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. 2022 Apr 20;12(4):e058101.
doi: 10.1136/bmjopen-2021-058101.

Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis

Anne M de Graaff  1 , Pim Cuijpers  2 , Ceren Acarturk  3 , Aemal Akhtar  4 , Mhd Salem Alkneme  5 , May Aoun  6 , Manar Awwad  7 , Ahmad Y Bawaneh  7 , Felicity L Brown  6   8 , Richard Bryant  4 , Sebastian Burchert  5 , Kenneth Carswell  9 , Annelieke Drogendijk  10 , Michelle Engels  11 , Daniela C Fuhr  12 , Pernille Hansen  11 , Edith van 't Hof  9 , Luana Giardinelli  7 , Mahmoud Hemmo  13 , Jonas M Hessling  5 , Zeynep Ilkkursun  3 , Mark J D Jordans  6   8 , Nikolai Kiselev  13 , Christine Knaevelsrud  5 , Gülsah Kurt  3 , Saara Martinmäki  10 , David McDaid  14 , Naser Morina  13 , Hadeel Naser  7 , A-La Park  14 , Monique C Pfaltz  13   15 , Bayard Roberts  12 , Matthis Schick  13 , Ulrich Schnyder  13 , Julia Spaaij  13 , Frederik Steen  6 , Karine Taha  6 , Ersin Uygun  16 , Peter Ventevogel  17 , Claire Whitney  7 , Anke B Witteveen  2 , Marit Sijbrandij  2 ; STRENGTHS consortium
Collaborators, Affiliations

Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis

Anne M de Graaff et al. BMJ Open. .

Abstract

Introduction: The World Health Organization's (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees.

Methods and analysis: Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list.

Ethics and dissemination: Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals.

Keywords: Anxiety disorders; Depression & mood disorders; MENTAL HEALTH.

PubMed Disclaimer

Conflict of interest statement

Competing interests: DM: Payment to institution for advice (not related to the interventions evaluated in STRENGTHS) given to the British Association for Counselling and Psychotherapy in January 2022.

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