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

Graaff, Anne M. de; Cuijpers, Pim; Acartürk, Ceren; Akhtar, Aemal; Alkneme, Mhd Salem; Aoun, May; Awwad, Manar; Bawaneh, Ahmad; Brown, Felicity L.; Bryant, Richard A.; Burchert, Sebastian; Carswell, Kenneth; Drogendijk, Annelieke N.; Engels, Michelle; Fuhr, Daniela C.; Hansen, Pernille; Hof, Edith van ‘t; Giardinelli, Luana; Hemmo, Mahmoud; Hessling, Jonas M.; İlkkurşun, Zeynep; Jordans, Mark J. D.; Kiselev, Nikolai; Knaevelsrud, Christine; Kurt, Gülşah; Martinmäki, Saara; McDaid, David; Morina, Naser; Naser, Hadeel; Park, A‐La; Pfaltz, Monique C.; Roberts, Bayard; Schick, Matthis; Schnyder, Ulrich; Spaaij, Julia; Steen, Frederik Van de; Taha, Karine; Uygun, Ersin; Ventevogel, Peter; Whitney, Claire; Witteveen, Anke B.; Sijbrandij, Marit

doi:10.1136/bmjopen-2021-058101

Cited by 7 publications

(8 citation statements)

References 76 publications

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“…Favorable intervention effects remain significant during short‐term follow‐up periods. Future individual participant data meta‐analyses 62 may shed light on participant‐level moderators of intervention effects and help to clarify for whom PM+ and SbS are most effective. If further research provides support for the cost‐effectiveness of PM+ and SbS, and their suitability for stepped‐care programs, both WHO interventions can help to reduce the negative mental health consequences of current and future global crises.…”

Section: Discussionmentioning

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: Discussionmentioning

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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show abstract

“…This may also point to the fact that a deeper understanding of effect modifiers for single interventions is needed. Recently registered traditional (Schäfer et al, 2022 ) and individual-participant data (IPD; [de Graaff et al, 2022 ]) meta-analysis projects on the WHO programmes PM + and Step-by-Step may point into this direction. However, such projects are also urgently needed for interventions delivered to children and adolescents like EASE (Brown et al, 2019 ; Dawson et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

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

Kunzler

Lindner

Broll

et al. 2023

European Journal of Psychotraumatology

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Background: People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders. Objective: To summarize evidence on the efficacy of psychosocial interventions aiming to promote mental health and/or to prevent mental symptoms by fostering transdiagnostic skills in forcibly displaced persons of all ages. Method: Four databases and reference lists were searched for randomized controlled trials on interventions in this population on 11 March 2022. Thirty-six studies were eligible, 32 studies (comprising 5299 participants) were included in random-effects multilevel meta-analyses examining the effects of interventions on mental symptoms and positive mental health (e.g. wellbeing) as well as moderators to account for heterogeneity. OSF Preregistration-ID: 10.17605/OSF.IO/XPMU3 Results: Our search resulted in 32 eligible studies, with 10 reporting on children/adolescents and 27 on adult populations. There was no evidence for favourable intervention effects in children/adolescents, with 44.4% of the effect sizes pointing to potentially negative effects yet remaining non-significant. For adult populations, our meta-analyses showed a close-to-significant favourable effect for mental symptoms, M (SMD) = 0.33, 95% CI [–0.03, 0.69], which was significant when analyses were limited to high-quality studies and larger for clinical compared to non-clinical populations. No effects emerged for positive mental health. Heterogeneity was considerable and could not be explained by various moderators (e.g. type of control, duration, setting, theoretical basis). Certainty of evidence was very low across all outcomes limiting the generalizability of our findings. Conclusion: The present review provides at most weak evidence for an effect favouring transdiagnostic psychosocial interventions over control conditions for adult populations but not for children and adolescents. Future research should combine the imperative of humanitarian aid in face of major crises with studying the diverse needs of forcibly displaced persons to improve and tailor future interventions.

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“…The collapse of the Syrian state has yielded an abundance of literature on displaced Syrians' MH (166), including related interventions (167). Yet, however useful the resulting literature may be for understanding "refugee mental health" as a discipline, challenges exist in applying these learnings to the Afghan context.…”

Section: Applicability Of Prior Mental Health Work With Other Displac...mentioning

confidence: 99%

Considerations in designing trauma-focused interventions for displaced Afghan women

Ramos

2023

Front. Glob. Womens Health

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In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.

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

Cited by 7 publications

References 76 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

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

Considerations in designing trauma-focused interventions for displaced Afghan women

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