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Cuijpers P, Boyce N, van Ommeren M. Why treatment manuals of psychological interventions should be freely available. Lancet Psychiatry 2024; 11:325-326. [PMID: 38513686 DOI: 10.1016/s2215-0366(24)00071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam 1081 BT Netherlands; International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Gray B, Asrat B, Brohan E, Chowdhury N, Dua T, van Ommeren M. Management of generalized anxiety disorder and panic disorder in general health care settings: new WHO recommendations. World Psychiatry 2024; 23:160-161. [PMID: 38214633 PMCID: PMC10785994 DOI: 10.1002/wps.21172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Affiliation(s)
- Brandon Gray
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Biksegn Asrat
- Department of Psychiatry, Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- UK Public Health Rapid Support Team, UK Health Security Agency/London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine Brohan
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhury
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Jordans MJD, Brown FL, Kane J, Taha K, Steen F, Ali R, Elias J, Meksassi B, Aoun M, Greene CM, Malik A, Akhtar A, van Ommeren M, Sijbrandij M, Bryant R. Evaluation of the Early Adolescent Skills for Emotions (EASE) intervention in Lebanon: A randomized controlled trial. Compr Psychiatry 2023; 127:152424. [PMID: 37748283 DOI: 10.1016/j.comppsych.2023.152424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/21/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND There is a need for scalable evidence-based psychological interventions for young adolescents experiencing high levels of psychological distress in humanitarian settings and low- and middle-income countries. Poor mental health during adolescence presents a serious public health concern as it is a known predictor of persistent mental disorders in adulthood. This study evaluates the effectiveness of a new group-based intervention developed by the World Health Organization (Early Adolescent Skills for Emotions; EASE), implemented by non-specialists, to reduce young adolescents' psychological distress among mostly Syrian refugees in Lebanon. METHODS We conducted a two-arm, single-blind, individually randomized group treatment trial. Adolescents aged 10 to 14 years who screened positive for psychological distress using the Pediatric Symptom Checklist (PSC) were randomly allocated to EASE or enhanced treatment as usual (ETAU) (1:1.6). ETAU consisted of a single scripted psycho-education home-visit session with the adolescent and their caregivers. EASE consists of seven group sessions with adolescents and three sessions with caregivers. The primary outcome was adolescent-reported psychological distress as measured with the PSC (internalizing, externalizing, and attentional symptoms). Secondary outcomes included depression, posttraumatic stress, well-being, functioning, and caregivers' parenting and distress. All outcomes were assessed at baseline, endline, and 3 months (primary time point) and 12 months follow-up. RESULTS Due to the COVID-19 pandemic and other adversities in Lebanon at the time of this research, the study was prematurely terminated, resulting in an under-powered trial sample (n = 198 enrolled compared to n = 445 targeted). We screened 604 children for eligibility. The 198 enrolled adolescents were assigned to EASE (n = 80) and ETAU (n = 118), with retention rates between 76.1 and 88.4% across all timepoints. Intent-to-treat analyses demonstrated no between-group differences on any of the outcome measures between the EASE and ETAU. We did observe a significant improvement on the primary outcome equally in the EASE and ETAU groups (-0.90, 95% CI: -3.6, 1.8; p = .52), - a trend that was sustained at three months follow-up. Sub-group analyses, for those with higher depression symptoms at baseline, showed ETAU outperformed EASE on reducing depression symptoms (difference in mean change = 2.7, 95% CI: 0.1, 5.3; p = .04; d = 0.59) and internalizing problems (difference in mean change 1.0, 95% CI: 0.08, 1.9; p = .03; d = 0.56) . CONCLUSION No conclusions can be drawn about the comparative effectiveness of the intervention given that the sample was underpowered as a result of early termination. Both EASE and single session psycho-education home visits resulted in meaningful improvements in reducing psychological distress. We did not identify any indications in the data suggesting that EASE was more effective than a single session family intervention in the context of the COVID-19 pandemic and other crises in Lebanon. Fully powered research is needed to evaluate the effectiveness of EASE.
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Affiliation(s)
- Mark J D Jordans
- War Child, Research and Development Department, Amsterdam, the Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Felicity L Brown
- War Child, Research and Development Department, Amsterdam, the Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jeremy Kane
- Department of Epidemiology, Columbia University, New York, USA.
| | - Karine Taha
- War Child, Lebanon Country Office, Beirut, Lebanon
| | - Frederik Steen
- War Child, Research and Development Department, Amsterdam, the Netherlands.
| | - Rayane Ali
- War Child, Lebanon Country Office, Beirut, Lebanon.
| | - Joseph Elias
- War Child, Lebanon Country Office, Beirut, Lebanon.
| | | | - May Aoun
- War Child, Lebanon Country Office, Beirut, Lebanon.
| | - Claire M Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, USA.
| | | | - Aemal Akhtar
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Sweden; School of Psychology, University of New South Wales, Australia.
| | | | - Marit Sijbrandij
- VU University, Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam, the Netherlands.
| | - Richard Bryant
- School of Psychology, University of New South Wales, Australia.
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Papola D, Ostuzzi G, Todesco B, Gastaldon C, Hanna F, Chatterjee S, van Ommeren M, Barbui C. Updating the WHO Model Lists of Essential Medicines to promote global access to the most cost-effective and safe medicines for mental disorders. Lancet Psychiatry 2023; 10:809-816. [PMID: 37475123 DOI: 10.1016/s2215-0366(23)00176-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 07/22/2023]
Abstract
Since 1977, the WHO Model Lists of Essential Medicines (EML) have been a benchmark to guide the procurement of medicines at the national level, especially in low-income and middle-income countries. Aiming to include the most effective, safe, and cost-effective medicines for priority conditions, WHO updates the EML for adults and the EML for children every 2 years. Over the past 45 years, updates to the EML mental health section have been infrequent, in most cases with additions of individual medicines. A comprehensive revision of the entire section has never been attempted. With the aim of increasing the use of the WHO EML to expand the selection of the most effective and safe medicines for mental disorders, a series of evidence-based applications were submitted to the WHO Expert Committee on the Selection and Use of Essential Medicines in 2022, recommending a substantial revision of the entire mental health section. In this Health Policy, we summarise the recommended update and the evidence justifying it. We also discuss challenges in the update process, suggesting possible solutions. The requested comprehensive revision of the WHO EML mental health section aligns the list with the latest evidence. The revision offers an opportunity for countries to promote access to the most effective, safe, and cost-effective medicines for mental disorders, contributing to universal health coverage and global mental health equity.
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Affiliation(s)
- Davide Papola
- 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; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Beatrice Todesco
- 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
| | - Chiara Gastaldon
- 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
| | - Fahmy Hanna
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - 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; Cochrane Global Mental Health, University of Verona, Verona, Italy.
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van Ommeren M, Lewis S, Van't Hof E, Carswell K. Putting psychological interventions first in primary health care. World Psychiatry 2023; 22:390-391. [PMID: 37713553 PMCID: PMC10503907 DOI: 10.1002/wps.21114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
- Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Sian Lewis
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Edith Van't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Augustinavicius J, Purgato M, Tedeschi F, Musci R, Leku MR, Carswell K, Lakin D, van Ommeren M, Cuijpers P, Sijbrandij M, Karyotaki E, Tol WA, Barbui C. Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda. BMJ Open 2023; 13:e048043. [PMID: 37699637 PMCID: PMC10503328 DOI: 10.1136/bmjopen-2020-048043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/26/2022] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda. METHODS This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores. RESULTS A single factor for mental health problems was identified with all factor loadings >0.30 and acceptable internal consistency (α=0.70). We excluded 161 women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative to EUC (Risk ratio =0.16, 95% CI: 0.05 to 0.53). Participation in SH+ versus EUC was also associated with increased subjective well-being (β=2.62, 95% CI: 1.63 to 3.60) and psychological flexibility (β=4.55, 95% CI: 2.92 to 6.18) at post-intervention assessment. CONCLUSIONS These results support the use and further testing of SH+ as a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings. TRIAL REGISTRATION NUMBER ISRCTN50148022.
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Affiliation(s)
- Jura Augustinavicius
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Rashelle Musci
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Wietse A Tol
- Global Health Section, University of Copenhagen, Kobenhavn, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- HealthRight International, New York city, New York, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
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Karyotaki E, Sijbrandij M, Purgato M, Acarturk C, Lakin D, Bailey D, Peckham E, Uygun E, Tedeschi F, Wancata J, Augustinavicius J, Carswell K, Välimäki M, van Ommeren M, Koesters M, Popa M, Leku MR, Anttila M, Churchill R, White RG, Al-Hashimi S, Lantta T, Au T, Klein T, Tol WA, Cuijpers P, Barbui C. Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis. BMJ Ment Health 2023; 26:e300672. [PMID: 37524517 PMCID: PMC10391800 DOI: 10.1136/bmjment-2023-300672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023]
Abstract
QUESTION Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers. STUDY SELECTION AND ANALYSIS Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm). FINDINGS There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90). CONCLUSIONS Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 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
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Ersin Uygun
- Department of Trauma and Disasters, Bilge University, Ankara, Turkey
| | - 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
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Jura Augustinavicius
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- Xiangya School of Nursing, The Xiangya Evidence-Based Practice and Healthcare Innovation, Central South University, Chang, People's Republic of China
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Mariana Popa
- School of Psychology, Queen's University Belfast, Belfast, UK
| | | | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross G White
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Sarah Al-Hashimi
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Wietse A Tol
- Xiangya School of Nursing, The Xiangya Evidence-Based Practice and Healthcare Innovation, Central South University, Chang, People's Republic of China
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - 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
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Malik A, Ayuso-Mateos JL, Baranyi G, Barbui C, Thornicroft G, van Ommeren M, Akhtar A. Mental health at work: WHO guidelines. World Psychiatry 2023; 22:331-332. [PMID: 37159361 PMCID: PMC10168149 DOI: 10.1002/wps.21094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 05/11/2023] Open
Affiliation(s)
- Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gergő Baranyi
- Centre for Research on Environment, Society and Health, Department of Geography, University of Edinburgh, Edinburgh, UK
| | - 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
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- School of Psychology, University of New South Wales, Sydney, Australia
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Tol WA, Le PD, Harrison SL, Galappatti A, Annan J, Baingana FK, Betancourt TS, Bizouerne C, Eaton J, Engels M, Hijazi Z, Horn RR, Jordans MJD, Kohrt BA, Koyiet P, Panter-Brick C, Pluess M, Rahman A, Silove D, Tomlinson M, Uribe-Restrepo JM, Ventevogel P, Weissbecker I, Ager A, van Ommeren M. Mental health and psychosocial support in humanitarian settings: research priorities for 2021-30. Lancet Glob Health 2023; 11:e969-e975. [PMID: 37116530 PMCID: PMC10188364 DOI: 10.1016/s2214-109x(23)00128-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 04/30/2023]
Abstract
We describe an effort to develop a consensus-based research agenda for mental health and psychosocial support (MHPSS) interventions in humanitarian settings for 2021-30. By engaging a broad group of stakeholders, we generated research questions through a qualitative study (in Indonesia, Lebanon, and Uganda; n=101), consultations led by humanitarian agencies (n=259), and an expert panel (n=227; 51% female participants and 49% male participants; 84% of participants based in low-income and middle-income countries). The expert panel selected and rated a final list of 20 research questions. After rating, the MHPSS research agenda favoured applied research questions (eg, regarding workforce strengthening and monitoring and evaluation practices). Compared with research priorities for the previous decade, there is a shift towards systems-oriented implementation research (eg, multisectoral integration and ensuring sustainability) rather than efficacy research. Answering these research questions selected and rated by the expert panel will require improved partnerships between researchers, practitioners, policy makers, and communities affected by humanitarian crises, and improved equity in funding for MHPSS research in low-income and middle-income countries.
