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

Abstract

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.

Mental health professionals’ perspective on a brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees

“…In the initial phase of our study, we developed an additional sixth session for the intervention that aimed to reduce the burden caused by PMLDs, and thus termed the intervention ‘adapted PM+’ (aPM+). We evaluated the effectiveness of the intervention in a randomized controlled trial study (Knefel et al, 2022 ). The aPM+ manual comprises of six weekly, individual face-to-face sessions based on six cross-cutting core therapeutic strategies: ‘Managing Stress’, ‘Managing Problems’, ‘Get Going, Keep Doing’, ‘Strengthening Social Support’, ‘Anger Regulation’, and ‘Increasing Self-efficacy’.…”

Considerations in designing trauma-focused interventions for displaced Afghan women

“…While potentially not capturing all relevant studies, a disproportionate gap in the literature is identified in that currently, publicly available research on trauma-focused interventions validated for or specifically tailored to displaced AW are almost entirely lacking, with the exception of first-line programming or other "low intensity" (30,31) interventions. Those interventions that have been assessed for suitability for Afghans have been studied primarily with male participants [e.g., (31)(32)(33)(34)], who inhabit a separate sphere of social expectations and constraints (35) within Afghan society.…”

“…Among the more well-known of these is the World Health Organizations' Problem Management Plus (PM+), which can be adapted for individuals or groups (145-147); however, a limitation of this and similar formats is that sustained intervention is rarely feasible in camps or other settings with severe challenges. Therefore, approaches such as the PM+ do not target the trauma itself to any great degree and instead focus mainly on quickly building problem management skills and self-regulation techniques to better manage feelings of overwhelm (30,147). Nevertheless, scholars such as Knefel et al (133) support adaptations of the PM+ for Afghans, with Knefel et al finding that the model is positively received by MH professionals.…”

“…Importantly, Droždek et al (34) found that exposure to others' trauma histories within a group setting was not found 5 For individual work, see Knefel et al (30). 6 Omidian and Lawrence (149) have described a psychosocial program for aid workers in Afghanistan that integrated "focusing" techniques and spirituality.…”

“Of course, you get depression in this situation”: Explanatory Models (EMs) among Afghan refugees in camps in Northern Greece

“…Belonging in the family of interventions aiming to scale up mental health care in primary care context, the World Health Organization [ 85 ] developed Problem Management Plus (PM +) as a manualized response to a wide range of mental health problems [ 86 ]. So far, it has been implemented in European context and specifically for Afghan refugees, as it is already being documented in Austria [ 87 ] and Greece [ 88 ].…”