft B, Hunaidy S, Elsawy M, Gorgis N, Bouman TK, Lommen MJJ, Acarturk C, Bryant R, Burchert S, Dawson KS, Fuhr DC, Hansen P, Jordans M, Knaevelsrud C, McDaid D, Morina N, Moergeli H, Park AL, Roberts B, Ventevogel P, Wiedemann N, Woodward A, Sijbrandij M. Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus. BMJ MENTAL HEALTH 2023; 26:e300637. [PMID: 36789918 PMCID: PMC10035776 DOI: 10.1136/bmjment-2022-300637] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited. OBJECTIVE To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands. METHODS We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019-December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat. FINDINGS Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference -0.25; 95% CI -0.385 to -0.122; p=0.0001, Cohen's d=0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen's d=0.42), anxiety (p=0.001, Cohen's d=0.27), PTSD symptoms (p=0.0005, Cohen's d=0.39) and self-identified problems (p=0.03, Cohen's d=0.26), but not on impairment (p=0.084, Cohen's d=0.21). CONCLUSIONS PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit. CLINICAL IMPLICATIONS Peer-provided psychological interventions should be considered for scale-up in HICs.
Collapse
Affiliation(s)
- Anne M de Graaff
- Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Pim Cuijpers
- Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Barbara Kieft
- ARQ National Psychotrauma Centre, Amsterdam, The Netherlands
| | - Sam Hunaidy
- Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Mariam Elsawy
- Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Noer Gorgis
- i-Psy, Parnassia Groep, The Hague, South Holland, The Netherlands
| | - Theo K Bouman
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Miriam J J Lommen
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Ceren Acarturk
- Department of Psychology, Koc Universitesi, Istanbul, Turkey
| | - Richard Bryant
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sebastian Burchert
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Katie S Dawson
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
| | - Daniela C Fuhr
- Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
- Health Sciences, University of Bremen, Bremen, Bremen, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Pernille Hansen
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Mark Jordans
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | | | - David McDaid
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - A-La Park
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Bayard Roberts
- Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nana Wiedemann
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review. Glob Ment Health (Camb) 2023; 10:e5. [PMID: 36843880 PMCID: PMC9947613 DOI: 10.1017/gmh.2022.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.
Collapse
|
28
|
Scalable interventions for refugees. Glob Ment Health (Camb) 2023; 10:e8. [PMID: 36843882 PMCID: PMC9947626 DOI: 10.1017/gmh.2022.59] [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: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 02/10/2023] Open
Abstract
Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.
Collapse
|
29
|
Videoconferencing-delivered psychological intervention for the treatment of COVID-19 related psychological distress in University students: study protocol for a randomised controlled trial in India. BMC Psychiatry 2022; 22:808. [PMID: 36539730 PMCID: PMC9763790 DOI: 10.1186/s12888-022-04471-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The mental health impacts of the COVID-19 pandemic have been profound. This paper outlines the study protocol for a trial that tests the efficacy of a brief group-based psychological intervention (Coping with COVID; CWC), relative to Supportive Counselling, to reduce distress associated with COVID-19 in a young adult population in Bangalore, India. METHODS A single-blind, parallel, randomized controlled trial will be carried out via video conferencing in a small group format. Following informed consent, adults that screen positive for levels of psychological distress (Kessler 10 (K-10 score ≥ 20) and have access to a videoconferencing platform will be randomised to an adapted version of CWC (n = 90) or Supportive Counselling (SC) (n = 90). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, positive wellbeing, and stress in relation to COVID-19. DISCUSSION This treatment trial will assess whether CWC will result in reduced distress relative to Supportive Counselling in a young adult population in Bangalore, India. This study will yield important insights into the role of nonspecific factors versus the intervention's components in impacting COVID-19 related distress. TRIAL REGISTRATION This trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12621001064897). ETHICS AND DISSEMINATION Ethics approval has been obtained from the participating institution, CHRIST University in Bangalore. Results of the trial will be submitted for publication in peer reviewed journals and findings presented at scientific conferences and to key service providers and policy makers.
Collapse
|
30
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| |
Collapse
|
31
|
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 + .