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Affiliation(s)
- Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - PhuongThao D Le
- Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; School of Global Public Health, New York University, New York, NY, USA
| | - Sarah L Harrison
- International Federation of Red Cross Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Ananda Galappatti
- Mental Health and Psychosocial Support Network (MHPSS.net), Colombo, Sri Lanka
| | - Jeannie Annan
- Airbel Impact Lab, The International Rescue Committee, New York, NY, USA
| | | | - Theresa S Betancourt
- Boston College, School of Social Work, Research Program on Children and Adversity, Chestnut Hill, MA, USA
| | - Cecile Bizouerne
- Mental Health, PsychoSocial Support and Protection Sector, Action Contre la Faim, Paris, France
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK; CBM Global, Amstelveen, Netherlands
| | | | - Zeinab Hijazi
- Mental Health Unit, Programme Division, UNICEF, New York, NY, USA
| | - Rebecca R Horn
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
| | - Mark J D Jordans
- Centre for Global Mental Health, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | | | - Catherine Panter-Brick
- Department of Anthropology and Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Peter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Inka Weissbecker
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alastair Ager
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Cuijpers P, Heim E, Ramia JA, Burchert S, Carswell K, Cornelisz I, Knaevelsrud C, Noun P, van Klaveren C, Van't Hof E, Zoghbi E, van Ommeren M, El Chammay R. Correction: Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial. PLoS Med 2023; 20:e1004231. [PMID: 37058690 PMCID: PMC10104678 DOI: 10.1371/journal.pmed.1004231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1004025.].
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Witteveen AB, Young SY, Cuijpers P, Ayuso-Mateos JL, Barbui C, Bertolini F, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior M, Gray B, Melchior M, van Ommeren M, Palantza C, Purgato M, van der Waerden J, Wang S, Sijbrandij M. COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence. PLoS Med 2023; 20:e1004206. [PMID: 37098048 PMCID: PMC10129001 DOI: 10.1371/journal.pmed.1004206] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/21/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations. METHODS AND FINDINGS A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies. CONCLUSIONS A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.
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Affiliation(s)
- Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Susanne Y. Young
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, WHO Collaborating Center for Research and Training in Mental Health Services at the Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Cabello
- Department of Psychiatry, Universidad Autonoma de Madrid, WHO Collaborating Center for Research and Training in Mental Health Services at the Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Naomi Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Daniele Franzoi
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Michael Gasior
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Brandon Gray
- World Health Organization, Department of Mental Health and Substance Use, Geneva, Switzerland
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Mark van Ommeren
- World Health Organization, Department of Mental Health and Substance Use, Geneva, Switzerland
| | - Christina Palantza
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, 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, University of Verona, Verona, Italy
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, Paris, France
| | - Siyuan Wang
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
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Bertolini F, Witteveen AB, Young S, Cuijpers P, Ayuso-Mateos JL, Barbui C, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior ME, Gray B, John A, Melchior M, van Ommeren M, Palantza C, Purgato M, Van der Waerden J, Wang S, Sijbrandij M. Risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 mortality in people with pre-existing mental disorders: an umbrella review. BMC Psychiatry 2023; 23:181. [PMID: 36941591 PMCID: PMC10026202 DOI: 10.1186/s12888-023-04641-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has posed a serious health risk, especially in vulnerable populations. Even before the pandemic, people with mental disorders had worse physical health outcomes compared to the general population. This umbrella review investigated whether having a pre-pandemic mental disorder was associated with worse physical health outcomes due to the COVID-19 pandemic. METHODS Following a pre-registered protocol available on the Open Science Framework platform, we searched Ovid MEDLINE All, Embase (Ovid), PsycINFO (Ovid), CINAHL, and Web of Science up to the 6th of October 2021 for systematic reviews on the impact of COVID-19 on people with pre-existing mental disorders. The following outcomes were considered: risk of contracting the SARS-CoV-2 infection, risk of severe illness, COVID-19 related mortality risk, risk of long-term physical symptoms after COVID-19. For meta-analyses, we considered adjusted odds ratio (OR) as effect size measure. Screening, data extraction and quality assessment with the AMSTAR 2 tool have been done in parallel and duplicate. RESULTS We included five meta-analyses and four narrative reviews. The meta-analyses reported that people with any mental disorder had an increased risk of SARS-CoV-2 infection (OR: 1.71, 95% CI 1.09-2.69), severe illness course (OR from 1.32 to 1.77, 95%CI between 1.19-1.46 and 1.29-2.42, respectively) and COVID-19 related mortality (OR from 1.38 to 1.52, 95%CI between 1.15-1.65 and 1.20-1.93, respectively) as compared to the general population. People with anxiety disorders had an increased risk of SAR-CoV-2 infection, but not increased mortality. People with mood and schizophrenia spectrum disorders had an increased COVID-19 related mortality but without evidence of increased risk of severe COVID-19 illness. Narrative reviews were consistent with findings from the meta-analyses. DISCUSSION AND CONCLUSIONS As compared to the general population, there is strong evidence showing that people with pre-existing mental disorders suffered from worse physical health outcomes due to the COVID-19 pandemic and may therefore be considered a risk group similar to people with underlying physical conditions. Factors likely involved include living accommodations with barriers to social distancing, cardiovascular comorbidities, psychotropic medications and difficulties in accessing high-intensity medical care.
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Affiliation(s)
- Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - 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
| | - Susanne Young
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - María Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Naomi Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Daniele Franzoi
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Michael Elizabeth Gasior
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Brandon Gray
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Ann John
- Population Psychiatry, Suicide and Informatics, Medical School, Swansea University, Swansea, UK
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Christina Palantza
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, 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, University of Verona, Verona, Italy
| | - Judith Van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Siyuan Wang
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - 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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Weissbecker I, Bhaird CNA, Alves V, Ventevogel P, Willhoite A, Hijazi Z, Hanna F, Atukunda Friberg P, Dakkak H, van Ommeren M. A Minimum Service Package (MSP) to improve response to mental health and psychosocial needs in emergency situations. World Psychiatry 2023; 22:161-162. [PMID: 36640410 PMCID: PMC9840487 DOI: 10.1002/wps.21048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Inka Weissbecker
- Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
| | | | - Vania Alves
- Child Protection ProgrammeUNICEFNew YorkNYUSA
| | | | | | - Zeinab Hijazi
- Office of Director of Programmes, Programme DivisionUNICEFNew YorkNYUSA
| | - Fahmy Hanna
- Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
| | | | | | - Mark van Ommeren
- Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
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Cuijpers P, Heim E, Ramia JA, Burchert S, Carswell K, Cornelisz I, Knaevelsrud C, Noun P, van Klaveren C, van’t Hof E, Zoghbi E, van Ommeren M, El Chammay R. Guided digital health intervention for depression in Lebanon: randomised trial. Evid Based Ment Health 2022; 25:e34-e40. [PMID: 35577536 PMCID: PMC9811068 DOI: 10.1136/ebmental-2021-300416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/27/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Most people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic. OBJECTIVE To examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic. METHODS We conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment. FINDINGS 680 people with depression (PHQ-9>10) and impaired functioning (WHODAS>16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up. CONCLUSIONS Guided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition. CLINICAL IMPLICATIONS Guided digital mental health interventions should be considered for implementation in LMICs. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03720769.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland,Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jinane Abi Ramia
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Sebastian Burchert
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Ilja Cornelisz
- Department of Educational, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Philip Noun
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Chris van Klaveren
- Department of Educational, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Edith van’t Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | | | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon,Psychiatry Department, Saint Joseph University, Beirut, Lebanon
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Kestel D, Lewis S, Freeman M, Chisholm D, Siegl OG, van Ommeren M. A world report on the transformation needed in mental health care. Bull World Health Organ 2022; 100:583. [PMID: 36188024 PMCID: PMC9511667 DOI: 10.2471/blt.22.289123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dévora Kestel
- Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | | | - Dan Chisholm
- Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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17
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Hamdani SU, Huma ZE, Malik A, Nizami AT, Baneen UU, Suleman N, Javed H, Wang D, van Ommeren M, Mazhar S, Khan SA, Minhas FA, Rahman A. Improving psychosocial distress for young adolescents in rural schools of Pakistan: study protocol of a cluster randomised controlled trial. BMJ Open 2022; 12:e063607. [PMID: 36153028 PMCID: PMC9511576 DOI: 10.1136/bmjopen-2022-063607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Emotional problems are leading contributors to health burden among adolescents worldwide. There is an urgent need for evidence-based psychological interventions for young people. This study aims to evaluate the effectiveness of a school-based, group psychological intervention, Early Adolescent Skills for Emotions (EASE) developed by the WHO to improve psychosocial distress in Pakistani adolescents. METHOD AND ANALYSIS A two-arm, single-blinded, cluster randomised controlled trial, with a wait-list control arm is being conducted in school settings of rural Pakistan. Forty eligible public-school clusters have been randomised (stratified by gender) on a 1:1 allocation ratio into intervention (n=20) and control arm (n=20). Following informed consent, 564 adolescents with psychosocial distress (Youth-reported Paediatric Symptoms Checklist, cut-off ≥28) from 40 schools have been enrolled into the trial (14±3 average cluster size) between 2 November 2021 and 30th November 2021. Participants in the intervention arm will receive EASE in 7-weekly adolescents and 3-biweekly caregivers group sessions in schools. The adolescent sessions involve the components of psychoeducation, stress management, behavioural activation, problem-solving and relapse prevention. Caregivers will receive training to learn and implement active listening; spending quality time and using praise as a strategy to help their children. The primary outcome is reduction in psychosocial distress at 3 months postintervention. Secondary outcomes include symptoms of depression and anxiety, caregiver-adolescent relationship and caregivers' well-being. Outcomes will be assessed at baseline, immediate 1 week and 3-months postintervention. Qualitative process evaluation will explore barriers and facilitators to programme implementation in low-resource school settings. ETHICS Ethics approval has been obtained from Central Ethics Committee of University of Liverpool, UK, Ethics Review Committee of WHO Geneva and from the Institutional Review Board of Human Development Research Foundation (HDRF), Pakistan. DISSEMINATION The findings of the study will be disseminated by WHO and through peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN17755448.
