Background: Afghan refugees often face hardship and traumatic experiences before, during, and after migration and frequently suffer from mental health burdens. Evidence based psychological treatments for refugees mostly focus on symptoms of posttraumatic stress disorder (PTSD), however, refugees often suffer from a variety of general health problems as well as depression and anxiety. We thus aimed to evaluate the effectiveness of a transdiagnostic psychological intervention. Objective: To investigate the effectiveness of an adapted version of Problem Management Plus (aPM+) delivered by mental health professionals to adult Afghan refugees and asylum seekers. Methods: We randomly allocated 88 Afghan refugees either to aPM+ in addition to treatment as usual (aPM+/TAU) or TAU alone. APM+ comprises of six weekly 90-minute individual sessions including strategies of stress management, problem solving, behavioural activation, strengthening social support and either anger regulation or increasing self-efficacy. The primary outcome was general health (GHQ-28) post intervention. Secondary outcome measures included distress by PMLD, Complex PTSD symptoms, quality of life, self-identified problems, and integration. Results: Attrition was high: 42% of the randomized participants did not participate in the post-treatment assessment. A repeated measures per-protocol (completers only) ANCOVA evidenced a significant group × timepoint interaction for GHQ total scores [F(1, 47) =  14.80, p < .001, partial η 2 = 0.24]. Post-hoc analyses showed significantly lower symptoms in the aPM+/TAU arm ( n = 26) as compared to the TAU arm ( n = 25) for the GHQ total scores ( d z = 1.04). Most secondary outcomes significantly improved in the aPM+/TAU arm, but not in the TAU arm. Conclusion: APM+ was effective in reducing general health problems in Afghan refugees and might be considered as a first-line intervention. High drop-out rate limit the interpretations of our results, where future investigations should focus on possibilities to reduce these rates. Trial registration: . HIGHLIGHTS Refugees’ mental health can be strengthened with a brief psychological intervention that also focuses on skills in the context of post-migration stressors. High drop-out rates are a major challenge for future research and delivery of psychological interventions as part of health care systems to refugees and asylum seekers.

Background: The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare. Objective: This qualitative study aimed to explore self-perceived challenges and opportunities related to COVID-19 across six European countries. The overall objective was to provide a differentiated picture of individual subjective experiences in the early stages of the pandemic. Method: The present study included 7309 participants from Austria, Croatia, Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis according to Mayring analyse open-ended questions regarding stressful events, positive and negative aspects of the pandemic, and recommendations to cope with the pandemic situation. MAXQDA software was used for data management and analysis. Results: Participants’ accounts were moderately consistent across the countries. The most prominent themes regarding stressful and negative pandemic aspects included: Restrictions and changes in daily life , Emotional distress , and Work and finances. Answers about positive pandemic consequences were mainly centred around the themes Reflection and growth , Opportunity for meaningful/enjoyable activities , and Benefits on interpersonal level . Key themes identified from participants’ recommendations to cope with the pandemic included Beneficial behavioural adjustment , Beneficial cognitive–emotional strategies , and Social support . Conclusions: Participants experienced various challenges, but also shared several positive pandemic consequences and recommendations to cope with the pandemic. These first-hand data could inform mental health practices to promote well-being during COVID-19 and similar global challenges in the participating countries and possibly beyond. HIGHLIGHTS We examined COVID-19-related experiences in 7309 adults from six European countries. Besides challenges, participants identified many positive pandemic consequences. Participants’ recommendations to cope with COVID-19 included behavioural and cognitive–emotional strategies.

Integrating indigenous cultural knowledge into conceptualizing mental illness offers highly valuable insights to better contextualize mental health. The meaning given to symptoms determines what is abnormal and requiring treatment. In Uganda, the formal health care system is neither the only nor the most widespread treatment provider. Help is often sought from traditional and religious healers, too. Despite numerous calls for cooperation between the healing systems, this has translated into reality only to a very limited degree. The purpose of this study was to gain insight into local explanatory models of mental illness, to gain an understanding of the different patients’ needs, and to develop a more comprehensive system of care. We used an ethnographic investigation approach, which allowed for a more holistic view of the research field. This was geographically delimited to the West Nile subregion in Northern Uganda. We conducted a total of 56 semistructured interviews with traditional healers (n = 5), Christian religious healers (n = 3), psychiatric patients (n = 16), their attendants (n = 16), and community members (n = 16). In addition, we used the method of participant observation. The data collected were analyzed using Qualitative Content Analysis and Grounded Theory methodology. For the purpose of this article, we exclusively extracted the spiritual explanatory models. These were spirit possession and curse. Both were traditional concepts with a religious reinterpretation involving the action of spirits.