Collapse
|
32
|
Galea JT, Sanabria G, Greene KY, Thompson M, Doering T, Fuchs D, Grey A, Saucedo A, Rosler M, Simmons C. MSW Students' Perspectives on Learning and Delivering a Protocolized, Low-Intensity Transdiagnostic Psychological Intervention: Implications for Experiential Learning. Community Ment Health J 2022; 59:812-817. [PMID: 36374380 DOI: 10.1007/s10597-022-01053-2] [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] [Received: 07/17/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
Problem Management Plus (PM+) is a protocolized, low-intensity, transdiagnostic psychological intervention designed to be delivered by lay individuals. Faculty at the University of South Florida School of Social Work recognized PM + as a potential psychological intervention for master's students to learn to complement their clinical coursework and simultaneously provide an experiential learning experience to support their clinical skills. Before this pilot, the feasibility and acceptability of integrating PM + into a Master of Social Work (MSW) setting were unknown. Upon analyzing the students' feedback using inductive content analysis, it is evident that experiential learning using interventions is crucial to building the self-efficacy of MSW students. Students reported that PM + helped their personal mental health and client interactions, using the tools they learned even a year after the pilot. Future research should focus on integrating PM + into experiential learning experiences within social work and allied academic settings and professions.
Collapse
Affiliation(s)
- Jerome T Galea
- School of Social Work, University of South Florida, Tampa, USA. .,College of Public Health, University of South Florida, Tampa, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
| | | | - Karah Y Greene
- School of Social Work, University of South Florida, Tampa, USA
| | | | - Tracy Doering
- School of Social Work, University of South Florida, Tampa, USA
| | - Doriangel Fuchs
- School of Social Work, University of South Florida, Tampa, USA
| | - Amanda Grey
- School of Social Work, University of South Florida, Tampa, USA
| | - Adilene Saucedo
- School of Social Work, University of South Florida, Tampa, USA
| | - Melanie Rosler
- School of Social Work, University of South Florida, Tampa, USA
| | | |
Collapse
|
33
|
Woodward A, de Graaff AM, Dieleman MA, Roberts B, Fuhr DC, Broerse JE, Sijbrandij M, Cuijpers P, Ventevogel P, Gerretsen B, Sondorp E. Scalability of a task-sharing psychological intervention for refugees: A qualitative study in the Netherlands. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
34
|
Schäfer I, Hiller P, Milin S, Lotzin A. A multicenter, randomized controlled trial to compare the effectiveness of STARC-SUD (Skills Training in Affect Regulation - a Culture-sensitive approach) versus treatment as usual in trauma-exposed refugees with substance use problems. Trials 2022; 23:915. [PMID: 36307862 PMCID: PMC9617425 DOI: 10.1186/s13063-022-06761-4] [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: 07/01/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees often report high levels of psychological distress due to traumatic experiences before and during flight as well as many post-migration stressors. Refugees with hazardous substance use or existing substance use disorder (SUD) are a particularly vulnerable group for whom few preventive and therapeutic measures are available. The aim of this study is to investigate the effectiveness of an integrative culturally sensitive group therapy approach (STARC-SUD) to improve affect regulation in refugees with substance-related problems. METHODS The study aims to include N = 286 male refugees with psychological distress (GHQ-12 > 13) and hazardous substance use or SUD (AUDIT > 7 or DUDIT > 6). Therapists working supported by interpreters will deliver the STARC-SUD intervention in addiction aid facilities in six metropolitan regions of Germany. The primary endpoint is severity of psychological distress (GHQ-12). The effectiveness of STARC-SUD is compared with treatment as usual (TAU) post-intervention and 3 months later. DISCUSSION This trial will be one of the first RCTs on a culturally sensitive transdiagnostic intervention for trauma-exposed refugees with hazardous substances or SUD. The trial might gain new insights into the efficacy of such an intervention. TRIAL REGISTRATION OSF Registry osf.io/nhxd4 . Registered prospectively on September 22, 2020, doi: 10.17605/OSF.IO/NHXD4. DRKS DRKS00017668.
Collapse
Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Milin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
| |
Collapse
|
35
|
Mediavilla R, McGreevy KR, Felez-Nobrega M, Monistrol-Mula A, Bravo-Ortiz MF, Bayón C, Rodríguez-Vega B, Nicaise P, Delaire A, Sijbrandij M, Witteveen AB, Purgato M, Barbui C, Tedeschi F, Melchior M, van der Waerden J, McDaid D, Park AL, Kalisch R, Petri-Romão P, Underhill J, Bryant RA, Haro JM, Ayuso-Mateos JL. Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial. Digit Health 2022; 8:20552076221129084. [PMID: 36211795 PMCID: PMC9537484 DOI: 10.1177/20552076221129084] [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: 01/17/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aims The coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers' mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms. Methods We present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional 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 at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness. Conclusions This study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies. Registration details ClinicalTrials.gov Identifier: NCT04980326.
