Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Feb;26(1):e300637.
doi: 10.1136/bmjment-2022-300637. Epub 2023 Feb 8.

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

Anne M de Graaff  1 , Pim Cuijpers  2   3 , Jos W R Twisk  4 , Barbara Kieft  5 , Sam Hunaidy  2 , Mariam Elsawy  2 , Noer Gorgis  6 , Theo K Bouman  7 , Miriam J J Lommen  7 , Ceren Acarturk  8 , Richard Bryant  9 , Sebastian Burchert  10 , Katie S Dawson  9 , Daniela C Fuhr  11   12   13 , Pernille Hansen  14 , Mark Jordans  15   16 , Christine Knaevelsrud  10 , David McDaid  17 , Naser Morina  18 , Hanspeter Moergeli  18 , A-La Park  17 , Bayard Roberts  11 , Peter Ventevogel  19 , Nana Wiedemann  14 , Aniek Woodward  20 , Marit Sijbrandij  2 ; STRENGTHS Consortium; STRENGTHS consortium
Collaborators, Affiliations
Randomized Controlled Trial

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

Anne M de Graaff et al. BMJ Ment Health. 2023 Feb.

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.

Keywords: Adult psychiatry; Anxiety disorders; Depression & mood disorders.

PubMed Disclaimer

Conflict of interest statement

Competing interests: MS is the president of the International Society of Traumatic Stress Studies (unpaid) and provided a keynote lecture for the Dutch Organisation of Psychiatry (ECAP) (paid).

Figures

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

References

    1. UNHCR . Global trends forced displacement in 2021. 2022. Available: https://www.unhcr.org/62a9d1494/global-trends-report-2021 [Accessed 4 Aug 2022].
    1. Acarturk C, McGrath M, Roberts B, et al. Prevalence and predictors of common mental disorders among syrian refugees in istanbul, turkey: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2021;56:475–84. 10.1007/s00127-020-01941-6 - DOI - PubMed
    1. Schick M, Zumwald A, Knöpfli B, et al. Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees. Eur J Psychotraumatol 2016;7:1–9. 10.3402/ejpt.v7.28057 - DOI - PMC - PubMed
    1. Drescher A, Kiselev N, Akhtar A, et al. Problems after flight: understanding and comparing syrians’ perspectives in the middle east and europe. BMC Public Health 2021;21. 10.1186/s12889-021-10498-1 - DOI - PMC - PubMed
    1. Patanè M, Ghane S, Karyotaki E, et al. Prevalence of mental disorders in refugees and asylum seekers: a systematic review and meta-analysis. Global Mental Health 2022;14:1–14. - PMC - PubMed

Publication types

LinkOut - more resources