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Affiliation(s)
- Syed Usman Hamdani
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Zill-E- Huma
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | | | - Um Ul Baneen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Nadia Suleman
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Hashim Javed
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Samra Mazhar
- Noncommunicable Diseases and Mental Health Department, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
| | - Shahzad Alam Khan
- Noncommunicable Diseases and Mental Health Department, World Health Organization, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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19
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Hall J, Jordan S, van Ommeren M, Au T, Sway RA, Crawford J, Ghalayani H, Hamdani SU, Luitel NP, Malik A, Servili C, Sorsdahl K, Watts S, Carswell K. Sustainable Technology for Adolescents and youth to Reduce Stress (STARS): a WHO transdiagnostic chatbot for distressed youth. World Psychiatry 2022; 21:156-157. [PMID: 35015345 PMCID: PMC8751560 DOI: 10.1002/wps.20947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jennifer Hall
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Stewart Jordan
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Teresa Au
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Rajiah Abu Sway
- WHO Office for West Bank and Gaza, occupied Palestinian territories
| | | | | | - Syed Usman Hamdani
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Human Development Research Foundation, Punjab, Pakistan
| | | | - Aiysha Malik
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Chiara Servili
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sarah Watts
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Kenneth Carswell
- 1Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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20
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Acarturk C, Uygun E, Ilkkursun Z, Carswell K, Tedeschi F, Batu M, Eskici S, Kurt G, Anttila M, Au T, Baumgartner J, Churchill R, Cuijpers P, Becker T, Koesters M, Lantta T, Nosè M, Ostuzzi G, Popa M, Purgato M, Sijbrandij M, Turrini G, Välimäki M, Walker L, Wancata J, Zanini E, White RG, van Ommeren M, Barbui C. Effectiveness of a WHO self-help psychological intervention for preventing mental disorders among Syrian refugees in Turkey: a randomized controlled trial. World Psychiatry 2022; 21:88-95. [PMID: 35015365 PMCID: PMC8751562 DOI: 10.1002/wps.20939] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Refugees are at high risk of developing mental disorders. There is no evidence from randomized controlled trials (RCTs) that psychological interventions can prevent the onset of mental disorders in this group. We assessed the effectiveness of a self-help psychological intervention developed by the World Health Organization, called Self-Help Plus, in preventing the development of mental disorders among Syrian refugees experiencing psychological distress in Turkey. A two-arm, assessor-masked RCT was conducted in two Turkish areas. Eligible participants were adult Syrian refugees experiencing psychological distress (General Health Questionnaire ≥3), but without a diagnosis of mental disorder. They were randomly assigned either to the Self-Help Plus arm (consisting of Self-Help Plus combined with Enhanced Care as Usual, ECAU) or to ECAU only in a 1:1 ratio. Self-Help Plus was delivered in a group format by two facilitators over five sessions. The primary outcome measure was the presence of any mental disorder assessed by the Mini International Neuropsychiatric Interview at six-month follow-up. Secondary outcome measures were the presence of mental disorders at post-intervention, and psychological distress, symptoms of post-traumatic stress disorder and depression, personally identified psychological outcomes, functional impairment, subjective well-being, and quality of life at post-intervention and six-month follow-up. Between October 1, 2018 and November 30, 2019, 1,186 refugees were assessed for inclusion. Five hundred forty-four people were ineligible, and 642 participants were enrolled and randomly assigned to either Self-Help Plus (N=322) or ECAU (N=320). Self-Help Plus participants were significantly less likely to have any mental disorders at six-month follow-up compared to the ECAU group (21.69% vs. 40.73%; Cramer's V = 0.205, p<0.001, risk ratio: 0.533, 95% CI: 0.408-0.696). Analysis of secondary outcomes suggested that Self-Help Plus was not effective immediately post-intervention, but was associated with beneficial effects at six-month follow-up in terms of symptoms of depression, personally identified psychological outcomes, and quality of life. This is the first prevention RCT ever conducted among refugees experiencing psychological distress but without a mental disorder. Self-Help Plus was found to be an effective strategy for preventing the onset of mental disorders. Based on these findings, this low-intensity self-help psychological intervention could be scaled up as a public health strategy to prevent mental disorders in refugee populations exposed to ongoing adversities.
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Affiliation(s)
- Ceren Acarturk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Ersin Uygun
- Department of Trauma and Disasters Mental Health, Bilgi University, Istanbul, Turkey
| | - Zeynep Ilkkursun
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mine Batu
- Department of Trauma and Disasters Mental Health, Bilgi University, Istanbul, Turkey
| | - Sevde Eskici
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Gulsah Kurt
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariana Popa
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Johannes Wancata
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Elisa Zanini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ross G White
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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21
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Purgato M, Carswell K, Tedeschi F, Acarturk C, Anttila M, Au T, Bajbouj M, Baumgartner J, Biondi M, Churchill R, Cuijpers P, Koesters M, Gastaldon C, Ilkkursun Z, Lantta T, Nosè M, Ostuzzi G, Papola D, Popa M, Roselli V, Sijbrandij M, Tarsitani L, Turrini G, Välimäki M, Walker L, Wancata J, Zanini E, White R, van Ommeren M, Barbui C. Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial. Psychother Psychosom 2021; 90:403-414. [PMID: 34350902 PMCID: PMC8619740 DOI: 10.1159/000517504] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Self-Help Plus (SH+) is a group-based psychological intervention developed by the World Health Organization for managing stress. OBJECTIVE To assess the effectiveness of SH+ in preventing mental disorders in refugees and asylum seekers in Western Europe. METHODS We conducted a randomized controlled trial in 5 European countries. Refugees and asylum seekers with psychological distress (General Health Questionnaire score ≥3), but without a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) or ICD/10 diagnosis of mental disorder, as assessed with the Mini International Neuropsychiatric Interview (MINI), were randomized to SH+ or enhanced treatment as usual (ETAU). The primary outcome was the frequency of mental disorders with the MINI at 6 months. Secondary outcomes included the frequency of mental disorders at postintervention, self-identified problems, psychological symptoms, and other outcomes. RESULTS Four hundred fifty-nine individuals were randomly assigned to SH+ or ETAU. For the primary outcome, we found no difference in the frequency of mental disorders at 6 months (Cramer V = 0.007, p = 0.90, RR = 0.96; 95% CI 0.52-1.78), while the difference significantly favored SH+ at after the intervention (secondary outcome, measured within 2 weeks from the last session; Cramer V = 0.13, p = 0.01, RR = 0.50; 95% CI 0.29-0.87). CONCLUSIONS This is the first randomized indicated prevention study with the aim of preventing the onset of mental disorders in asylum seekers and refugees in Western Europe. As a prevention effect of SH+ was not observed at 6 months, but rather after the intervention only, modalities to maintain its beneficial effect in the long term need to be identified.
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Affiliation(s)
- Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ceren Acarturk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Malek Bajbouj
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Universitätsmedizin, Berlin, Germany
| | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Rachel Churchill
- Centre for Review and Dissemination, University of York, York, United Kingdom
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Zeynep Ilkkursun
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Mariana Popa
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Valentina Roselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Lauren Walker
- Mental Health and Addiction Research Group, University of York, York, United Kingdom
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Elisa Zanini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ross White
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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22
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Jordans MJD, Kohrt BA, Sangraula M, Turner EL, Wang X, Shrestha P, Ghimire R, van’t Hof E, Bryant RA, Dawson KS, Marahatta K, Luitel NP, van Ommeren M. Effectiveness of Group Problem Management Plus, a brief psychological intervention for adults affected by humanitarian disasters in Nepal: A cluster randomized controlled trial. PLoS Med 2021; 18:e1003621. [PMID: 34138875 PMCID: PMC8211182 DOI: 10.1371/journal.pmed.1003621] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. METHODS AND FINDINGS We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI: 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of -0.4 (95% CI: -0.5, -0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI: 0.3, 2.5, p = 0.014), with SMD of -0.2 (95% CI: -0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI: 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have "heart-mind" problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information. CONCLUSIONS In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. TRIAL REGISTRATION ClinicalTrials.gov NCT03747055.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Depression/diagnosis
- Depression/etiology
- Depression/psychology
- Depression/therapy
- Female
- Functional Status
- Humans
- Male
- Mental Health
- Middle Aged
- Natural Disasters
- Nepal
- Problem Solving
- Psychotherapy, Brief
- Psychotherapy, Group
- Relief Work
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/etiology
- Stress Disorders, Post-Traumatic/psychology
- Stress Disorders, Post-Traumatic/therapy
- Stress, Psychological/diagnosis
- Stress, Psychological/etiology
- Stress, Psychological/psychology
- Stress, Psychological/therapy
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Mark J. D. Jordans
- Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
- Division of Global Mental Health, Department of Psychiatry & Behavioral Sciences, The George Washington University, Washington, DC, United States of America
| | - Manaswi Sangraula
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Elizabeth L. Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Xueqi Wang
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Pragya Shrestha
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Renasha Ghimire
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | | | | | | | - Kedar Marahatta
- World Health Organization Country Office for Nepal, Kathmandu, Nepal
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23
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Heim E, Ramia JA, Hana RA, Burchert S, Carswell K, Cornelisz I, Cuijpers P, El Chammay R, Noun P, van Klaveren C, van Ommeren M, Zoghbi E, van't Hof E. Step-by-step: Feasibility randomised controlled trial of a mobile-based intervention for depression among populations affected by adversity in Lebanon. Internet Interv 2021; 24:100380. [PMID: 33747798 PMCID: PMC7967003 DOI: 10.1016/j.invent.2021.100380] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND E-mental health interventions may help to bridge the mental health treatment gap. Evidence on their effectiveness is compelling in high-income countries. Not enough evidence has been generated on their use with communities affected by adversity in low- and middle-income countries. The World Health Organization (WHO), the National Mental Health Programme (NMMP) at Ministry of Public Health (MoPH) in Lebanon and other partners have adapted a WHO intervention called Step-by-Step for use with Lebanese and displaced people living in Lebanon. Step-by-Step is a minimally guided, internet-based intervention for adults with depression. In this study, a feasibility randomised controlled trial (RCT) and a qualitative process evaluation were conducted to explore the feasibility and the acceptability of the research methods, and the intervention, in preparation for two fully powered trials to assess the effectiveness and cost-effectiveness of Step-by-Step in Lebanon. METHOD Participants were recruited through social media. Inclusion criteria were: being able to understand and speak Arabic or English; access to an internet connected device; aged over 18; living in Lebanon; scores above cut-off on the Patient Health Questionnaire and the WHO Disability Assessment Schedule 2.0. Participants were randomly assigned to the intervention or enhanced care as usual. They completed post-assessments eight weeks after baseline, and follow-up assessments another three months later. Primary outcomes were depression and level of functioning, secondary outcomes were anxiety, post-traumatic stress, and well-being. Qualitative interviews were conducted to evaluate the feasibility and acceptability of the research procedures and the intervention. RESULTS A total of N = 138 participants, including 33 Syrians, were recruited and randomised into two equal groups. The dropout rate was higher in the control group (73% post- and 82% follow-up assessment) than in the intervention group (63% post- and 72% follow-up assessment). The intervention was perceived as relevant, acceptable and beneficial to those who completed it. Suggestions were made to further adapt the content and to make the intervention more engaging. Statistical analyses were conducted despite the small sample size. Complete cases analysis showed a statistically significant symptom reduction in depression, anxiety, disability, and post-traumatic stress, and statistically significant improvement in well-being and functioning. Intention-to-treat analysis revealed non-significant effects. CONCLUSION The research design, methods and procedures are feasible and acceptable in the context of Lebanon and can be applied in the RCTs. Preliminary findings suggest that Step-by-Step may be effective in reducing symptoms of depression and anxiety and improving functioning and well-being.