Collapse
Affiliation(s)
- 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
| | - Kerry R McGreevy
- 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,Kerry R. McGreevy, Department of
Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo, 4, 28029,
Madrid, 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
| | - Anna Monistrol-Mula
- Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - María-Fe Bravo-Ortiz
- 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, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Carmen Bayón
- 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, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- 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, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Pablo Nicaise
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Audrey Delaire
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Marit Sijbrandij
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - Anke B. Witteveen
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - 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, Verona, Italy
| | - 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, 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, Verona, Italy
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research
(LIR), Mainz, Germany,Neuroimaging Center (NIC), Focus Program Translational Neuroscience
(FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | | | - Richard A. Bryant
- School of Psychology, University of New
South Wales, Sydney, NSW, Australia
| | - 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
| | - 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 Princesa (IIS-Princesa),
Madrid, Spain
| | | |
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
Michelson D, Hodgson E, Bernstein A, Chorpita BF, Patel V. Problem Solving as an Active Ingredient in Indicated Prevention and Treatment of Youth Depression and Anxiety: An Integrative Review. J Adolesc Health 2022; 71:390-405. [PMID: 35803863 DOI: 10.1016/j.jadohealth.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/09/2022] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
Abstract
Problem solving is a common focus of psychological interventions for young people. However, existing evidence syntheses are relatively limited in their scope and conclusions. Taking a transdiagnostic approach and incorporating diverse sources of evidence, we examined the role of problem solving as an active ingredient for the indicated prevention and treatment of depression and anxiety in 14-24-year-olds. Three information sources were integrated using framework synthesis: (1) a systematic review of randomized controlled trials of problem solving; (2) a metasynthesis of qualitative evidence on the therapeutic experience of problem solving; and (3) consultations with a Youth Advisory Group. Intervention protocols that included problem solving and no more than one other specific component appeared to be effective for depression but not anxiety. Larger multicomponent interventions with a problem-solving element achieved moderate effect sizes for both conditions. There was no clear evidence that effectiveness varied by population characteristics, intervention formats, or contextual factors. Qualitative evidence and youth consultations highlighted positive views about the practicality, simplicity, and flexibility of problem solving. Converging sources also suggested changes in problem orientation as a key transdiagnostic process contributing to positive outcomes. Problem solving is a widely applicable therapeutic approach that can help young people with emotional problems to resolve specific stressors and lead to a more hopeful mindset about managing future challenges. Implications for practice are discussed.
Collapse
Affiliation(s)
- Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom.
| | - Eleanor Hodgson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, California
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
38
|
Nyongesa MK, Mwangome E, Mwangi P, Nasambu C, Mbuthia JW, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. Adaptation, acceptability and feasibility of Problem Management Plus (PM+) intervention to promote the mental health of young people living with HIV in Kenya: formative mixed-methods research. BJPsych Open 2022; 8:e161. [PMID: 36000431 PMCID: PMC9438483 DOI: 10.1192/bjo.2022.564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Problem Management Plus (PM+) is a psychological intervention that seeks to address common mental disorders among individuals exposed to adversity. Thus far, the potential for delivering PM+ by mobile phones has not been evaluated. AIMS To adapt PM+ for telephone delivery (ten weekly sessions of about 45 min each) and preliminarily evaluate its acceptability and feasibility with young people living with HIV (YLWH) in coastal Kenya. METHOD This was a mixed-method formative research. Qualitative data collection included consultations with stakeholders, conducting key informant interviews with HIV care providers and focus group discussions with potential end-users, i.e. YLWH. Moreover, brief exit interviews with recipients of the adapted PM+ were conducted. Quantitative acceptability and feasibility indicators and outcome measures were tracked/assessed during PM+ preliminary implementation involving 70 YLWH. RESULTS From the qualitative inquiries, the adapted PM+ emerged as contextually appropriate, acceptable and feasible for mobile phone delivery, despite some concerns around missing nonverbal cues and poor network connectivity. High recruitment (85%) and fair programme retention (69%) were observed. Intervention sessions over the telephone lasted 46 min on average (range 42-55 min). Preliminary feasibility data indicated that the adapted PM+ has the potential of reducing common mental disorders among YLWH from the Kenyan coast. CONCLUSIONS PM+ is acceptable and can feasibly be delivered via mobile phone to YLWH in coastal Kenya. This study sets the stage for a future fully powered, randomised controlled trial assessing the efficacy of the adapted PM+ in this or a similar setting.
