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

Abstract

Background: While many elaborated treatment protocols focus on post-traumatic stress symptoms, a large number of refugees suffer from a range of mental health problems. Thus, brief and transdiagnostic psychological interventions may be helpful first interventions for help-seeking refugees and asylum seekers in a stepped-care approach. Critically, there is limited research on how transdiagnostic interventions are received in general practice in non-specialized mental healthcare settings in high-income countries, where often only mental health professionals (MHPs) are legally allowed to treat people with mental disorders. MHPs may thus deliver such interventions, but their perspective towards them has not yet been investigated. Objective: We aimed to investigate MHPs’ perception of the usability of adapted Problem Management Plus (aPM+), a brief transdiagnostic psychological intervention for refugees, which we adapted to address distress caused by post-migration living difficulties (PMLDs). Method: Employing an e-learning tool, we introduced the aPM+ intervention to 59 MHPs and assessed their perspective towards the intervention. We then used an inductive approach to analyse their perspective towards the intervention with open-ended questions. Results: Altogether, 59 MHPs enrolled in the webinar and 29 provided feedback on the intervention. MHPs had a positive view on the intervention but emphasized the importance of situation-specific adaptations to the structure of the manual. The most favoured specific strategies were ‘managing stress/slow-breathing’, the ‘tree of capabilities’, and the ‘riding the anger’ exercise. The last two were additionally developed to reduce distress caused by PMLDs by either enhancing self-efficacy or reducing anger regulation difficulties. Conclusions: An adaptation to aPM+ regarding more flexibility of the manual may enhance the likelihood of MHPs implementing the intervention in their daily practice. Strategies addressing coping with PMLDs could be particularly helpful. Trial registration: . HIGHLIGHTS Mental health professionals had a positive view on a brief transdiagnostic psychological intervention for refugees but emphasized the importance of situation-specific adaptations to the structure of the manual. Low -intensity interventions may be useful not only in low- and middle-income countries but also in high-income countries as part of a stepped-care approach, even if distributed by MHPs instead of trained laypersons.

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

“…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).…”

“…However, one study 38 found favorable symptom changes in children to be asso ciated with more consistent disciplinary behavior in parents who received group PM+. Two studies 46,47 investigated effects on somatic symptoms, both finding no evidence for favorable effects of (group) PM+. Health care costs and health care utilization were examined in three studies 10,36,52 , with none of them finding evidence for favorable effects.…”

Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis

“…Thus, especially low-intensity transdiagnostic interventions may have the potential to improve mental health care in forcibly displaced persons by targeting a broad range of symptoms, in low-resource settings and at lower costs than standard interventions (Dawson et al, 2015 ). At the same time, concerns were raised whether those low-intensity interventions are sufficient to meet the complex demands of this population due to rigid time schedules and their reliance on internal resources (Knefel et al, 2022 ).…”

Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions

“…For example, problem management plus (PM+) is a low-intensity, transdiagnostic psychological treatment aiming to enhance self-efficacy, social support and skills pertinent to coping with stress. It was adapted for Afghan refugees in Austria, 225 and found to be effective in terms of reducing distress and PTSD symptoms and improving quality of life. 226 It was also adapted for Afghans living in refugee camp settings in Greece, 231 with ongoing programme evaluation.…”