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.
Bibliographical noteFunding 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.
Copyright 2021 Elsevier B.V., All rights reserved.
- Asylum seekers
- Psychological stress
- Psychological trauma
- Psychological well-being
- Randomized controlled trial
- Self-Help Plus
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Supplementary Material for: Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial
Barbui, C. (Contributor), Tedeschi, F. (Contributor), Nos?, M. (Contributor), Popa, M. (Contributor), Bajbouj, M. (Contributor), Van Ommeren, M. (Contributor), Roselli, V. (Contributor), V?lim?ki, M. (Contributor), White, R. (Contributor), Papola, D. (Contributor), Purgato, M. (Contributor), Cuijpers, P. (Contributor), Ostuzzi, G. (Contributor), Koesters, M. (Contributor), Churchill, R. (Contributor), Tarsitani, L. (Contributor), Biondi, M. (Contributor), Acarturk, C. (Contributor), Gastaldon, C. (Contributor), Ilkkursun, Z. (Contributor), Walker, L. (Contributor), Anttila, M. (Contributor), Wancata, J. (Contributor), Au, T. (Contributor), Baumgartner, J. (Contributor), Zanini, E. (Contributor), Carswell, K. (Contributor), Lantta, T. (Contributor), Turrini, G. (Contributor) & Sijbrandij, M. (Contributor), figshare Academic Research System, 1 Jan 2021