Collapse
Affiliation(s)
- Moses Kachama Nyongesa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya; and Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eva Mwangome
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya
| | - Paul Mwangi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya
| | - Carophine Nasambu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya
| | | | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Charles R. J. C. Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya; Department of Public Health, Pwani University, Kenya; Department of Psychiatry, University of Oxford, UK; and Institute for Human Development, Aga Khan University, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya; Department of Public Health, Pwani University, Kenya; Department of Psychiatry, University of Oxford, UK; and Institute for Human Development, Aga Khan University, Kenya
| |
Collapse
|
39
|
Bryant RA, Malik A, Aqel IS, Ghatasheh M, Habashneh R, Dawson KS, Watts S, Jordans MJD, Brown FL, van Ommeren M, Akhtar A. Effectiveness of a brief group behavioural intervention on psychological distress in young adolescent Syrian refugees: A randomised controlled trial. PLoS Med 2022; 19:e1004046. [PMID: 35960704 PMCID: PMC9374250 DOI: 10.1371/journal.pmed.1004046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Millions of young adolescents in low- and middle-income countries (LMICs) affected by humanitarian crises experience elevated rates of poor mental health. There is a need for scalable programs that can improve the mental health of young adolescents. This study evaluated the effectiveness of a nonspecialist delivered group-based intervention (Early Adolescent Skills for Emotions (EASE)) to improve young adolescents' mental health. METHODS AND FINDINGS In this single-blind, parallel, controlled trial, Syrian refugees aged 10 to 14 years in Jordan were identified through screening of psychological distress as defined by scores ≥15 on the Paediatric Symptom Scale. Participants were randomised to either EASE or enhanced usual care (EUC) involving referral to local psychosocial services (on a 1:1.6 ratio). Participants were aware of treatment allocation but assessors were blinded. Primary outcomes were scores on the Paediatric Symptom Checklist (PSC; internalising, externalising, and attentional difficulty scales) assessed at week 0, 9 weeks, and 3 months after treatment (primary outcome time point). It was hypothesised that EASE would result in greater reductions on internalising symptoms than EUC. Secondary outcomes were depression, posttraumatic stress, well-being, functioning, school belongingness, and caregivers' parenting and mental health. Between June 2019 and January 2020, 1,842 young adolescent refugees were screened for eligibility on the basis of psychological distress. There were 520 adolescents (28.2%) who screened positive, of whom 471 (90.6%) agreed to enter the trial. Overall, 185 were assigned to EASE and 286 to EUC, and 169 and 254 were retained at 3 months for EASE and EUC, respectively. Intent-to-treat analyses indicated that at 3 months, EASE resulted in greater reduction on the PSC-internalising scale than EUC (estimated mean difference 0.69, 95% CI 0.19 to 1.19; p = 0.007; effect size, 0.38) but there were no differences for PSC-externalising (estimated mean difference 0.24, 95% CI -0.43 to 0.91; p = 0.49; effect size, -0.10), PSC-attentional problem (estimated mean difference -0.01, 95% CI -0.51 to 0.54; p = 0.97; effect size, -0.01) scores, or on depression, posttraumatic stress, well-being, functioning, or school belongingness. Relative to EUC, caregivers in EASE had less psychological distress (estimated mean difference 1.95, 95% CI 0.71 to 3.19; p = 0.002) and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < 0.001). Secondary analyses that (a) focused on adolescents with probable internalising disorders; (b) completed the 3-month assessment; and (c) controlled for trauma exposure did not alter the primary results. Mediation analysis indicated that for caregivers in the EASE condition, reduction in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) and internalising (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) problems in their children. No adverse events were attributable to the intervention. A limitation was that EUC was not matched to EASE in terms of facilitator attention or group involvement. CONCLUSIONS EASE led to reduced internalising problems in young refugee adolescents and was associated with reduced distress and less inconsistent disciplinary parenting in caregivers. This intervention has the potential as a scalable intervention to mitigate young adolescents' emotional difficulties in LMIC. TRIAL REGISTRATION Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619000341123.