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Affiliation(s)
- Eva Heim
- Department of Psychology, University of Zurich, Switzerland,Corresponding author at: University of Zurich, Department of Psychology, Binzmuehlestrasse 14/17, 8050 Zurich, Switzerland.
| | - Jinane Abi Ramia
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Racha Abi Hana
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Sebastian Burchert
- Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Ilja Cornelisz
- Amsterdam Center for Learning Analytics, 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
| | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon,Psychiatry Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Philip Noun
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon
| | - Chris van Klaveren
- Amsterdam Center for Learning Analytics, Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Edwina Zoghbi
- Country Office for Lebanon, World Health Organization, Beirut, Lebanon
| | - Edith van't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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van 't Hof E, Heim E, Abi Ramia J, Burchert S, Cornelisz I, Cuijpers P, El Chammay R, Harper Shehadeh M, Noun P, Smit F, van Klaveren C, van Ommeren M, Zoghbi E, Carswell K. Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials. JMIR Res Protoc 2021; 10:e21585. [PMID: 33507158 PMCID: PMC7878105 DOI: 10.2196/21585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/31/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background The lack of availability of evidence-based services for people exposed to adversity globally has led to the development of psychological interventions with features that will likely make them more scalable. The evidence for the efficacy of e-mental health from high-income countries is compelling, and the use of these interventions could be a way to increase the coverage of evidence-based psychological interventions in low- and middle-income countries. Step-by-Step is a brief (5-session) intervention proposed by the World Health Organization as an innovative approach to reducing the suffering and disability associated with depression. Objective This study aims to evaluate the effectiveness and cost-effectiveness of a locally adapted version of Step-by-Step with Syrian nationals (trial 1) and Lebanese nationals and other populations residing in Lebanon (trial 2). Methods This Step-by-Step trial involves 2 parallel, two-armed, randomized controlled trials comparing the e-intervention Step-by-Step to enhanced care as usual in participants with depressive symptoms and impaired functioning. The randomized controlled trials are designed and powered to detect effectiveness in 2 populations: Syrians in Lebanon (n=568) and other people residing in Lebanon (n=568; Lebanese nationals and other populations resident in Lebanon). The primary outcomes are depressive symptomatology (measured with the Patient Health Questionnaire-9) and functioning (measured with the World Health Organization Disability Assessment Scale 2.0). Secondary outcomes include anxiety symptoms, posttraumatic stress disorder symptoms, personalized measures of psychosocial problems, subjective well-being, and economic effectiveness. Participants are mainly recruited through online advertising. Additional outreach methods will be used if required, for example through dissemination of information through partner agencies and organizations. They can access the intervention on a computer, tablet, and mobile phone through a hybrid app. Step-by-Step has 5 sessions, and users are guided by trained nonspecialist “e-helpers” providing phone-based or message-based support for around 15 minutes a week. Results The trials were funded in 2018. The study protocol was last verified June 20, 2019 (WHO ERC.0002797) and registered with ClinicalTrials.gov (NCT03720769). The trials started recruitment as of December 9, 2019, and all data collection was completed in December 2020. Conclusions The Step-by-Step trials will provide evidence about the effectiveness of an e-mental health intervention in Lebanon. If the intervention proves to be effective, this will inform future scale-up of this and similar interventions in Lebanon and in other settings across the world. Trial Registration ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID) DERR1-10.2196/21585
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Affiliation(s)
- Edith van 't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Eva Heim
- Department of Psychology Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Jinane Abi Ramia
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Ilja Cornelisz
- Department of Educational and Family Studies, Amsterdam Center for Learning Analytics, Vrije Universiteit, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Melissa Harper Shehadeh
- Department of Digital Health and Innovations, World Health Organization, Geneva, Switzerland
| | - Philip Noun
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Filip Smit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Chris van Klaveren
- Department of Educational and Family Studies, Amsterdam Center for Learning Analytics, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Edwina Zoghbi
- Country Office for Lebanon, World Health Organization, Beirut, Lebanon
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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25
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Hamdani SU, Huma ZE, Masood A, Zhou K, Ahmed Z, Nazir H, Amin H, Akhtar P, Bryant RA, Dawson K, van Ommeren M, Wang D, Rahman A, Minhas FA. Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial. Int J Ment Health Syst 2021; 15:11. [PMID: 33468192 PMCID: PMC7814584 DOI: 10.1186/s13033-020-00434-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan. METHODS A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N = 192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM + plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS 2.0) at 20 weeks after baseline. RESULTS The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20 weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, - 3.10; 95% CI, - 0.26 to - 5.76); p = 0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, - 4.35; 95% CI, - 1.45 to - 7.24); p = 0.004 in PM + plus TAU versus TAU arm. The follow-up rate was 67% at primary end-point. CONCLUSIONS Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered March 23, 2016. Retrospectively registered, https://www.anzctr.org.au/Default.aspx/ ACTRN12616000381482.
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Affiliation(s)
- Syed Usman Hamdani
- University of Liverpool, Liverpool, UK.
- Human Development Research Foundation, Islamabad, Pakistan.
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan.
| | - Zill-E- Huma
- University of Liverpool, Liverpool, UK
- Human Development Research Foundation, Islamabad, Pakistan
| | - Aqsa Masood
- Human Development Research Foundation, Islamabad, Pakistan
| | - Kaina Zhou
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Zainab Ahmed
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - Hania Amin
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan
| | - Parveen Akhtar
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Katie Dawson
- University of New South Wales, Sydney, Australia
| | | | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Fareed Aslam Minhas
- Institute of Psychiatry, WHO Collaborating Center for Mental Health Research and Training, Rawalpindi, Pakistan
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Karyotaki E, Sijbrandij M, Purgato M, Acarturk C, Lakin D, Bailey D, Peckham E, Uygun E, Tedeschi F, Wancata J, Augustinavicius J, Carswell K, Välimäki M, van Ommeren M, Koesters M, Popa M, Leku MR, Anttila M, Churchill R, White R, Al-Hashimi S, Lantta T, Au T, Klein T, Tol WA, Cuijpers P, Barbui C. Self-help plus for refugees and asylum seekers; study protocol for a series of individual participant data meta-analyses. Eur J Psychotraumatol 2021; 12:1930690. [PMID: 34262667 PMCID: PMC8259851 DOI: 10.1080/20008198.2021.1930690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers face various stressors due to displacement and are especially vulnerable to common mental disorders. To effectively manage psychological distress in this population, innovative interventions are required. The World Health Organization (WHO) Self-Help Plus (SH+) intervention has shown promising outcomes in reducing symptoms of common mental disorders among refugees and asylum seekers. However, individual participant differences in response to SH+ remain largely unknown. The Individual Participant Data (IPD) meta-analysis synthesizes raw datasets of trials to provide cutting-edge evidence of outcomes that cannot be examined by conventional meta-analytic approaches. OBJECTIVES This protocol outlines the methods of a series of IPD meta-analyses aimed at examining the effects and potential moderators of SH+ in (a) reducing depressive symptoms at post-intervention and (b) preventing the six-month cumulative incidence of mental disorders in refugees and asylum seekers. METHOD RCTs on SH+ have been identified through WHO and all authors have agreed to share the datasets of the trials. The primary outcomes of the IPD meta-analyses are (a) reduction in depressive symptoms at post-intervention, and (b) prevention of six-month cumulative incidence of mental disorders. Secondary outcomes include post-traumatic stress disorder symptoms, well-being, functioning, quality of life, and twelve-month cumulative incidence of mental disorders. One-stage IPD meta-analyses will be performed using mixed-effects linear/logistic regression. Missing data will be handled by multiple imputation. CONCLUSIONS These results will enrich current knowledge about the response to SH+ and will facilitate its targeted dissemination. The results of these IPD meta-analyses will be published in peer-reviewed journals.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, 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
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Ersin Uygun
- Department of Trauma and Disasters, Bilgi University, Istanbul, Turkey
| | - 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
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Jura Augustinavicius
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ken Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Mariana Popa
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross White
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Sarah Al-Hashimi
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Wietse A Tol
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - 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
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Hamdani SU, Huma ZE, Rahman A, Wang D, Chen T, van Ommeren M, Chisholm D, Farooq S. Cost-effectiveness of WHO Problem Management Plus for adults with mood and anxiety disorders in a post-conflict area of Pakistan: randomised controlled trial. Br J Psychiatry 2020; 217:623-629. [PMID: 32720628 DOI: 10.1192/bjp.2020.138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND With the development of evidence-based interventions for treatment of priority mental health conditions in humanitarian settings, it is important to establish the cost-effectiveness of such interventions to enable their scale-up. AIMS To evaluate the cost-effectiveness of the Problem Management Plus (PM+) intervention compared with enhanced usual care (EUC) for common mental disorders in primary healthcare in Peshawar, Pakistan. Trial registration ACTRN12614001235695 (anzctr.org.au). METHOD We randomly allocated 346 participants to either PM+ (n = 172) or EUC (n = 174). Effectiveness was measured using the Hospital Anxiety and Depression Scale (HADS) at 3 months post-intervention. Cost-effectiveness analysis was performed as incremental costs (measured in Pakistani rupees, PKR) per unit change in anxiety, depression and functioning scores. RESULTS The total cost of delivering PM+ per participant was estimated at PKR 16 967 (US$163.14) using an international trainer and supervisor, and PKR 3645 (US$35.04) employing a local trainer. The mean cost per unit score improvement in anxiety and depression symptoms on the HADS was PKR 2957 (95% CI 2262-4029) (US$28) with an international trainer/supervisor and PKR 588 (95% CI 434-820) (US$6) with a local trainer/supervisor. The mean incremental cost-effectiveness ratio (ICER) to successfully treat a case of depression (PHQ-9 ≥ 10) using an international supervisor was PKR 53 770 (95% CI 39 394-77 399) (US$517), compared with PKR 10 705 (95% CI 7731-15 627) (US$102.93) using a local supervisor. CONCLUSIONS The PM+ intervention was more effective but also more costly than EUC in reducing symptoms of anxiety, depression and improving functioning in adults impaired by psychological distress in a post-conflict setting of Pakistan.
