Effectiveness of a brief group behavioral intervention for common mental disorders in Syrian refugees in Jordan: A randomized controlled trial

Abstract

Background Common mental disorders are frequently experienced by refugees. This study evaluates the impact of a brief, lay provider delivered group-based psychological intervention [Group Problem Management Plus (gPM+)] on the mental health of refugees in a camp, as well as on parenting behavior and children’s mental health. Methods and findings In this single-blind, parallel, randomized controlled trial, 410 adult Syrian refugees (300 females, 110 males) in Azraq Refugee Camp (Jordan) were identified through screening of psychological distress (≥16 on the Kessler Psychological Distress Scale) and impaired functioning (≥17 on the WHO Disability Assessment Schedule). Participants were randomly allocated to gPM+ or enhanced usual care (EUC) involving referral information for psychosocial services on a 1:1 ratio. Participants were aware of treatment allocation, but assessors were blinded to treatment condition. Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL; depression and anxiety scales) assessed at baseline, 6 weeks, and 3 months follow-up as the primary outcome time point. It was hypothesized that gPM+ would result in greater reductions of scores on the HSCL than EUC. Secondary outcomes were disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behavior, and children’s mental health. Between October 15, 2019 and March 2, 2020, 624 refugees were screened for eligibility, 462 (74.0%) screened positive, of whom 204 were assigned to gPM+ and 206 to EUC. There were 168 (82.4%) participants in gPM+ and 189 (91.7%) in EUC assessed at follow-up. Intent-to-treat analyses indicated that at follow-up, participants in gPM+ showed greater reduction on HSCL depression scale than those receiving EUC (mean difference, 3.69 [95% CI 1.90 to 5.48], p = .001; effect size, 0.40). There was no difference between conditions in anxiety (mean difference −0.56, 95% CI −2.09 to 0.96; p = .47; effect size, −0.03). Relative to EUC, participants in gPM+ had greater reductions in severity of personally identified problems (mean difference 0.88, 95% CI 0.07 to 1.69; p = .03), and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < .001). There were no significant differences between conditions for changes in PTSD, disability, grief, prodromal symptoms, or childhood mental health outcomes. Mediation analysis indicated the change in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE .07; 95% CI .003 to .274) and internalizing (β = 0.08, SE .05; 95% CI .003 to 0.19) problems in children. No adverse events were attributable to the interventions or the trial. Major limitations included only one-quarter of participants being male, and measures of personally identified problems, grief, prodromal psychotic symptoms, inconsistent parenting behavior, and children’s mental health have not been validated with Syrians. Conclusions In camp-based Syrian refugees, a brief group behavioral intervention led to reduced depressive symptoms, personally identified problems, and disciplinary parenting compared to usual care, and this may have indirect benefits for refugees’ children. The limited capacity of the intervention to reduce PTSD, disability, or children’s psychological problems points to the need for development of more effective treatments for refugees in camp settings. Trial registration Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619001386123.

Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR’s Health Information System (2009–2018)

“…Not only do primary health care workers within refugee contexts need to be better equipped to address common mental health conditions (e.g., depression, anxiety, PTSD, and substance use), but more also needs to be done to provide treatment and support outside of health facilities. As mentioned previously, the recent surge in research around “scalable psychological interventions” in humanitarian settings provides increasing opportunities to administer brief, evidence-based psychological therapies that can be delivered by trained and supervised non-specialist providers, including refugees themselves [ 49 – 51 , 64 ]. Again, efforts towards this action are ongoing.…”

Twelve-month follow-up of a randomised clinical trial of a brief group psychological intervention for common mental disorders in Syrian refugees in Jordan

“…There were 1377 caravans approached during screen, 624 refugees agreed to be screened, of which 462 met entry criteria and 410 proceeded to randomisation (204 randomised to gPM + and 206 to EUC). Full details of the participants are reported in the prior report of the study (Bryant et al ., 2022 ) and reported in online Supplementary Tables 2 and 3. The mean age of participants was 40.03 years ( s.d.…”

“…This intervention teaches skills in arousal reduction, problem management, behavioural activation and accessing social support across five sessions (Dawson et al ., 2015 ). PM + delivered in individual (Rahman et al ., 2016 ; Bryant et al ., 2017 ) and group (Rahman et al ., 2019 ; Jordans et al ., 2021 ; Bryant et al , 2022 ) formats has been shown to be effective in reducing common mental disorders.…”

“…This trial aimed to assess the extent to which gPM + could reduce anxiety, depression, personally identified problems, unhelpful parenting behaviours and refugees' children psychological distress. Prior reporting on this study found that at the 3-month follow-up, refugees who received gPM + achieved greater reductions in the primary outcome of depression, as well as personally identified problems and inconsistent disciplinary parenting, relative to those who received enhanced usual care (EUC) (Bryant et al ., 2022 ). We hypothesised that refugees receiving PM + would still have greater reductions in depression, personally identified problems and inconsistent disciplinary parenting at 12-months relative to those receiving EUC.…”

Videoconferencing-delivered psychological intervention for the treatment of COVID-19 related psychological distress in University students: study protocol for a randomised controlled trial in India

“…The intervention comprises of evidence-based techniques including stress management, problem solving, behavioral activation, and social support enhancement [14]. Developed to be delivered by lay personnel involving those without specialist mental health qualifications, PM + has been shown to reduce mental distress and increase wellbeing in those exposed to adversity and crises across diverse demographic groups [15][16][17][18][19]. Recently, an adapted version of this program was delivered via video teleconferencing, Coping with COVID (CWC) was found to reduce worry, anhedonia, and contamination fears arising during the pandemic [20].…”