Collapse
Affiliation(s)
- Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, Australia
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | | | - Maha Ghatasheh
- Institute for Family Health, King Hussein Foundation, Amman, Jordan
| | - Rand Habashneh
- Institute for Family Health, King Hussein Foundation, Amman, Jordan
| | - Katie S. Dawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sarah Watts
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark J. D. Jordans
- Research and Development Department, War Child Holland, Amsterdam, the Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Felicity L. Brown
- Research and Development Department, War Child Holland, Amsterdam, the Netherlands
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| |
Collapse
|
40
|
Williams JL, Hardt MM, Henschel AV, Jamison JR, Brymer MJ, Rheingold AA. An Open Trial of Skills for Psychological Recovery for Sudden Loss Survivors. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
41
|
The Lancet Psychiatry Commission on intimate partner violence and mental health: advancing mental health services, research, and policy. Lancet Psychiatry 2022; 9:487-524. [PMID: 35569504 DOI: 10.1016/s2215-0366(22)00008-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023]
|
42
|
Jewkes R. Mental health care for survivors and others affected by intimate partner violence: the case for research and investment. Lancet Psychiatry 2022; 9:425-426. [PMID: 35569495 DOI: 10.1016/s2215-0366(22)00146-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel Jewkes
- South African Medical Research Council, Pretoria 0001, South Africa.
| |
Collapse
|
43
|
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.
Collapse
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
| | | |
Collapse
|
44
|
Pinto JV, Hunt C, O'Toole B. Advancing PTSD Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Non-Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38223. [PMID: 35596546 PMCID: PMC9244657 DOI: 10.2196/38223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Decentralized health systems in Low and Middle-Income Countries (LMICs) impacted by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Innovative approaches that are safe, cost-effective, and scalable are needed to address the burden of traumatic stress brought by emergencies. High mobile phone ownership rates combined with the precision of neural, cognitive, and biometric measures of trauma and its feasible integration with Artificial Intelligence (AI) makes digital application (app) interventions a promising pathway to promote precision diagnosis and high-impact care. OBJECTIVE The aims of this study are to advance methods for the objective diagnosis and treatment of trauma in emergencies across LMICs by examining (i) neural, cognitive, and biometric markers and (ii) the efficacy of the eResilience App, a neuroscience-informed mobile health mental health app intervention, via changes in clinical symptomatology, cognitive performance, and brain activity. METHODS Trauma-exposed African refugees residing in Australia were selected for this study. A research software version of the eResilience App with advanced monitoring capabilities was designed for the trial. Participants completed the eResilience App at home during a seven-day period. Clinical, cognitive, and electrophysiological data were collected during baseline and post-test to examine biomarkers of trauma and the efficacy of the proposed digital intervention for the treatment of trauma and its potential outcomes including depression, anxiety, physical symptoms, self-harm, substance misuse, and cognitive impairment. In addition, biofeedback, wellbeing, and subjective stress data points were collected via the app during the treatment week, followed by clinical interviews at 1, 3, 6 and 12-months post-intervention. RESULTS Data collection was conducted between 2018 and 2020. A total n=100 participants exposed to war were screened, n= 75 were enrolled and assigned to a trauma-exposed control (n=38) or Posttraumatic Stress Disorder (PTSD) condition (n=37), and n= 70 completed all baseline, treatment, and post-test assessments. A total n=62 of the n=70 who completed the intervention opted to enrol in the 3, 6 and 12-month follow-ups. Data collection is complete, and results are being prepared for publication. If proven efficacious, this proof-of-concept clinical trial will inform fully powered randomized clinical trials in LMICs to further develop AI-powered, app-based diagnostic and prognostic features, and determine the app's cross-cultural efficacy for the treatment of trauma in emergency settings. CONCLUSIONS This protocol provides researchers with a comprehensive background of the study rationale, a detailed guideline for replication studies interested in examining the feasibility and the efficacy of the eResilience App across varied demographics, and a robust framework for investigations of low-cost objective diagnostic markers in mental health interventions. Methodological limitations and suggestions are also provided. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001205426. Universal Trial Number (UTN): U1111-1180-0347.