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Affiliation(s)
- Syed Usman Hamdani
- Institute of Life and Human Sciences, University of Liverpool, UK; and Human Development Research Foundation, Islamabad, Pakistan
| | - Zill-E- Huma
- Human Development Research Foundation, Islamabad, Pakistan
| | - Atif Rahman
- Institute of Life and Human Sciences, University of Liverpool, UK
| | | | - Tao Chen
- Liverpool School of Tropical Medicine, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Dan Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Saeed Farooq
- Lady Reading Hospital, Peshawar, Pakistan; and School of Primary, Community and Social Care, Keele University, UK
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28
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Tol WA, Ager A, Bizouerne C, Bryant R, El Chammay R, Colebunders R, García-Moreno C, Hamdani SU, James LE, Jansen SCJ, Leku MR, Likindikoki S, Panter-Brick C, Pluess M, Robinson C, Ruttenberg L, Savage K, Welton-Mitchell C, Hall BJ, Harper Shehadeh M, Harmer A, van Ommeren M. Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC. Confl Health 2020; 14:71. [PMID: 33292413 PMCID: PMC7602334 DOI: 10.1186/s13031-020-00317-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC's research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).
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Affiliation(s)
- Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, bg 9, DK-1014, Copenhagen, Denmark.
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Cecile Bizouerne
- Mental Health, Child Care Practices, Gender and Protection, Action Contre La Faim, Paris, France
| | - Richard Bryant
- School of Psychology & Traumatic Stress Clinic, University of New South Wales, Sydney, Australia
| | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon
- Department of Psychiatry, Saint Joseph University, Beirut, Lebanon
| | | | - Claudia García-Moreno
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Leah E James
- Institute of Behavioral Science, University of Colorado, Boulder, CA, USA
| | - Stefan C J Jansen
- Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Catherine Panter-Brick
- Jackson Institute of Global Affairs, Yale University, New Haven, CT, USA
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Courtland Robinson
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, London, UK
| | - Leontien Ruttenberg
- International Medical Relief Services (IMRES), Prior association: Arq International, Europe, Netherlands
| | - Kevin Savage
- Evidence Building, World Vision International, Geneva, Switzerland
| | - Courtney Welton-Mitchell
- Institute of Behavioral Science and Colorado School of Public Health, University of Colorado, Boulder, Denver, USA
| | - Brian J Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China
| | | | | | - Mark van Ommeren
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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29
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Papola D, Purgato M, Gastaldon C, Bovo C, van Ommeren M, Barbui C, Tol WA. Psychological and social interventions for the prevention of mental disorders in people living in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2020; 9:CD012417. [PMID: 32897548 PMCID: PMC8094402 DOI: 10.1002/14651858.cd012417.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND People living in 'humanitarian settings' in low- and middle-income countries (LMICs) are exposed to a constellation of physical and psychological stressors that make them vulnerable to developing mental disorders. A range of psychological and social interventions have been implemented with the aim to prevent the onset of mental disorders and/or lower psychological distress in populations at risk, and it is not known whether interventions are effective. OBJECTIVES To compare the efficacy and acceptability of psychological and social interventions versus control conditions (wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at preventing the onset of non-psychotic mental disorders in people living in LMICs affected by humanitarian crises. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMD-CTR), the Cochrane Drugs and Alcohol Review Group (CDAG) Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), PsycINFO (OVID), and ProQuest PILOTS database with results incorporated from searches to February 2020. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies. We checked the reference lists of relevant studies and reviews. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing psychological and social interventions versus control conditions to prevent the onset of mental disorders in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure). DATA COLLECTION AND ANALYSIS We calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random-effects model. We analysed data at endpoint (zero to four weeks after therapy) and at medium term (one to four months after intervention). No data were available at long term (six months or longer). We used GRADE to assess the quality of evidence. MAIN RESULTS In the present review we included seven RCTs with a total of 2398 participants, coming from both children/adolescents (five RCTs), and adults (two RCTs). Together, the seven RCTs compared six different psychosocial interventions against a control comparator (waiting list in all studies). All the interventions were delivered by paraprofessionals and, with the exception of one study, delivered at a group level. None of the included studies provided data on the efficacy of interventions to prevent the onset of mental disorders (incidence). For the primary outcome of acceptability, there may be no evidence of a difference between psychological and social interventions and control at endpoint for children and adolescents (RR 0.93, 95% CI 0.78 to 1.10; 5 studies, 1372 participants; low-quality evidence) or adults (RR 0.96, 95% CI 0.61 to 1.50; 2 studies, 767 participants; very low quality evidence). No information on adverse events related to the interventions was available. For children's and adolescents' secondary outcomes of prevention interventions, there may be no evidence of a difference between psychological and social intervention groups and control groups for reducing PTSD symptoms (standardised mean difference (SMD) -0.16, 95% CI -0.50 to 0.18; 3 studies, 590 participants; very low quality evidence), depressive symptoms (SMD -0.01, 95% CI -0.29 to 0.31; 4 RCTs, 746 participants; very low quality evidence) and anxiety symptoms (SMD 0.11, 95% CI -0.09 to 0.31; 3 studies, 632 participants; very low quality evidence) at study endpoint. In adults' secondary outcomes of prevention interventions, psychological counselling may be effective for reducing depressive symptoms (MD -7.50, 95% CI -9.19 to -5.81; 1 study, 258 participants; very low quality evidence) and anxiety symptoms (MD -6.10, 95% CI -7.57 to -4.63; 1 study, 258 participants; very low quality evidence) at endpoint. No data were available for PTSD symptoms in the adult population. Owing to the small number of RCTs included in the present review, it was not possible to carry out neither sensitivity nor subgroup analyses. AUTHORS' CONCLUSIONS Of the seven prevention studies included in this review, none assessed whether prevention interventions reduced the incidence of mental disorders and there may be no evidence for any differences in acceptability. Additionally, for both child and adolescent populations and adult populations, a very small number of RCTs with low quality evidence on the review's secondary outcomes (changes in symptomatology at endpoint) did not suggest any beneficial effect for the studied prevention interventions. Confidence in the findings is hampered by the scarcity of prevention studies eligible for inclusion in the review, by risk of bias in the studies, and by substantial levels of heterogeneity. Moreover, it is possible that random error had a role in distorting results, and that a more thorough picture of the efficacy of prevention interventions will be provided by future studies. For this reason, prevention studies are urgently needed to assess the impact of interventions on the incidence of mental disorders in children and adults, with extended periods of follow-up.
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Affiliation(s)
- Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Bovo
- Direzione Sanitaria, Azienda ULSS 20, Verona, Italy
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA
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Affiliation(s)
- Sarah Watts
- Department of Mental Health and Substance Use, World Health OrganizationGenevaSwitzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health OrganizationGenevaSwitzerland
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Van't Hof E, Sangraula M, Luitel NP, Turner EL, Marahatta K, van Ommeren M, Shrestha P, Bryant R, Kohrt BA, Jordans MJD. Effectiveness of Group Problem Management Plus (Group-PM+) for adults affected by humanitarian crises in Nepal: study protocol for a cluster randomized controlled trial. Trials 2020; 21:343. [PMID: 32307009 PMCID: PMC7168994 DOI: 10.1186/s13063-020-04263-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 03/17/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Globally, the lack of availability of psychological services for people exposed to adversities has led to the development of a range of scalable psychological interventions with features that enable better scale-up. Problem Management Plus (PM+) is a brief intervention of five sessions that can be delivered by non-specialists. It is designed for people in communities in low- and middle-income countries (LMIC) affected by any kind of adversity. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the effectiveness of individually delivered PM+. A group version of PM+ has been developed to make the intervention more scalable and acceptable. This paper describes the protocol for a cluster randomized controlled trial (c-RCT) on locally adapted Group PM+ in Nepal. METHODS/DESIGN This c-RCT will compare Group PM+ to enhanced usual care (EUC) in participants with high levels of psychological distress recruited from the community. The study is designed as a two-arm, single-blind c-RCT that will be conducted in a community-based setting in Morang, a flood affected district in Eastern Nepal. Randomization will occur at ward level, the smallest administrative level in Nepal, with 72 enrolled wards allocated to Group PM+ or to EUC (ratio 1:1). Group PM+ consists of five approximately 2.5-h sessions, in which participants are taught techniques to manage their stressors and problems, and is delivered by trained and supervised community psychosocial workers (CPSWs). EUC consists of a family meeting with (a) basic information on adversity and mental health, (b) benefits of getting support, (c) information on seeking services from local health facilities with mhGAP-trained staff. The primary outcome measure is levels of individual psychological distress at endline (equivalent to 20 ± 1 weeks after baseline), measured by the General Health Questionnaire (GHQ-12). Secondary outcome measures include levels of functioning, depressive symptoms, post-traumatic stress disorder symptoms, levels of social support, somatic symptoms, and ways of coping. We hypothesize that skills acquired will mediate any impact of the intervention. DISCUSSION This c-RCT will contribute to the growing evidence-base for transdiagnostic psychological interventions delivered by non-specialists for people in communities affected by adversity. If Group PM+ is proven effective, the intervention manual will be released for use, giving the opportunity for further adaptation and implementation of the intervention in diverse settings with communities that require better access to psychological interventions. TRIAL REGISTRATION ClinicalTrials.gov, NCT03747055.
