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 Moergeli; A-La Park; Bayard Roberts; Peter Ventevogel; Nana Wiedemann; Aniek Woodward; Marit Sijbrandij

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 Moergeli

A-La Park, Bayard Roberts, Peter Ventevogel, Nana Wiedemann, Aniek Woodward, Marit Sijbrandij

Research output: Contribution to Journal › Article › Academic › peer-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 language	English
Pages (from-to)	1-10
Number of pages	10
Journal	BMJ Mental Health
Volume	16
Issue number	1
Early online date	8 Feb 2023
Publication status	Published - Jul 2023

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de Graaff, A., Cuijpers, P., Twisk, J. W. R., Kieft, B., Hunaidy, S., Elsawy, M., Gorgis, N., Bouman, T., Lommen, M., Acarturk, C., Bryant, R., Burchert, S., Dawson, K., Fuhr, D. C., Hansen, P., Jordans, M. J. D., Knaevelsrud, C., McDaid, D., Morina, N., ... Sijbrandij, M. (2023). Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus. BMJ Mental Health, 16(1), 1-10. https://mentalhealth.bmj.com/content/26/1/e300637

@article{40f33507e69e4e8089970adc40564168,

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

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{\textquoteright}s d=0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen{\textquoteright}s d=0.42), anxiety (p=0.001, Cohen{\textquoteright}s d=0.27), PTSD symptoms (p=0.0005, Cohen{\textquoteright}s d=0.39) and self-identified problems (p=0.03, Cohen{\textquoteright}s d=0.26), but not on impairment (p=0.084, Cohen{\textquoteright}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.",

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

year = "2023",

month = jul,

language = "English",

volume = "16",

pages = "1--10",

journal = "BMJ Mental Health",

issn = "2755-9734",

publisher = "BMJ Publishing Group",

number = "1",

}

de Graaff, A, Cuijpers, P, Twisk, JWR, Kieft, B, Hunaidy, S, Elsawy, M, Gorgis, N, Bouman, T, Lommen, M, Acarturk, C, Bryant, R, Burchert, S, Dawson, K, Fuhr, DC, Hansen, P, Jordans, MJD, Knaevelsrud, C, McDaid, D, Morina, N, Moergeli, H, Park, A-L, Roberts, B, Ventevogel, P, Wiedemann, N, Woodward, A & Sijbrandij, M 2023, 'Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus', BMJ Mental Health, vol. 16, no. 1, pp. 1-10. <https://mentalhealth.bmj.com/content/26/1/e300637>

TY - JOUR

T1 - Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus

AU - de Graaff, Anne

AU - Cuijpers, Pim

AU - Twisk, Jos W.R.

AU - Kieft, Barbara

AU - Hunaidy, Sam

AU - Elsawy, Mariam

AU - Gorgis, Noer

AU - Bouman, Theo

AU - Lommen, Miriam

AU - Acarturk, Ceren

AU - Bryant, Richard

AU - Burchert, Sebastian

AU - Dawson, Katie

AU - Fuhr, Daniela C.

AU - Hansen, Pernille

AU - Jordans, Mark J D

AU - Knaevelsrud, Christine

AU - McDaid, David

AU - Morina, Naser

AU - Moergeli, Hanspeter

AU - Park, A-La

AU - Roberts, Bayard

AU - Ventevogel, Peter

AU - Wiedemann, Nana

AU - Woodward, Aniek

AU - Sijbrandij, Marit

PY - 2023/7

Y1 - 2023/7

N2 - 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.

AB - 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.

M3 - Article

SN - 2755-9734

VL - 16

SP - 1

EP - 10

JO - BMJ Mental Health

JF - BMJ Mental Health

IS - 1

ER -

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

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