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Randomized Controlled Trial
. 2022 Jun 8:31:e39.
doi: 10.1017/S2045796022000269.

Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial

G Turrini  1   2 , M Purgato  1   2 , F Tedeschi  1 , C Acartürk  3 , M Anttila  4 , T Au  5 , K Carswell  5 , R Churchill  6 , P Cuijpers  7 , F Friedrich  8 , C Gastaldon  1   2 , T Klein  9 , M Kösters  9 , T Lantta  4 , M Nosè  1   2 , G Ostuzzi  1   2 , D Papola  1   2 , M Popa  10 , M Sijbrandij  7 , L Tarsitani  11 , L Todini  11 , E Uygun  12 , M Välimäki  4   13 , L Walker  14 , J Wancata  8 , R G White  15 , E Zanini  1 , M van Ommeren  5 , C Barbui  1   2
Affiliations
Randomized Controlled Trial

Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial

G Turrini et al. Epidemiol Psychiatr Sci. .

Abstract

Aims: As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe.

Methods: Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes.

Results: Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389-1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180-1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001).

Conclusions: The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.

Keywords: Prevention; psychosocial intervention; randomised controlled trial; refugees.

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Figures

Fig. 1.
Fig. 1.
CONSORT flow diagram.
Fig. 2.
Fig. 2.
Trend in the frequency of any mental disorders over time. SH + , Self-Help Plus; ETAU, Enhanced Treatment as Usual; PP, Per Protocol; ITT, Intention to Treat.
See this image and copyright information in PMC

References

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