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Affiliation(s)
- Edith Van't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Manaswi Sangraula
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal.
| | - Elizabeth L Turner
- Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kedar Marahatta
- World Health Organization, Country Office for Nepal, Kathmandu, Nepal
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Pragya Shrestha
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | | | - Brandon A Kohrt
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mark J D Jordans
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
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Harper Shehadeh M, Van't Hof E, Schafer A, van Ommeren M, Farooq S, Hamdani SU, Koyiet P, Akhtar P, Masood A, Nazir H, Dawson K, Albanese E. Using a person-generated mental health outcome measure in large clinical trials in Kenya and Pakistan: Self-perceived problem responses in diverse communities. Transcult Psychiatry 2020; 57:108-123. [PMID: 31237805 DOI: 10.1177/1363461519854831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health care should be informed by the physical, socioeconomic, mental, and emotional well-being of the person, and account for social circumstances and culture. Patient-generated outcome measures can contribute positively to mental health research in culturally diverse populations. In this study, we analysed qualitative responses to the Psychological Outcome Profiles (PSYCHLOPS) Questionnaire-a patient-generated outcome measure based on open-ended questions, and compared the qualitative responses gathered to conventional, nomothetic measures used alongside the PSYCHLOPS in two studies. Data were collected as part of outcome research on a psychological intervention in Pakistan (N = 346) and Kenya (N = 521). Two researchers coded the qualitative responses to the PSYCHLOPS and identified overarching themes. We compared the overarching themes identified to the items in the conventional, nomothetic outcome measures to investigate conceptual equivalence. Using the PSYCHLOPS, the most frequently reported problems in Kenya were financial constraints, poor health, and unemployment. In Pakistan, the most frequent problems were poor health and emotional problems. Most of the person-generated problem concepts were covered also in nomothetic measures that were part of the same study. However, there was no item equivalence in the nomothetic measures for the most frequent PSYCHLOPS problem cited in both countries. Response bias and measurement bias may not be excluded. More research on the use of PSYCHLOPS alongside conventional outcome measures is needed to further explore the extent to which it may bring added value. Use of a PSYCHLOPS semistructured interview schedule and efforts to minimise response biases should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Aqsa Masood
- Human Development Research Foundation, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Pakistan
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33
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Tol WA, Leku MR, Lakin DP, Carswell K, Augustinavicius J, Adaku A, Au TM, Brown FL, Bryant RA, Garcia-Moreno C, Musci RJ, Ventevogel P, White RG, van Ommeren M. Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial. Lancet Glob Health 2020; 8:e254-e263. [PMID: 31981556 PMCID: PMC9899129 DOI: 10.1016/s2214-109x(19)30504-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/10/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help intervention (Self-Help Plus) to reduce psychological distress in female refugees. METHODS We did a cluster randomised trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cutoff ≥5 on the Kessler 6). The intervention comprised access to usual care and five 2-h audio-recorded stress-management workshops (20-30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomly assigned to either intervention (Self-Help Plus or enhanced usual care) on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20-30 eligible participants were identified per site. The primary outcome was individual psychological distress, assessed using the Kessler 6 symptom checklist 1 week before, 1 week after, and 3 months after intervention, in the intention-to-treat population. All outcomes were measured at the individual (rather than cluster) level. Secondary outcomes included personally identified problems, post-traumatic stress, depression symptoms, feelings of anger, social interactions with other ethnic groups, functional impairment, and subjective wellbeing. Assessors were masked to allocation. This trial was prospectively registered at ISRCTN, number 50148022. FINDINGS Of 694 eligible participants (331 Self-Help Plus, 363 enhanced usual care), 613 (88%) completed all assessments. Compared with controls, we found stronger improvements for Self-Help Plus on psychological distress 3 months post intervention (β -1·20, 95% CI -2·33 to -0·08; p=0·04; d -0·26). We also found larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range -0·30 to -0·36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. With regard to safety considerations, the independent data safety management board responded to six adverse events, and none were evaluated to be concerns in response to the intervention. INTERPRETATION Self-Help Plus is an innovative, facilitator-guided, group-based self-help intervention that can be rapidly deployed to large numbers of participants, and resulted in meaningful reductions in psychological distress at 3 months among South Sudanese female refugees. FUNDING Research for Health in Humanitarian Crises (R2HC) Programme.
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Kohrt BA, Schafer A, Willhoite A, van't Hof E, Pedersen GA, Watts S, Ottman K, Carswell K, van Ommeren M. Ensuring Quality in Psychological Support (WHO EQUIP): developing a competent global workforce. World Psychiatry 2020; 19:115-116. [PMID: 31922690 PMCID: PMC6953555 DOI: 10.1002/wps.20704] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Alison Schafer
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Ann Willhoite
- Bureau of Democracy, Conflict and Humanitarian Assistance, United States Agency for International Development (USAID), Washington, DC, USA
| | - Edith van't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Gloria A. Pedersen
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Sarah Watts
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Katherine Ottman
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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35
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Balasubramanyam S, Bloodgood MA, van Ommeren M, Faraz T, Vandalon V, Kessels WMM, Verheijen MA, Bol AA. Probing the Origin and Suppression of Vertically Oriented Nanostructures of 2D WS 2 Layers. ACS Appl Mater Interfaces 2020; 12:3873-3885. [PMID: 31880425 PMCID: PMC6978813 DOI: 10.1021/acsami.9b19716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
Two-dimensional (2D) layered transition metal dichalcogenides (TMDs) such as WS2 are promising materials for nanoelectronic applications. However, growth of the desired horizontal basal-plane oriented 2D TMD layers is often accompanied by the growth of vertical nanostructures that can hinder charge transport and, consequently, hamper device application. In this work, we discuss both the formation and suppression of vertical nanostructures during plasma-enhanced atomic layer deposition (PEALD) of WS2. Using scanning transmission electron microscopy studies, formation pathways of vertical nanostructures are established for a two-step (AB-type) PEALD process. Grain boundaries are identified as the principal formation centers of vertical nanostructures. Based on the obtained insights, we introduce an approach to suppress the growth of vertical nanostructures, wherein an additional step (C)-a chemically inert Ar plasma or a reactive H2 plasma-is added to the original two-step (AB-type) PEALD process. This approach reduces the vertical nanostructure density by 80%. It was confirmed that suppression of vertical nanostructures goes hand in hand with grain size enhancement. The vertical nanostructure density reduction consequently lowers film resistivity by an order of magnitude. Insights obtained in this work can contribute toward devising additional pathways, besides plasma treatments, for suppressing the growth of vertical nanostructures and improving the material properties of 2D TMDs that are relevant for nanoelectronic device applications.
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Affiliation(s)
- Shashank Balasubramanyam
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
| | - Matthew A. Bloodgood
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
| | - Mark van Ommeren
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
| | - Tahsin Faraz
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
| | - Vincent Vandalon
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
| | - Wilhelmus M. M. Kessels
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
| | - Marcel A. Verheijen
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
- Eurofins
Materials Science Netherlands B.V., High Tech Campus 11, 5656 AE Eindhoven, The Netherlands
| | - Ageeth A. Bol
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MB Eindhoven, The Netherlands
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Affiliation(s)
- Fiona Charlson
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, WHO, Geneva 1211, Switzerland.
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Brown FL, Steen F, Taha K, Aoun M, Bryant RA, Jordans MJD, Malik A, van Ommeren M, Abualhaija A, Aqel IS, Ghatasheh M, Habashneh R, Sijbrandij M, El Chammay R, Watts S, Akhtar A. Correction to: Early Adolescent Skills for Emotions (EASE) intervention for the treatment of psychological distress in adolescents: study protocol for randomised controlled trials in Lebanon and Jordan. Trials 2019; 20:617. [PMID: 31665074 PMCID: PMC6820940 DOI: 10.1186/s13063-019-3717-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Felicity L Brown
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Frederik Steen
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Karine Taha
- War Child Holland Lebanon Office, Beirut, Lebanon
| | - May Aoun
- War Child Holland Lebanon Office, Beirut, Lebanon
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - 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.
| | - Aiysha Malik
- 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
| | | | | | | | | | - 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
| | - Sarah Watts
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia.,Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
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38
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Affiliation(s)
- Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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39
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Brown FL, Steen F, Taha K, Aoun M, Bryant RA, Jordans MJD, Malik A, van Ommeren M, Abualhaija A, Aqel IS, Ghatasheh M, Habashneh R, Sijbrandij M, El Chammay R, Watts S, Akhtar A. Early Adolescent Skills for Emotions (EASE) intervention for the treatment of psychological distress in adolescents: study protocol for randomised controlled trials in Lebanon and Jordan. Trials 2019; 20:545. [PMID: 31477178 PMCID: PMC6721330 DOI: 10.1186/s13063-019-3654-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are significant barriers to providing accessible, quality mental health care for young adolescents affected by adversity. In an attempt to overcome this, the World Health Organization (WHO) has developed the Early Adolescent Skills for Emotions (EASE) psychological intervention for young adolescents with internalising problems. EASE is group-based (seven sessions for adolescents, three sessions for their caregivers) and can be delivered by non-specialist providers. This paper outlines the study protocols for two trials of EASE in the Middle East - one in Lebanon and one in Jordan. METHODS We will conduct two, single-blind, two-arm, individually randomised group treatment trials in Lebanon and Jordan, with at least 445 young adolescents per trial. Adolescents will be screened eligible for the trial if they demonstrate levels of psychological distress indicative of internalizing problems requiring treatment. Participants will be randomly assigned to receive the EASE intervention, or enhanced usual care (one home-visit psychoeducation session). The primary outcome is reduction in overall child-reported psychological distress over time, with 3 months post-treatment as the primary end point. Secondary child-reported outcomes include post-traumatic stress symptoms, depression symptoms, daily functioning, and wellbeing. Secondary caregiver-reported outcomes include parenting style, overall child distress, and caregiver psychological distress. Coping strategy use will be explored as a mediator of treatment effects in Lebanon, and relevant moderators of treatment effects will be explored. DISCUSSION These trials will provide the first assessments of the effectiveness of the EASE intervention for use in the Middle East, with important implications for the use of low-intensity, non-specialist interventions for this age range. TRIAL REGISTRATION Lebanon: ISRCTN75375136 . Registered on 11 March 2019. Jordan: Australia New Zealand Clinical Trials Registry, ACTRN12619000341123. Registered on 5 March 2019 ( https://www.anzctr.org.au/ ).
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Affiliation(s)
- Felicity L. Brown
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Frederik Steen
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Karine Taha
- War Child Holland Lebanon Office, Beirut, Lebanon
| | - May Aoun
- War Child Holland Lebanon Office, Beirut, Lebanon
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - 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
| | - Aiysha Malik
- 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
| | | | | | | | | | - 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
| | - Sarah Watts
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - on behalf of the STRENGTHS-consortium
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
- War Child Holland Lebanon Office, Beirut, Lebanon
- School of Psychology, University of New South Wales, Sydney, Australia
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- Institute for Family Health, Amman, Jordan
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
- Ministry of Public Health, Beirut, Lebanon
- Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet 2019; 394:240-248. [PMID: 31200992 PMCID: PMC6657025 DOI: 10.1016/s0140-6736(19)30934-1] [Citation(s) in RCA: 507] [Impact Index Per Article: 101.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. METHODS In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. FINDINGS We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8-25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3-16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9-5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0-6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. INTERPRETATION The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. FUNDING WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Fiona Charlson
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, QLD, Australia; School of Public Health, University of Queensland, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland.
