A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: a randomized controlled trial

Abstract

Background: Asylum seekers and refugees are at great risk for developing mental disorders. Afghan refugees are a particularly vulnerable group with a low average education and mental health literacy level. Traumatic experiences and hardship before and during migration are predictive of mental health problems. However, post-migration living difficulties (PMLDs) also account for a large proportion of mental distress in such populations, which, critically, are not sufficiently considered in treatment protocols and research investigations. Indeed, the evidence base for the treatment of refugees and asylum seekers is sparse and limited mainly to trauma-specific treatments, where refugees may likely suffer from other mental health problems such as depression or anxiety. Methods/design: This trial is the first evaluation of a short-term, transdiagnostic treatment protocol for treatmentseeking Afghan refugees which addresses mental health problems and PMLDs while using an adapted version of the Problem Management Plus (PM+) protocol. Here, we will investigate the efficacy of an intervention manual with a prospective, single-center, randomized, assessor-blind, two-group trial among refugees who are on a waiting list for professional mental health treatment. Furthermore, we will investigate participants' subjective experiences with the intervention manual via in-depth interviews. One hundred twenty people will be assessed and randomly allocated to either the intervention arm or a treatment-as-usual arm. Clinical psychologists will conduct the treatment, and the sessions will take place with a Dari interpreter. The protocol consists of six 90-min sessions. The primary endpoint is the general symptom distress measure, assessed with the General Health Questionnaire 28 (GHQ-28). Secondary endpoints are the Post-Migration Living Difficulties Checklist (PMLDC), the International Trauma Questionnaire (ITQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), the Psychological Outcome Profile (PSYCHLOPS), service and health care use (assessed with several items), and the Immigrant Integration Index (IPL-12). Discussion: This trial may provide substantial evidence for a brief transdiagnostic psychological intervention. Here, we intend to contribute to the treatment of mental health problems among Afghan refugees. The assessment of subjective experience with this treatment manual, as well as the evaluation of its clinical applicability, may optimize treatment acceptance and outcomes across a wide range of mental health problems among refugees.

Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers

“…Data were collected as part of the baseline assessment of a randomized controlled trial (RCT; PIAAS-Study; Knefel et al, 2020 ) between July 2019 and December 2020. All participants provided full informed consent, and the study was approved by the ethics committee of the University of Vienna (reference numbers: 00356 and 00445).…”

“…Participants were reimbursed for travel expenses. Sample size calculations and power analysis were conducted for the RCT and can be found in the published study protocol (Knefel et al, 2020 ). Sample characteristics are reported in Table 1 .…”

“…The PMLD Checklist is a self-report questionnaire used to assess a wide range of PMLDs in refugees and asylum seekers (Silove, Sinnerbrink, Field, Manicavasagar, & Steel, 1997 ). The final version was adapted for Austria and contains 26 items (Knefel et al, 2020 ). Participants were asked to record the frequency of experiencing the different PMLDs in the last month on a 5-point Likert scale from ‘not at all’ (0) to ‘extremely’ (4).…”

Exploring Informal Education for Promoting Mental Health Literacy: A Study to Youth in Malaysia

“…This positive psychological method applies to all informal education agents to confront youth in improving mental health literacy (Knefel et al, 2020;Nasharudin et al, 2020). Because youths are very unique and have complicated internal and mental situations, so with the psychological approach it is easier for these informal education agents to face the challenge of understanding the real life situations of youths.…”

Interventions and participatory clinical research for the enhancement of health systems interfacing with displaced Afghan women

“…Organization's PM+ do not target the trauma itself to any great degree and instead focus on building problem management skills (Knefel et al, 2020;World Health Organization, 2020).…”