Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial

Marianna Purgato; Kenneth Carswell; Federico Tedeschi; Ceren Acarturk; Minna Anttila; Teresa Au; Malek Bajbouj; Josef Baumgartner; Massimo Biondi; Rachel Churchill; Pim Cuijpers; Markus Koesters; Chiara Gastaldon; Zeynep Ilkkursun; Tella Lantta; Michela Nosè; Giovanni Ostuzzi; Davide Papola; Mariana Popa; Valentina Roselli; Marit Sijbrandij; Lorenzo Tarsitani; Giulia Turrini; Maritta Välimäki; Lauren Walker; Johannes Wancata; Elisa Zanini; Ross White; Mark van Ommeren; Corrado Barbui

doi:10.1159/000517504

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(6):403-414. doi: 10.1159/000517504. Epub 2021 Jul 20.

Authors

Marianna Purgato^{1

2}, Kenneth Carswell³, Federico Tedeschi¹, Ceren Acarturk⁴, Minna Anttila⁵, Teresa Au³, Malek Bajbouj⁶, Josef Baumgartner⁷, Massimo Biondi⁸, Rachel Churchill⁹, Pim Cuijpers^{10

11}, Markus Koesters¹², Chiara Gastaldon^{1

2}, Zeynep Ilkkursun⁴, Tella Lantta⁵, Michela Nosè^{1

2}, Giovanni Ostuzzi^{1

2}, Davide Papola^{1

2}, Mariana Popa¹³, Valentina Roselli⁸, Marit Sijbrandij^{10

11}, Lorenzo Tarsitani⁸, Giulia Turrini^{1

2}, Maritta Välimäki⁵, Lauren Walker¹⁴, Johannes Wancata⁷, Elisa Zanini¹, Ross White¹³, Mark van Ommeren³, Corrado Barbui^{1

2}

Affiliations

¹ 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.
² Cochrane Global Mental Health, University of Verona, Verona, Italy.
³ Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
⁴ Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey.
⁵ Department of Nursing Science, University of Turku, Turku, Finland.
⁶ Department of Psychiatry, Campus Benjamin Franklin, Charité, Universitätsmedizin, Berlin, Germany.
⁷ Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
⁸ Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
⁹ Centre for Review and Dissemination, University of York, York, UK.
¹⁰ Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹¹ WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹² Department of Psychiatry II, Ulm University, Ulm, Germany.
¹³ Institute of Population Health, University of Liverpool, Liverpool, UK.
¹⁴ Mental Health and Addiction Research Group, University of York, York, UK.

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.

Keywords: Adult; Asylum seekers; Psychological stress; Psychological trauma; Psychological well-being; Randomized controlled trial; Refugees; Self-Help Plus.

Publication types

Randomized Controlled Trial

MeSH terms

Europe
Humans
Mental Disorders* / therapy
Psychological Distress*
Refugees*
Stress Disorders, Post-Traumatic*

Grants and funding

001/WHO_/World Health Organization/International