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph Cornett
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, QLD, Australia
| | - Harvey Whiteford
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, QLD, Australia; School of Public Health, University of Queensland, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Shekhar Saxena
- T H Chan School of Public Health, Harvard University, Boston, MA, USA
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Rahman A, Khan MN, Hamdani SU, Chiumento A, Akhtar P, Nazir H, Nisar A, Masood A, Din IU, Khan NA, Bryant RA, Dawson KS, Sijbrandij M, Wang D, van Ommeren M. Effectiveness of a brief group psychological intervention for women in a post-conflict setting in Pakistan: a single-blind, cluster, randomised controlled trial. Lancet 2019; 393:1733-1744. [PMID: 30948286 DOI: 10.1016/s0140-6736(18)32343-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many women are affected by anxiety and depression after armed conflict in low-income and middle-income countries, yet few scalable options for their mental health care exist. We aimed to establish the effectiveness of a brief group psychological intervention for women in a conflict-affected setting in rural Swat, Pakistan. METHODS In a single-blind, cluster, randomised, controlled trial, 34 community clusters in two union councils of rural Swat, Pakistan, were randomised using block permutation at a 1:1 ratio to intervention (group intervention with five sessions incorporating behavioural strategies facilitated by non-specialists) or control (enhanced usual care) groups. Researchers responsible for identifying participants, obtaining consent, enrolment, and outcome assessments were masked to allocation. A community cluster was defined as neighbourhood of about 150 households covered by a lady health worker. Women aged 18-60 years who provided written informed consent, resided in the participating cluster catchment areas, scored at least 3 on the General Health Questionnaire-12, and at least 17 on the WHO Disability Assessment Schedule were recruited. The primary outcome, combined anxiety and depression symptoms, was measured 3 months after the intervention with the Hospital Anxiety and Depression Scale (HADS). Modified intention-to-treat analyses were done using mixed models adjusted for covariates and clusters defined a priori. The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12616000037404, and is now closed to new participants. FINDINGS From 34 eligible community clusters, 306 women in the intervention group and 306 women in the enhanced usual care (EUC) group were enrolled between Jan 11, 2016, and Aug 21, 2016, and the results of 288 (94%) of 306 women in the intervention group and 290 (95%) of 306 women in the EUC group were included in the primary endpoint analysis. At 3 months, women in the intervention group had significantly lower mean total scores on the HADS than women in the control group (10·01 [SD 7·54] vs 14·75 [8·11]; adjusted mean difference [AMD] -4·53, 95% CI -7·13 to -1·92; p=0·0007). Individual HADS anxiety scores were also significantly lower in the intervention group than in the control group (5·43 [SD 4·18] vs 8·02 [4·69]; AMD -2·52, 95% CI -4·04 to -1·01), as were depression scores (4·59 [3·87] vs 6·73 [3·91]; AMD -2·04, -3·19 to -0·88). No adverse events were reported in either group. INTERPRETATION Our group psychological intervention resulted in clinically significant reductions in anxiety and depressive symptoms at 3 months, and might be a feasible and effective option for women with psychological distress in rural post-conflict settings. FUNDING WHO through a grant from the Office for Foreign Disaster Assistance.
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Affiliation(s)
- Atif Rahman
- Institute of Life and Human Sciences, University of Liverpool, Liverpool, UK.
| | | | | | - Anna Chiumento
- Institute of Life and Human Sciences, University of Liverpool, Liverpool, UK
| | - Parveen Akhtar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - Anum Nisar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Aqsa Masood
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Nasir Ali Khan
- Human Development Research Foundation, Islamabad, Pakistan
| | | | | | | | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
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Dawson KS, Watts S, Carswell K, Shehadeh MH, Jordans MJ, Bryant RA, Miller KE, Malik A, Brown FL, Servili C, van Ommeren M. Improving access to evidence-based interventions for young adolescents: Early Adolescent Skills for Emotions (EASE). World Psychiatry 2019; 18:105-107. [PMID: 30600639 PMCID: PMC6313693 DOI: 10.1002/wps.20594] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Katie S. Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Watts
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Kenneth Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Melissa Harper Shehadeh
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark J.D. Jordans
- Department of Research and Development, War Child, Amster‐dam, The Netherlands,Center for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Kenneth E. Miller
- Department of Research and Development, War Child, Amster‐dam, The Netherlands
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland,Oxford Institute of Clinical Psychology Training, Isis Education Centre, University of Oxford, Oxford, UK
| | - Felicity L. Brown
- Department of Research and Development, War Child, Amster‐dam, The Netherlands
| | - 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
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Abstract
Mental disorders often coexist with other non-communicable diseases and they share many risk factors. Dan Stein and colleagues examine the evidence for an integrated approach
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Affiliation(s)
- Dan J Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town
- Groote Schuur Hospital, Cape Town, South Africa
| | - Corina Benjet
- Department of Epidemiology and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Crick Lund
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Vladimir Poznyak
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Harper Shehadeh MJ, Abi Ramia J, Cuijpers P, El Chammay R, Heim E, Kheir W, Saeed K, van Ommeren M, Van't Hof E, Watts S, Wenger A, Zoghbi E, Carswell K. Step-by-Step, an E-Mental Health Intervention for Depression: A Mixed Methods Pilot Study From Lebanon. Front Psychiatry 2019; 10:986. [PMID: 32116815 PMCID: PMC7034323 DOI: 10.3389/fpsyt.2019.00986] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 12/11/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND E-mental health is an established mode of delivering treatment for common mental disorders in many high income countries. However, evidence of its effectiveness in lower income countries is lacking. This mixed methods study presents lessons learned and preliminary data on the feasibility of a minimally guided e-mental health intervention in Lebanon. The aim was to pilot test Step-by-Step, a WHO guided e-mental health intervention, and research methods prior to future, controlled testing. METHODS Participants were recruited using social media and advertisements in primary care clinics. Participants completed baseline and post-intervention questionnaires on depression symptoms (primary outcome, PHQ-8), anxiety symptoms, well-being, disability and self-perceived problem severity, and a client satisfaction questionnaire. In addition, seven completers, four drop-outs, 11 study staff, and four clinic managers were interviewed with responses thematically analyzed. Website analytics were used to understand participant behavior when using the website. RESULTS A total of 129 participants signed up via the Step-by-Step website. Seventy-four participants started session 1 after completing pre-test questionnaires and 26 completed both baseline and post-intervention data. Among those who completed post-assessments, depression symptoms improved (PHQ-8 scores (t=5.62, p < 0.001 two-tailed, df = 25). Wilcoxon signed ranks tests showed a significant difference between baseline and post-Step-by-Step scores on all secondary outcome measures. Client satisfaction data was positive. Interview responses suggested that the intervention could be made more appropriate for younger, single people, more motivating, and easier to use. Those who utilized the support element of the intervention were happy with their relationship with the non-specialist support person (e-helper), though some participants would have preferred specialist support. E-helpers would have liked more training on complex cases. Website analytics showed that many users dropped out before intervention start, and that some re-entered screening data having been excluded from the study. CONCLUSION Step-by-Step skills and techniques, model of service integration, and its non-specialist support element are acceptable. Though the sample was small and non-controlled and drop-out was high, results suggest that it may be effective in reducing depression and anxiety symptoms and increasing well-being. Lessons learned will inform content revision, the development of an app version of Step-by-Step, and the research methodology of upcoming effectiveness studies.
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Affiliation(s)
- Melissa Joanne Harper Shehadeh
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jinane Abi Ramia
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Pim Cuijpers
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.,Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Eva Heim
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Wissam Kheir
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Khalid Saeed
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Edith Van't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Sarah Watts
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Edwina Zoghbi
- Country Office for Lebanon, World Health Organization, Beirut, Lebanon
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Sijbrandij M, Farooq S, Bryant RA, Dawson K, Hamdani SU, Chiumento A, Minhas F, Saeed K, Rahman A, van Ommeren M. Correction to: Problem management plus (PM+) for common mental disorders in a humanitarian setting in Pakistan; study protocol for a randomised controlled trial (RCT). BMC Psychiatry 2018; 18:331. [PMID: 30322401 PMCID: PMC6191994 DOI: 10.1186/s12888-018-1922-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 11/28/2022] Open
Abstract
Following publication of the original article [1], the first author reported an error in referring his paper.
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Affiliation(s)
- Marit Sijbrandij
- 0000 0001 0686 3219grid.466632.3Department of Clinical Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Saeed Farooq
- 0000 0004 0481 4343grid.415726.3Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Richard A Bryant
- 0000 0004 4902 0432grid.1005.4School of Psychology, University of New South Wales, Sydney, Australia
| | - Katie Dawson
- 0000 0004 4902 0432grid.1005.4School of Psychology, University of New South Wales, Sydney, Australia
| | - Syed Usman Hamdani
- grid.490844.5University of Liverpool and Human Development Research Foundation, Islamabad, Pakistan
| | - Anna Chiumento
- grid.490844.5University of Liverpool and Human Development Research Foundation, Islamabad, Pakistan
| | - Fareed Minhas
- grid.412956.dWHO Collaborating Centre for Mental Health Research, Training and Substance Abuse and Institute of Psychiatry, Rawalpindi Medical College, University of Health Sciences, Rawalpindi, Pakistan
| | - Khalid Saeed
- 0000 0001 1942 4602grid.483405.eWHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Atif Rahman
- University of Liverpool and Human Development Research Foundation, Islamabad, Pakistan.
| | - Mark van Ommeren
- 0000000121633745grid.3575.4Department of Mental Health and Substance Abuse, World Health Organization (WHO), Geneva, Switzerland
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Sijbrandij M, Bryant RA, Schafer A, Dawson KS, Anjuri D, Ndogoni L, Ulate J, Hamdani SU, van Ommeren M. Correction to: Problem Management Plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial. Int J Ment Health Syst 2018; 12:55. [PMID: 30337952 PMCID: PMC6182821 DOI: 10.1186/s13033-018-0236-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Marit Sijbrandij
- 1Department of Clinical Neuro- and Developmental Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Richard A Bryant
- 2School of Psychology, University of New South Wales, Sydney, Australia
| | - Alison Schafer
- 3World Vision International and World Vision Australia, Burwood East, Australia
| | - Katie S Dawson
- 2School of Psychology, University of New South Wales, Sydney, Australia
| | | | | | | | - Syed Usman Hamdani
- 6University of Liverpool, Liverpool, UK.,7Human Development Research Foundation, Islamabad, Pakistan
| | - Mark van Ommeren
- 8Department of Mental Health and Substance Abuse, World Health Organization (WHO), Geneva, Switzerland
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Hamdani SU, Ahmed Z, Sijbrandij M, Nazir H, Masood A, Akhtar P, Amin H, Bryant RA, Dawson K, van Ommeren M, Rahman A, Minhas FA. Correction to: Problem Management Plus (PM+) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial. Int J Ment Health Syst 2018; 12:53. [PMID: 30275875 PMCID: PMC6158843 DOI: 10.1186/s13033-018-0231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13033-017-0147-1.].
