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

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 RoselliMarit Sijbrandij, Lorenzo Tarsitani, Giulia Turrini, Maritta Välimäki, Lauren Walker, Johannes Wancata, Elisa Zanini, Ross White, Mark Van Ommeren, Corrado Barbui

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	403-414
Number of pages	12
Journal	Psychotherapy and Psychosomatics
Volume	90
Issue number	6
Early online date	20 Jul 2021
DOIs	https://doi.org/10.1159/000517504
Publication status	Published - 1 Oct 2021

Bibliographical note

© 2021 The Author(s)
Funding Information:
This work was supported by the European Commission (grant agreement No. 779255; “RE-DEFINE: Refugee Emergency: DEFining and Implementing Novel Evidence-based psychosocial interventions”). The authors are grateful to peer facilitators and cofacilitators, who delivered the SH+ intervention, and to all of the assessors who administered baseline and follow-up interviews. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Keywords

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

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Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial
© 2021 The Author(s)
Final published version, 304 KBLicence: CC BY-NC

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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., ... 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. https://doi.org/10.1159/000517504

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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.",

keywords = "Adult, Asylum seekers, Psychological stress, Psychological trauma, Psychological well-being, Randomized controlled trial, Refugees, Self-Help Plus",

author = "Marianna Purgato and Kenneth Carswell and Federico Tedeschi and Ceren Acarturk and Minna Anttila and Teresa Au and Malek Bajbouj and Josef Baumgartner and Massimo Biondi and Rachel Churchill and Pim Cuijpers and Markus Koesters and Chiara Gastaldon and Zeynep Ilkkursun and Tella Lantta and Michela Nos{\`e} and Giovanni Ostuzzi and Davide Papola and Mariana Popa and Valentina Roselli and Marit Sijbrandij and Lorenzo Tarsitani and Giulia Turrini and Maritta V{\"a}lim{\"a}ki and Lauren Walker and Johannes Wancata and Elisa Zanini and Ross White and {Van Ommeren}, Mark and Corrado Barbui",

note = "{\textcopyright} 2021 The Author(s) Funding Information: This work was supported by the European Commission (grant agreement No. 779255; “RE-DEFINE: Refugee Emergency: DEFining and Implementing Novel Evidence-based psychosocial interventions”). The authors are grateful to peer facilitators and cofacilitators, who delivered the SH+ intervention, and to all of the assessors who administered baseline and follow-up interviews. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. ",

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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 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, vol. 90, no. 6, pp. 403-414. https://doi.org/10.1159/000517504

TY - JOUR

T1 - Effectiveness of Self-Help plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe

T2 - A Multinational Randomized Controlled Trial

AU - Purgato, Marianna

AU - Carswell, Kenneth

AU - Tedeschi, Federico

AU - Acarturk, Ceren

AU - Anttila, Minna

AU - Au, Teresa

AU - Bajbouj, Malek

AU - Baumgartner, Josef

AU - Biondi, Massimo

AU - Churchill, Rachel

AU - Cuijpers, Pim

AU - Koesters, Markus

AU - Gastaldon, Chiara

AU - Ilkkursun, Zeynep

AU - Lantta, Tella

AU - Nosè, Michela

AU - Ostuzzi, Giovanni

AU - Papola, Davide

AU - Popa, Mariana

AU - Roselli, Valentina

AU - Sijbrandij, Marit

AU - Tarsitani, Lorenzo

AU - Turrini, Giulia

AU - Välimäki, Maritta

AU - Walker, Lauren

AU - Wancata, Johannes

AU - Zanini, Elisa

AU - White, Ross

AU - Van Ommeren, Mark

AU - Barbui, Corrado

N1 - © 2021 The Author(s) Funding Information: This work was supported by the European Commission (grant agreement No. 779255; “RE-DEFINE: Refugee Emergency: DEFining and Implementing Novel Evidence-based psychosocial interventions”). The authors are grateful to peer facilitators and cofacilitators, who delivered the SH+ intervention, and to all of the assessors who administered baseline and follow-up interviews. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

PY - 2021/10/1

Y1 - 2021/10/1

N2 - 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.

AB - 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.

KW - Adult

KW - Asylum seekers

KW - Psychological stress

KW - Psychological trauma

KW - Psychological well-being

KW - Randomized controlled trial

KW - Refugees

KW - Self-Help Plus

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U2 - 10.1159/000517504

DO - 10.1159/000517504

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AN - SCOPUS:85111565463

SN - 0033-3190

VL - 90

SP - 403

EP - 414

JO - Psychotherapy and Psychosomatics

JF - Psychotherapy and Psychosomatics

IS - 6

ER -

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

Abstract

Bibliographical note

Keywords

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