Guided digital health intervention for depression in Lebanon: randomised trial

Cuijpers, Pim; Heim, Eva; Ramia, Jinane Abi; Burchert, Sebastian; Carswell, Kenneth; Cornelisz, Ilja; Knaevelsrud, Christine; Noun, Philip; Klaveren, Chris van; Hof, Edith Van’t; Zoghbi, Edwina; Ommeren, Mark van; Chammay, Rabih El

doi:10.1136/ebmental-2021-300416

Cited by 16 publications

(24 citation statements)

References 27 publications

(46 reference statements)

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“…Table 1 presents the characteristics of the 23 studies, comprising 5,298 participants (range of sample sizes: 8 to 680), included in our review [10][11][12][13][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] . These were performed in Pakistan (four studies); Lebanon, Kenya (three studies each); Jordan, The Netherlands, Nepal (two studies each); Australia, Austria, China, Colombia, Switzerland, Turkey and the UK (one study each).…”

Section: Search Outcome and Study Characteristicsmentioning

confidence: 99%

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

Schäfer,

Thomas,

Lindner

et al. 2023

World Psychiatry

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Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post‐traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low‐intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step‐by‐Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post‐traumatic stress disorder symptoms; functional impairment, self‐identified problems) and positive mental health outcomes (i.e., well‐being, quality of life, social support/relationships). We performed random‐effects multilevel meta‐analyses on standardized mean differences (SMDs) at post‐intervention and short‐term follow‐up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=–0.45, 95% CI: –0.56 to –0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14‐0.47), which both remained significant at follow‐up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between‐study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high‐quality evidence base is needed, as well as research on participant‐level moderators of the effects of these interventions, their suitability for stepped‐care programs, and their cost‐effectiveness.

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Section: Search Outcome and Study Characteristicsmentioning

confidence: 99%

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

Schäfer,

Thomas,

Lindner

et al. 2023

World Psychiatry

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“…The program is supported by ‘e-helpers’ who provide weekly telephone or message-based support for the users. In a controlled trial in Lebanon of 680 people with depressive symptoms, it was found that Step-by-Step resulted in reduced depression, functioning problems, posttraumatic stress and personally identified problems relative to enhanced usual care (Cuijpers et al, 2022 ). Early piloting suggests that the Step-by-Step program has the potential for scale-up with refugees, however, there are reported barriers in terms of the extent to which refugees will persist with the sessions and achieve an adequate dose of the intervention (Burchert et al, 2018 ).…”

Section: The Emergence Of Scalable Interventionsmentioning

confidence: 99%

Scalable interventions for refugees

Bryant

2023

Camb. prisms Glob. ment. health

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Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.

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“…This single-blind, 2-arm pragmatic randomized clinical trial examined the effects of a digital health intervention for depression compared with ECAU in displaced Syrians in Lebanon. The study was conducted together with an identical study in Lebanese citizens, which is reported elsewhere [ 16 ]. Ethical approval was received from the WHO Ethical Review Committee (ERC.0002797) and Saint-Joseph’s University, Beirut (CEHDF862).…”

Section: Methodsmentioning

confidence: 99%

Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial

et al. 2022

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Background Most displaced people with mental disorders in low- and middle-income countries do not receive effective care, and their access to care has deteriorated during the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health interventions are scalable when digital access is adequate, and they can be safely delivered during the COVID-19 pandemic. We examined whether a new WHO-guided digital mental health intervention, Step-by-Step, in which participants were supported by a nonspecialist helper, was effective in reducing depression among displaced people in Lebanon. Methods and findings We conducted a single-blind, 2-arm pragmatic randomized clinical trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among displaced Syrians suffering from depression and impaired functioning in Lebanon. Primary outcomes were depression (Patient Health Questionnaire, PHQ-9) and impaired functioning (WHO Disability Assessment Schedule-12, WHODAS) at posttreatment. Secondary outcomes included subjective well-being, anxiety, post-traumatic stress, and self-described problems. A total of 569 displaced people from Syria with depression (PHQ-9 ≥ 10) and impaired functioning (WHODAS > 16) were randomized to Step-by-Step (N = 283; lost to follow-up: N = 167) or ECAU (N = 286; lost to follow-up: 133). Participants were considered to be lost to follow-up when they did not fill in the outcome measures at posttest or follow-up. Recruitment started on December 9, 2019 and was completed on July 9, 2020. The last follow-up assessments were collected in December 2020. The study team had access to the online platform, where they could see treatment arm assignment for each participant. All questionnaires were completed by participants online. Intention-to-treat (ITT) analyses showed intervention effects on depression (standardized mean differences [SMDs]: 0.48; 95% CI: 0.26; 0.70; p < 0.001), impaired functioning (SMD: 0.35; 95% CI: 0.14; 0.56; p < 0.001), post-traumatic stress (SMD: 0.36; 95% CI: 0.16; 0.56; p < 0.001), anxiety (SMD: 0.46; 95% CI: 0.24; 0.68; p < 0.001), subjective well-being (SMD: 0.47; 95% CI: 0.26; 0.68; p < 0.001), and self-identified personal problems (SMD: 0.49; 95% CI 0.28; 0.70; p < 0.001). Significant effects on all outcomes were maintained at 3 months follow-up. During the trial, one serious adverse event occurred, unrelated to the intervention. The main limitation of the current trial is the high dropout rate. Conclusions In this study, we found that a guided, digital intervention was effective in reducing depression in displaced people in Lebanon. The guided WHO Step-by-Step intervention we examined should be made available to communities of displaced people that have digital access. Trial registration ClinicalTrials.gov NCT03720769.

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Guided digital health intervention for depression in Lebanon: randomised trial

Cited by 16 publications

References 27 publications

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

Scalable interventions for refugees

Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial

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