Effectiveness of self-help plus in preventing mental disorders in refugees and asylum seekers in Western Europe: A multinational randomized controlled trial

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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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Citation:

Purgato, M., Carswell, K., Tedeschi, F., Acarturk, C., Anttila, M., Au, T., … & Barbui, C. (2021). Effectiveness of self-help plus in preventing mental disorders in refugees and asylum seekers in Western Europe: A multinational randomized controlled trial. Psychotherapy and Psychosomatics, 90(6), 403-414.

About This Study:

Outcome(s): General Distress Reduction
Intervention(s): Self-help Plus
Intervention Duration: 5 sessions
Relevant ORR Program: Refugee Health Promotion, Refugee Support Services, Targeted Assistance Grant Discretionary Program, Wilson/Fish
Direction of Evidence: Inconclusive or mixed impact
Strength of Evidence: Moderate
Population(s): Refugees
Gender(s) of Participants: All
Age(s) of Participants: Adults
Region(s) of Origin of Participants: Multiple Regions