Collapse
Affiliation(s)
- Janaina Videira Pinto
- Faculty of Medicine and Health, the University of Sydney, 94 Mallett St, Sydney, AU.,Sync Body-Brain Health, Currimundi, AU
| | - Caroline Hunt
- School of Psychology, Faculty of Science, the University of Sydney, Sydney, AU
| | - Brian O'Toole
- Faculty of Medicine and Health, the University of Sydney, 94 Mallett St, Sydney, AU
| |
Collapse
|
45
|
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
|
46
|
de Graaff AM, Cuijpers P, Acarturk C, Akhtar A, Alkneme MS, Aoun M, Awwad M, Bawaneh AY, Brown FL, Bryant R, Burchert S, Carswell K, Drogendijk A, Engels M, Fuhr DC, Hansen P, van 't Hof E, Giardinelli L, Hemmo M, Hessling JM, Ilkkursun Z, Jordans MJD, Kiselev N, Knaevelsrud C, Kurt G, Martinmäki S, McDaid D, Morina N, Naser H, Park AL, Pfaltz MC, Roberts B, Schick M, Schnyder U, Spaaij J, Steen F, Taha K, Uygun E, Ventevogel P, Whitney C, Witteveen AB, Sijbrandij M. Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis. BMJ Open 2022; 12:e058101. [PMID: 35443961 PMCID: PMC9021771 DOI: 10.1136/bmjopen-2021-058101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The World Health Organization's (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees. METHODS AND ANALYSIS Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list. ETHICS AND DISSEMINATION Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals.
Collapse
Affiliation(s)
- Anne M de Graaff
- 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
| | - Ceren Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Mhd Salem Alkneme
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - May Aoun
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Manar Awwad
- Technical Unit, International Medical Corps, London, UK
| | | | - Felicity L Brown
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - Kenneth Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneve, Switzerland
| | | | - Michelle Engels
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pernille Hansen
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Edith van 't Hof
- Department of Mental Health and Substance Abuse, World Health Organization, Geneve, Switzerland
| | | | - Mahmoud Hemmo
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Jonas M Hessling
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | | | - Mark J D Jordans
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - Gülsah Kurt
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Saara Martinmäki
- ARQ International, ARQ National Psychotrauma Centre, Amsterdam, The Netherlands
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hadeel Naser
- Technical Unit, International Medical Corps, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Sundsvall, Sweden
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Frederik Steen
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Karine Taha
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Ersin Uygun
- Trauma and Disaster Mental Health Master Programme, Istanbul Bilgi University, Istanbul, İstanbul, Turkey
| | - Peter Ventevogel
- Public Health, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Anke B 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
| | - 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
| |
Collapse
|
47
|
Setyowibowo H, Yudiana W, Hunfeld JAM, Iskandarsyah A, Passchier J, Arzomand H, Sadarjoen SS, de Vries R, Sijbrandij M. Psychoeducation for breast cancer: A systematic review and meta-analysis. Breast 2022; 62:36-51. [PMID: 35121502 PMCID: PMC8819101 DOI: 10.1016/j.breast.2022.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/24/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Psychoeducation has emerged as an intervention for women with breast cancer (BC). This meta-analysis evaluated the effectiveness of psychoeducation on adherence to diagnostic procedures and medical treatment, anxiety, depression, quality of life (QoL), and BC knowledge among patients with BC symptoms or diagnosis and BC survivors. METHODS A systematic literature search (in PubMed, Embase, PsycINFO and Cochrane) for randomised controlled trials (RCTs) comparing the effects of psychoeducation to control among patients with BC symptoms or diagnosis and BC survivors. Effects were expressed as relative risks (RRs) and standardized mean differences (SMDs) with their 95% confidence intervals. RESULTS Twenty-seven RCTs (7742 participants; 3880 psychoeducation and 3862 controls) were included. Compared with controls, psychoeducation had no significant effect on adherence to diagnostic procedures and medical treatment (RR 1.553; 95% CI 0.733 to 3.290, p = .16), but it significantly decreased anxiety (SMD -0.710, 95% CI -1.395 to -0.027, p = .04) and improved QoL with (SMD 0.509; 95% CI 0.096 to 0.923, p < .01). No effects were found for psychoeducation on depression (SMD -0.243, 95% CI -0.580 to 0.091, p = .14), or BC knowledge (SMD 0.718, 95% CI -0.800 to 2.236, p = .23). CONCLUSION We demonstrated that psychoeducation did not improve adherence to diagnostic procedures and treatment, depression and BC knowledge but was valuable for reducing anxiety and improving QoL. Future studies may explore the effectiveness of psychoeducation in promoting adherence across various types of cancer.
