Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis

Eirini Karyotaki*, Marit Sijbrandij, Marianna Purgato, Ceren Acarturk, Daniel Lakin, Della Bailey, Emily Peckham, Ersin Uygun, Federico Tedeschi, Johannes Wancata, Jura Augustinavicius, Kenneth Carswell, Maritta Välimäki, Mark Van Ommeren, Markus Koesters, Mariana Popa, Marx Ronald Leku, Minna Anttila, Rachel Churchill, Ross G. WhiteSarah Al-Hashimi, Tella Lantta, Teresa Au, Thomas Klein, Wietse A. Tol, Pim Cuijpers, Corrado Barbui

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Question Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers. Study selection and analysis Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm). Findings There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90). Conclusions Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.

Original languageEnglish
Article numbere300672
Number of pages8
JournalBMJ Mental Health
Volume26
Issue number1
DOIs
Publication statusPublished - 31 Jul 2023

Bibliographical note

© Author(s) (or their employer(s)) 2023.

Keywords

  • Adult psychiatry
  • Depression & mood disorders

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