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Background: While many elaborated treatment protocols focus on post-traumatic stress symptoms, a large number of refugees suffer from a range of mental health problems. Thus, brief and transdiagnostic psychological interventions may be helpful first interventions for help-seeking refugees and asylum seekers in a stepped-care approach. Critically, there is limited research on how transdiagnostic interventions are received in general practice in non-specialized mental healthcare settings in high-income countries, where often only mental health professionals (MHPs) are legally allowed to treat people with mental disorders. MHPs may thus deliver such interventions, but their perspective towards them has not yet been investigated. Objective: We aimed to investigate MHPs’ perception of the usability of adapted Problem Management Plus (aPM+), a brief transdiagnostic psychological intervention for refugees, which we adapted to address distress caused by post-migration living difficulties (PMLDs). Method: Employing an e-learning tool, we introduced the aPM+ intervention to 59 MHPs and assessed their perspective towards the intervention. We then used an inductive approach to analyse their perspective towards the intervention with open-ended questions. Results: Altogether, 59 MHPs enrolled in the webinar and 29 provided feedback on the intervention. MHPs had a positive view on the intervention but emphasized the importance of situation-specific adaptations to the structure of the manual. The most favoured specific strategies were ‘managing stress/slow-breathing’, the ‘tree of capabilities’, and the ‘riding the anger’ exercise. The last two were additionally developed to reduce distress caused by PMLDs by either enhancing self-efficacy or reducing anger regulation difficulties. Conclusions: An adaptation to aPM+ regarding more flexibility of the manual may enhance the likelihood of MHPs implementing the intervention in their daily practice. Strategies addressing coping with PMLDs could be particularly helpful. Trial registration: . HIGHLIGHTS Mental health professionals had a positive view on a brief transdiagnostic psychological intervention for refugees but emphasized the importance of situation-specific adaptations to the structure of the manual. Low -intensity interventions may be useful not only in low- and middle-income countries but also in high-income countries as part of a stepped-care approach, even if distributed by MHPs instead of trained laypersons.

Background: This study examined Afghan asylum seekers and refugees’ experiences treated with an adapted version of the brief psychological intervention Problem Management Plus (aPM+) and explored which problems trouble them most, and how these problems influence their daily functioning. It further examined how various standardized outcome measures correlate with these subjectively perceived problems. Method: This study is part of a larger research project (PIAAS study) and uses a multi-method approach consisting of two parts. First, it investigated the participants’ self-identified problems and subjective functional impairment with quantitative and an qualitative assessments within the treatment and control group (n=88). Second, we conducted qualitative in-depth interviews to gain a deeper understanding of personal experiences with aPM+ as well as suggestions for improvement with a subsample of the treatment group (n=24). Spearman correlations were applied for quantitative data and for qualitative data deductive and inductive approaches of thematic analysis were used. Results: We identified six main themes of self-perceived problems (post migration living difficulties, general mental problems, interpersonal stressors, mental problems specifically associated with stress, and somatic problems) and their consequences as well as subjective functional impairment. Standardized measures of general mental health, posttraumatic psychopathology, and quality of life did not correlate with the perceived intensity of the self-perceived problems. aPM+ was perceived mostly positively and few participants had recommendations for its improvement. Conclusion: The study aimed at giving a voice to Afghan trauma survivors to inform service providers and policy makers about their needs. Further, it includes their expertise to tailored interventions for their actual needs and its practical use. APM+ shows to be a positively perceived intervention that reduces subjective symptom burden and facilitate daily functioning. Thus, culture-sensitive treatments should be facilitated within (mental) health services to increase service use and (mental) health in a long run.