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Acarturk C, Uygun E, Ilkkursun Z, Yurtbakan T, Kurt G, Adam-Troian J, Senay I, Bryant R, Cuijpers P, Kiselev N, McDaid D, Morina N, Nisanci Z, Park AL, Sijbrandij M, Ventevogel P, Fuhr DC. Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial. BMC Psychiatry 2022; 22:8. [PMID: 34983461 PMCID: PMC8728921 DOI: 10.1186/s12888-021-03645-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 05/06/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an effective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul, Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-effectiveness of the intervention. METHODS Refugees with psychological distress (Kessler Psychological Distress Scale, K10 > 15) and impaired psychosocial functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n = 24) or E-CAU only (n = 22). gPM+ comprised of five weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identified problems (Psychological Outcomes Profiles, PSYCHLOPS) were included as secondary outcomes. A modified version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. RESULTS There were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an effect. No significant difference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. CONCLUSIONS gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe intervention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03567083 ; date: 25/06/2018.
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Affiliation(s)
- C. Acarturk
- grid.15876.3d0000000106887552Department of Psychology, Koc University, Istanbul, Turkey
| | - E. Uygun
- grid.24956.3c0000 0001 0671 7131Trauma and Disaster, Mental Health, Bilgi University, Istanbul, Turkey
| | - Z. Ilkkursun
- grid.15876.3d0000000106887552Department of Psychology, Koc University, Istanbul, Turkey
| | - T. Yurtbakan
- grid.411781.a0000 0004 0471 9346Department of Psychology, Istanbul Medipol University, Istanbul, Turkey
| | - G. Kurt
- grid.15876.3d0000000106887552Department of Psychology, Koc University, Istanbul, Turkey
| | - J. Adam-Troian
- grid.411365.40000 0001 2218 0143Department of International Studies, American University of Sharjah, Sharjah, United Arab Emirates
| | - I. Senay
- grid.65862.3f0000 0004 0399 5103Department of Psychology, Istanbul Sehir University, Istanbul, Turkey
| | - R. Bryant
- grid.1005.40000 0004 4902 0432School of Psychology, University of New South Wales, Sydney, Australia
| | - P. Cuijpers
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - N. Kiselev
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D. McDaid
- grid.13063.370000 0001 0789 5319Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - N. Morina
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Z. Nisanci
- grid.16477.330000 0001 0668 8422Department of Applied Sociology, Marmara University, Istanbul, Turkey
| | - A. L. Park
- grid.13063.370000 0001 0789 5319Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - M. Sijbrandij
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - P. Ventevogel
- grid.475735.70000 0004 0404 6364United Nations High Commissioner for Refugees, Public Health Section, Genève, Switzerland
| | - D. C. Fuhr
- grid.8991.90000 0004 0425 469XDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Acarturk C, İlkkurşun Z, Yurtbakan T, Troian J, Uygun E. Group problem management plus for decreasing psychological distress in Syrian refugees in Turkey. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.627] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The crisis in Syria has caused millions of Syrians to seek refuge in neighboring countries and Europe. Refugees often experience war related traumatic events and other various adversities during war and flight. These traumatic events increase the risk for common mental health disorders such as depression, anxiety, posttraumatic stress disorder and related somatic symptoms compared to that of host populations. However, despite the high prevalence rates of mental health disorders, refugees' access to mental health services are low. As a public health priority, it is essential to address the mental health needs of refugees. The World Health Organization has developed evidence-based short psychosocial interventions to bridge this gap and Problem Management Plus (PM+) is one of them. PM+ is under investigation within the STRENGTHS project and in Turkey, which is a partner country to the project, the group version of the intervention has been implemented with Syrian refugees. This presentation will provide an overview of the pilot study in Turkey.
Methods
A randomized controlled trial with 46 Syrian refugees in a community sample was conducted. Participants with elevated levels of distress measured by Kessler 10 (K10 > 15) and self-reported functional impairment (WHODAS 2.0 > 16) were randomly allocated in a 1:1 ratio either to Group PM + (N= 24) or enhanced care as usual (E-CAU, N = 22).
Results
No adverse events were reported during the trial and assessments. There was no significant difference between control and experiment group with respect to anxiety (d = .14, p=.63), depression (d = .27, p=.36) and symptoms of posttraumatic stress disorder (d = .18, p=.55) at 3 months follow-up. The main trial will be conducted with a larger sample (N = 380) to detect any significant effect and provide more generalizable results.
Conclusions
The challenges of implementation of group PM+ in a community sample of Syrian refugees in Turkey will be discussed.
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Affiliation(s)
- C Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Z İlkkurşun
- Department of Psychology, Istanbul Sehir University, Istanbul, Turkey
| | - T Yurtbakan
- Department of Psychology, Istanbul Sehir University, Istanbul, Turkey
| | - J Troian
- Department of Psychology, Aix Marseille University, Marseille, France
| | - E Uygun
- Faculty of Health Sciences, Bilgi University, Istanbul, Turkey
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