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 journalArticlepeer-review


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 languageEnglish
Pages (from-to)403-414
Number of pages12
JournalPsychotherapy and Psychosomatics
Issue number6
Early online date20 Jul 2021
Publication statusPublished - 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.


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

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