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

Anne de Graaff, Pim Cuijpers, Jos W.R. Twisk, Barbara Kieft, Sam Hunaidy, Mariam Elsawy, Noer Gorgis, Theo Bouman, Miriam Lommen, Ceren Acarturk, Richard Bryant, Sebastian Burchert, Katie Dawson, Daniela C. Fuhr, Pernille Hansen, Mark J D Jordans, Christine Knaevelsrud, David McDaid, Naser Morina, Hanspeter MoergeliA-La Park, Bayard Roberts, Peter Ventevogel, Nana Wiedemann, Aniek Woodward, Marit Sijbrandij

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

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.
Original languageEnglish
JournalBMJ Mental Health
Publication statusPublished - 8 Feb 2023

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