BMJ Mental Health (Jun 2023)

Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus

  • Pim Cuijpers,
  • Jos W R Twisk,
  • Ceren Acarturk,
  • Martha Bird,
  • Zeynep Ilkkursun,
  • Marit Sijbrandij,
  • Bayard Roberts,
  • Richard Bryant,
  • Egbert Sondorp,
  • David McDaid,
  • Christine Knaevelsrud,
  • Mark Jordans,
  • A-La Park,
  • Aemal Akhtar,
  • Theo K Bouman,
  • Ulrich Schnyder,
  • Hanspeter Moergeli,
  • Sebastian Burchert,
  • Trudy Mooren,
  • Daniela Fuhr,
  • Peter Ventevogel,
  • Anne M de Graaff,
  • Annelieke Drogendijk,
  • Daniela C Fuhr,
  • Pernille Hansen,
  • Mahmoud Hemmo,
  • Nikolai Kiselev,
  • Gülsah Kurt,
  • Saara Martinmäki,
  • Naser Morina,
  • Matthis Schick,
  • Julia Spaaij,
  • Frederik Steen,
  • Karine Taha,
  • Claire Whitney,
  • Martine van den Dool,
  • Cansu Mirzanlı,
  • Nana Wiedemann,
  • Aniek Woodward,
  • Barbara Kieft,
  • Sam Hunaidy,
  • Mariam Elsawy,
  • Noer Gorgis,
  • Miriam J J Lommen,
  • Katie S Dawson,
  • Akinçi Ahmad Bawaneh,
  • Felicity Brown,
  • Anne de Graaff,
  • Jonas Maria Hessling,
  • Monique Pfaltz

DOI
https://doi.org/10.1136/bmjment-2022-300637
Journal volume & issue
Vol. 26, no. 1

Abstract

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Background The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited.Objective To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands.Methods We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019–December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat.Findings Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference −0.25; 95% CI −0.385 to −0.122; p=0.0001, Cohen’s d=0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen’s d=0.42), anxiety (p=0.001, Cohen’s d=0.27), PTSD symptoms (p=0.0005, Cohen’s d=0.39) and self-identified problems (p=0.03, Cohen’s d=0.26), but not on impairment (p=0.084, Cohen’s d=0.21).Conclusions PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit.Clinical implications Peer-provided psychological interventions should be considered for scale-up in HICs.