Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial

Abstract

Background Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an effective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul, Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-effectiveness of the intervention. Methods Refugees with psychological distress (Kessler Psychological Distress Scale, K10 > 15) and impaired psychosocial functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n = 24) or E-CAU only (n = 22). gPM+ comprised of five weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identified problems (Psychological Outcomes Profiles, PSYCHLOPS) were included as secondary outcomes. A modified version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. Results There were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an effect. No significant difference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. Conclusions gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe intervention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT. Trial registration ClinicalTrials.gov Identifier NCT03567083; date: 25/06/2018.

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)

“…For example, there is a growing body of evidence regarding the effectiveness of brief, psychotherapeutic interventions that target symptoms across a range of common mental health problems and can be delivered by trained non-specialist providers [ 53 – 55 ]. Unfortunately, despite several calls to action, research has lagged in generating evidence around promising approaches for addressing substance use in humanitarian settings [ 48 – 52 ].…”

Skin conductance response to trauma interview as a candidate biomarker of trauma and related psychopathology in youth resettled as refugees

“…Detecting and treating PTSS in refugee populations with scarce mental health resources is extremely important given the current global climate. Detection and risk assessment are essential first steps, and subsequently must be the development of culturally appropriate interventions that can be deployed to areas of conflict (Sijbrandij et al, 2017 ) and resettlement (Acarturk et al, 2022 ; de Graaff et al, 2020 ; Feen-Calligan et al, 2020 ; Grasser et al, 2019 ; Grasser & Javanbakht, 2021 ; Purgato et al, 2019 ; Purgato et al, 2021 ; Tol et al, 2018 ). As the needs for trauma-informed services are likely to become overwhelming in many areas – on top of recent increased burden on healthcare services – early detection of, and intervention for, trauma-related psychopathology is critical.…”

Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis

“…Scalable psychological interventions such as PM+, gPM+ and SbS for communities affected by adversity have been found to be effective in various RCTs 21–24. Pilot studies on PM+ adapted for Syrian refugees indicated the intervention’s feasibility and likely effectiveness when delivered by peer-refugees to individuals30 31 or groups 29 32. The STRENGTHS consortium tests the effectiveness of different types of scalable interventions (ie, PM+, gPM+ and SbS) among Syrian refugees across different settings (eg, refugee camp, community setting).…”

“…Pilot studies among Syrian refugees carried out by the STRENGTHS consortium indicated that PM+ delivered by peers is an acceptable and feasible intervention, and likely effective in reducing psychological distress 29–32. Currently, fully-powered (ie, based on a priori power analysis) pragmatic RCTs among adult Syrian refugees in Europe and the Middle East are being conducted to test the effectiveness of PM+ in individual format in Switzerland and the Netherlands,33 PM+ in group format (gPM+) in Jordan34 and Turkey,35 and the digital SbS intervention in Germany, Sweden and Egypt 16.…”