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Randomized Controlled Trial
. 2022 Jan 31;13(1):2002027.
doi: 10.1080/20008198.2021.2002027. eCollection 2022.

Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial

Julia Spaaij  1 , Nikolai Kiselev  1 , Christine Berger  1 , Richard A Bryant  2 , Pim Cuijpers  3 , Anne M de Graaff  4 , Daniela C Fuhr  5 , Mahmoud Hemmo  1 , David McDaid  5 , Hanspeter Moergeli  1 , A-La Park  6 , Monique C Pfaltz  1   7 , Matthis Schick  1   7 , Ulrich Schnyder  1 , Anna Wenger  1 , Marit Sijbrandij  4 , Naser Morina  1   7
Affiliations
Randomized Controlled Trial

Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial

Julia Spaaij et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Syrian refugees in Switzerland face several barriers in accessing mental health care. Cost-effective psychological interventions are urgently needed to meet the mental health needs of refugees. Problem Management Plus (PM+) is an evidence-based, psychological intervention delivered by trained non-specialist 'helpers'.

Objective: To assess the feasibility and acceptability of PM+ among Syrian refugees in Switzerland.

Methods: We conducted a single-blind pilot randomized controlled trial (RCT) with Syrian refugees impaired by psychological distress (K10 > 15 and WHODAS 2.0 > 16). Participants were randomized to PM+ or Enhanced Treatment As Usual (ETAU). Participants were assessed at baseline, and 1 week and 3 months after the intervention, and completed measures indexing mental health problems and health care usage. Semi-structured interviews were conducted with different stakeholders.

Results: N = 59 individuals were randomized into PM+ (n = 31) or ETAU (n = 28). N = 18 stakeholders were interviewed about facilitators and barriers for the implementation of PM+. Retention rates in the trial (67.8%) and mean intervention attendance (M = 3.94 sessions, SD = 1.97) were high. No severe events related to the study were reported. These findings indicate that the trial procedures and PM+ were feasible, acceptable and safe.

Conclusions: The findings support the conduct of a definitive RCT and show that PM+ might have the potential to be scaled-up in Switzerland. The importance, as well as the challenges, of implementing and scaling-up PM+ in high-income countries, such as Switzerland, are discussed.

Antecedentes: Los refugiados Sirios en Suiza enfrentan varias barreras para acceder a la atención en salud mental. Se necesitan con urgencia intervenciones psicológicas costo-efectivas, para satisfacer las necesidades de salud mental de los refugiados. Enfrentar Problemas Plus (PM + por sus siglas en inglés) es una intervención psicológica basada en la evidencia proporcionada por ‘ayudantes’ capacitados no especializados.Objetivo: Evaluar la viabilidad y aceptabilidad de PM + entre los refugiados sirios en Suiza.Métodos: Realizamos un ensayo controlado aleatorizado (ECA) piloto simple y ciego con refugiados sirios afectados por angustia psicológica (K10 > 15 y WHODAS 2.0 > 16). Los participantes fueron asignados al azar a PM + o Tratamiento usual mejorado (TUM). Los participantes fueron evaluados al inicio del estudio, 1 semana, y 3 meses después de la intervención, y completaron instrumentos que referencian problemas de salud mental y el uso de la atención médica. Se realizaron entrevistas semiestructuradas con diferentes partes relevantes.Resultados:N = 59 individuos fueron asignados al azar a PM + (n = 31) o TUM (n = 28). N = 18 partes relevantes fueron entrevistados sobre facilitadores y barreras para la implementación de PM +. Las tasas de retención en el ensayo (67,8%) y la asistencia media a la intervención (M = 3,94 sesiones, DE = 1,97) fueron altas. No se informaron eventos graves relacionados con el estudio. Estos hallazgos indican que los procedimientos del ensayo y PM + fueron factibles, aceptables y seguros.Conclusiones: Los hallazgos apoyan la realización de un ECA definitivo y muestran que PM + podría tener el potencial de ampliarse en Suiza. Se discute la importancia, así como los desafíos, de implementar y ampliar PM + en países de altos ingresos, como Suiza.

背景: 在瑞士的叙利亚难民在获得精神卫生保健方面面临一些障碍。迫切需要具有成本效益的心理干预措施来满足难民的心理健康需求。问题管理 Plus (PM+) 是一种由经过培训的非专业‘帮手’提供的循证心理干预。目的: 在瑞士的叙利亚难民中评估 PM+ 的可行性和可接受性。方法: 我们对有心理困扰 (K10 > 15 和 WHODAS 2.0 > 16) 的叙利亚难民进行了一项单盲试点随机对照试验 (RCT)。参与者被随机分配到 PM+ 或强化照常治疗 (ETAU)。在基线, 干预后 1 周和 3 个月对参与者进行评估, 并完成指标化心理健康问题和医疗保健使用情况的测量。对不同利益相关者进行了半结构化访谈。结果: 59 个个体被随机分为 PM+ (n = 31) 或 ETAU (n = 28) 。18 个利益相关者接受了关于实施 PM+ 的促进因素和障碍的访谈。试验中的保留率 (67.8%) 和平均干预出席率 (M = 3.94 次, SD = 1.97) 很高。没有报告与研究相关的重大事件。这些发现表明试验程序和 PM+ 是可行的, 可接受的和安全的。结论: 研究结果支持选定 RCT的实施, 并表明 PM+ 可能有在瑞士扩大规模的潜力。讨论了在瑞士等高收入国家实施和拓展PM+ 的重要性和挑战。.

Keywords: Mental health; asylums seekers; feasibility; lay-provider; problem management plus; refugees; task-shifting.

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Conflict of interest statement

No potential conflict of interest was reported by the author (s).

Figures

Figure 1.
Figure 1.
CONSORT flow-diagram.
See this image and copyright information in PMC

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