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Affiliation(s)
- Syed Usman Hamdani
- 1Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Zainab Ahmed
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Marit Sijbrandij
- 3Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Huma Nazir
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Aqsa Masood
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Parveen Akhtar
- 2Human Development Research Foundation, Islamabad, Pakistan
| | - Hania Amin
- 1Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Richard A Bryant
- 4School of Psychology, University of New South Wales, Sydney, Australia
| | - Katie Dawson
- 4School of Psychology, University of New South Wales, Sydney, Australia
| | - Mark van Ommeren
- 5World Health Organization (WHO), Department of Mental Health and Substance Abuse, Geneva, Switzerland
| | | | - Fareed Aslam Minhas
- 1Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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Sangraula M, Van't Hof E, Luitel NP, Turner EL, Marahatta K, Nakao JH, van Ommeren M, Jordans MJD, Kohrt BA. Protocol for a feasibility study of group-based focused psychosocial support to improve the psychosocial well-being and functioning of adults affected by humanitarian crises in Nepal: Group Problem Management Plus (PM+). Pilot Feasibility Stud 2018; 4:126. [PMID: 30038793 PMCID: PMC6052626 DOI: 10.1186/s40814-018-0315-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/27/2018] [Indexed: 12/29/2022] Open
Abstract
Background The prevalence of common mental disorders increases in humanitarian emergencies while access to services to address them decreases. Problem Management Plus (PM+) is a brief five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies that can be delivered by non-specialist lay-providers under specialist supervision to adults impaired by distress. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the efficacy of individually delivered PM+. To make PM+ more scalable and acceptable in different contexts, it is important to develop a group version as well, with 6–8 participants in session. A study is needed to demonstrate the feasibility and acceptability of both the intervention in a new cultural context and the procedures to evaluate Group PM+ in a cluster randomized controlled trial. Methods This protocol describes a feasibility trial to Group PM+ in Sindhuli, Nepal. This study will evaluate procedures for a cluster randomized controlled trial (c-RCT) with Village Development Committees (VDCs), which are the second smallest unit of government administration, as the unit of randomization. Adults with high levels of psychological distress and functional impairment will receive either Group PM+ (n = 60) or enhanced usual care (EUC; n = 60). Psychological distress, functional impairment, depression symptoms, posttraumatic stress disorder (PTSD) symptoms, and perceived problems will be measured during screening, pre-treatment baseline, and 7–10 days after the intervention. Qualitative data will be collected from beneficiaries, their families, local stakeholders, and staff to support quantitative data and to identify themes reporting that those involved and/or effected by Group PM+ perceived it as being acceptable, feasible, and useful. The primary objective of this trial is to evaluate the acceptability and feasibility of the intervention; to identify issues around implementation of local adaptation methods, training, supervision, and outcomes measures; and to assure that procedures are adequate for a subsequent effectiveness c-RCT. Discussion Outcomes from this trial will contribute to optimizing feasibility and acceptability through cultural adaptation and contextualization of the intervention as well as refining the design for a c-RCT, which will evaluate the effectiveness of Group PM+ in Nepal. Trial registration ClinicalTrials.gov identifier: NCT03359486
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Affiliation(s)
- Manaswi Sangraula
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Edith Van't Hof
- 2Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Elizabeth L Turner
- 3Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, USA
| | - Kedar Marahatta
- World Health Organization, Country Office for Nepal, Kathmandu, Nepal
| | - Jolene H Nakao
- 5Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA USA.,6Office of U.S. Foreign Disaster Assistance (OFDA), United States Agency for International Development (USAID), Washington, DC USA
| | - Mark van Ommeren
- 2Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark J D Jordans
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal.,7Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Brandon A Kohrt
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal.,8Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC USA
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Purgato M, Gastaldon C, Papola D, van Ommeren M, Barbui C, Tol WA. Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2018; 7:CD011849. [PMID: 29975811 PMCID: PMC6513488 DOI: 10.1002/14651858.cd011849.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND People living in humanitarian settings in low- and middle-income countries (LMICs) are exposed to a constellation of stressors that make them vulnerable to developing mental disorders. Mental disorders with a higher prevalence in these settings include post-traumatic stress disorder (PTSD) and major depressive, anxiety, somatoform (e.g. medically unexplained physical symptoms (MUPS)), and related disorders. A range of psychological therapies are used to manage symptoms of mental disorders in this population. OBJECTIVES To compare the effectiveness and acceptability of psychological therapies versus control conditions (wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at treating people with mental disorders (PTSD and major depressive, anxiety, somatoform, and related disorders) living in LMICs affected by humanitarian crises. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (Wiley), MEDLINE (OVID), Embase (OVID), and PsycINFO (OVID), with results incorporated from searches to 3 February 2016. We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov to identify any unpublished or ongoing studies. We checked the reference lists of relevant studies and reviews. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing psychological therapies versus control conditions (including no treatment, usual care, wait list, attention placebo, and psychological placebo) to treat adults and children with mental disorders living in LMICs affected by humanitarian crises. DATA COLLECTION AND ANALYSIS We used standard Cochrane procedures for collecting data and evaluating risk of bias. We calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random-effects model. We analysed data at endpoint (zero to four weeks after therapy); at medium term (one to four months after therapy); and at long term (six months or longer). GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence for post-traumatic stress disorder (PTSD), depression, anxiety and withdrawal outcomes. MAIN RESULTS We included 36 studies (33 RCTs) with a total of 3523 participants. Included studies were conducted in sub-Saharan Africa, the Middle East and North Africa, and Asia. Studies were implemented in response to armed conflicts; disasters triggered by natural hazards; and other types of humanitarian crises. Together, the 33 RCTs compared eight psychological treatments against a control comparator.Four studies included children and adolescents between 5 and 18 years of age. Three studies included mixed populations (two studies included participants between 12 and 25 years of age, and one study included participants between 16 and 65 years of age). Remaining studies included adult populations (18 years of age or older).Included trials compared a psychological therapy versus a control intervention (wait list in most studies; no treatment; treatment as usual). Psychological therapies were categorised mainly as cognitive-behavioural therapy (CBT) in 23 comparisons (including seven comparisons focused on narrative exposure therapy (NET), two focused on common elements treatment approach (CETA), and one focused on brief behavioural activation treatment (BA)); eye movement desensitisation and reprocessing (EMDR) in two comparisons; interpersonal psychotherapy (IPT) in three comparisons; thought field therapy (TFT) in three comparisons; and trauma or general supportive counselling in two comparisons. Although interventions were described under these categories, several psychotherapeutic elements were common to a range of therapies (i.e. psychoeducation, coping skills).In adults, psychological therapies may substantially reduce endpoint PTSD symptoms compared to control conditions (standardised mean difference (SMD) -1.07, 95% confidence interval (CI) -1.34 to -0.79; 1272 participants; 16 studies; low-quality evidence). The effect is smaller at one to four months (SMD -0.49, 95% CI -0.68 to -0.31; 1660 participants; 18 studies) and at six months (SMD -0.37, 95% CI -0.61 to -0.14; 400 participants; five studies). Psychological therapies may also substantially reduce endpoint depression symptoms compared to control conditions (SMD -0.86, 95% CI -1.06 to -0.67; 1254 participants; 14 studies; low-quality evidence). Similar to PTSD symptoms, follow-up data at one to four months showed a smaller effect on depression (SMD -0.42, 95% CI -0.63 to -0.21; 1386 participants; 16 studies). Psychological therapies may moderately reduce anxiety at endpoint (SMD -0.74, 95% CI -0.98 to -0.49; 694 participants; five studies; low-quality evidence) and at one to four months' follow-up after treatment (SMD -0.53, 95% CI -0.66 to -0.39; 969 participants; seven studies). Dropout rates are probably similar between study conditions (19.5% with control versus 19.1% with psychological therapy (RR 0.98 95% CI 0.82 to 1.16; 2930 participants; 23 studies, moderate quality evidence)).In children and adolescents, we found very low quality evidence for lower endpoint PTSD symptoms scores in psychotherapy conditions (CBT) compared to control conditions, although the confidence interval is wide (SMD -1.56, 95% CI -3.13 to 0.01; 130 participants; three studies;). No RCTs provided data on major depression or anxiety in children. The effect on withdrawal was uncertain (RR 1.87 95% CI 0.47 to 7.47; 138 participants; 3 studies, low quality evidence).We did not identify any studies that evaluated psychological treatments on (symptoms of) somatoform disorders or MUPS in LMIC humanitarian settings. AUTHORS' CONCLUSIONS There is low quality evidence that psychological therapies have large or moderate effects in reducing PTSD, depressive, and anxiety symptoms in adults living in humanitarian settings in LMICs. By one to four month and six month follow-up assessments treatment effects were smaller. Fewer trials were focused on children and adolescents and they provide very low quality evidence of a beneficial effect of psychological therapies in reducing PTSD symptoms at endpoint. Confidence in these findings is influenced by the risk of bias in the studies and by substantial levels of heterogeneity. More research evidence is needed, particularly for children and adolescents over longer periods of follow-up.
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Affiliation(s)
- Marianna Purgato
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Chiara Gastaldon
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Davide Papola
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Mark van Ommeren
- World Health OrganizationDepartment of Mental Health and Substance AbuseAvenue AppiaGenevaSwitzerlandCH‐1211
| | - Corrado Barbui
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public HealthDepartment of Mental Health624 N BroadwayHampton HouseBaltimoreMarylandUSA
- HealthRight InternationalPeter C. Alderman Program for Global Mental HealthNew YorkUSA
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Tol WA, Augustinavicius J, Carswell K, Leku MR, Adaku A, Brown FL, García‐Moreno C, Ventevogel P, White RG, Kogan CS, Bryant R, van Ommeren M. Feasibility of a guided self-help intervention to reduce psychological distress in South Sudanese refugee women in Uganda. World Psychiatry 2018; 17:234-235. [PMID: 29856552 PMCID: PMC5980508 DOI: 10.1002/wps.20537] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Wietse A. Tol
- Peter C. Alderman FoundationUganda,Johns Hopkins UniversityBaltimoreMDUSA
| | | | | | | | | | - Felicity L. Brown
- War Child HollandAmsterdamThe Netherlands,Harvard School of Public HealthBostonMAUSA
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