Collapse
Affiliation(s)
- Hari Setyowibowo
- Department of Clinical, Neuro, and Developmental Psychology and Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Educational Psychology, Universitas Padjadjaran, Jatinangor, Indonesia.
| | - Whisnu Yudiana
- Department of Experimental Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Joke A M Hunfeld
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Aulia Iskandarsyah
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Jan Passchier
- Department of Clinical, Neuro, and Developmental Psychology and Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Homra Arzomand
- Department of Clinical, Neuro, and Developmental Psychology and Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Sawitri S Sadarjoen
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology and Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, the Netherlands; World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, the Netherlands
| |
Collapse
|
48
|
Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052916. [PMID: 35270610 PMCID: PMC8910593 DOI: 10.3390/ijerph19052916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023]
Abstract
This paper provides an analytical overview of different types of psychological interventions that have demonstrated efficacy in low-income and/or humanitarian settings and points to special considerations that may be needed if used with women who have been subjected to gender-based violence (GBV). This paper reviews diverse therapeutic modalities and contrasts them across several domains, including their conventional use and principles; their documented use and efficacy in humanitarian settings; any special considerations or modifications necessary for GBV-affected clients; and any additional resources or implementation concerns when working in low-income contexts. By examining the evidence base of multiple interventions, we hope to provide clinicians and GBV-prevention advocates with an overview of tools/approaches to provide survivor-centered, trauma-informed responses to GBV survivors. This analysis responds to the growing recognition that gender-based violence, in particular intimate partner violence and sexual violence, is strongly associated with mental health problems, including anxiety, depression, and post-traumatic stress. This is likely to be exacerbated in humanitarian contexts, where people often experience multiple and intersecting traumatic experiences. The need for mental health services in these settings is increasingly recognized, and a growing number of psychological interventions have been shown to be effective when delivered by lay providers and in humanitarian settings.
Collapse
|
49
|
Sapkota D, Baird K, Saito A, Rijal P, Anderson D. Antenatal-Based Pilot Psychosocial Intervention to Enhance Mental Health of Pregnant Women Experiencing Domestic and Family Violence in Nepal. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP3605-NP3627. [PMID: 32812489 DOI: 10.1177/0886260520948151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Survivors of domestic and family violence (DFV) report poorer quality of life and worsening mental health. This study evaluated the effect of a counseling and education intervention on the mental health and help-seeking behaviors among pregnant women living with DFV. A parallel pilot randomized controlled trial was performed among 140 pregnant women attending an antenatal clinic of a tertiary hospital of Nepal. Using computer-generated random numbers, participants were randomized to the intervention group (a counseling session, an information booklet about DFV, and contact details of the counselor) or a control group (usual care plus a booklet containing contact details of local DFV support services). Outcome measures included mental health, quality of life (QOL), self-efficacy, social support, and safety planning behaviors. Analyses followed intention-to-treat, using the generalized estimating equation model. Intervention participants showed significant improvements in anxiety (β = -3.24, p < .001) and depression (β = -3.16, p < .001) at postintervention. Such improvements were also sustained at follow-up assessment (p < .001). Significant group and time interaction for QOL, social support, use of safety behaviors, and self-efficacy (p < .05) revealed a greater increase in these outcome measures among intervention participants at both follow-up assessments compared with the control group. This pilot integrated intervention showed promising outcomes in improving the mental health, social support, and the use of safety behaviors among women with DFV. This intervention could be incorporated into regular antenatal care as a strategy to identify and support victims of DFV. Larger controlled trials with longer follow-up are needed to support and expand on the current findings regarding the effectiveness of a psychosocial intervention targeting victims of DFV in resource-constrained settings.
Collapse
Affiliation(s)
- Diksha Sapkota
- Griffith University, Meadowbrook, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Australia
| | - Kathleen Baird
- Griffith University, Meadowbrook, Queensland, Australia
- University of Technology Sydney, New South Wales, Australia
| | - Amornrat Saito
- Griffith University, Meadowbrook, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Australia
| | - Pappu Rijal
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Debra Anderson
- Menzies Health Institute Queensland, Gold Coast, Australia
- University of Technology Sydney, New South Wales, Australia
| |
Collapse
|
50
|
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: 23] [Impact Index Per Article: 11.5] [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.
Collapse
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
| | | |
Collapse
|