Teaching Recovery Techniques: evaluation of a group intervention for unaccompanied refugee minors with symptoms of PTSD in Sweden

Abstract

In 2015, a total of 35,369 unaccompanied refugee minors (URMs) sought asylum in Sweden. In a previous study of 208 URMs, we found that 76% screened positive for PTSD. This study aimed to (1) evaluate the indicated prevention program Teaching Recovery Techniques (TRT) in a community setting and describe the program’s effects on symptoms of PTSD and depression in URMs; and (2) examine participants’ experiences of the program. The study included 10 groups. Methods for evaluation included the Children’s Revised Impact of Event Scale (CRIES-8) and the Montgomery–Åsberg Depression Rating Scale Self-report (MADRS-S) at baseline and at post-intervention. Qualitative interviews were conducted with 22 participating URMs to elicit their experiences. Pre- and post-measures were available for 46 participants. At baseline, 83% of the participants reported moderate or severe depression and 48% suicidal ideation or plans. Although more than half (62%) of the participants reported negative life events during the study period, both PTSD (CRIES-8) and depression (MADRS-S) symptoms decreased significantly after the intervention (p = 0.017, 95% CI − 5.55; − 0.58; and p < 0.001, 95% CI − 8.94; − 2.88, respectively). The qualitative content analysis resulted in six overall categories: social support, normalisation, valuable tools, comprehensibility, manageability, and meaningfulness when the youth described their experiences of the program, well reflecting TRT’s program theory. Overall, results indicate that TRT, delivered in a community setting, is a promising indicated preventive intervention for URMs with PTSD symptoms. This successful evaluation should be followed up with a controlled study.

Practitioner Review: Mental health problems of refugee children and adolescents and their management

“…This study did not involve parents. More positive results in a pre‐post treatment comparison of unaccompanied minors in Sweden found improvement in both PTSD and depressive symptoms (Sarkadi et al., ). Some parental involvement through homework was reported by Qouta, Palosaari, Diab, and Punamaki (), who also detected a small improvement in PTSD symptoms among boys; and more promising impact in reducing both PTSD and depressive symptoms in the face of ongoing violence in the Palestinian Territories were found by Barron, Abdallah, and Smith ().…”

Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT): study protocol for a randomised controlled trial

“…Information about the study will be distributed to community sites directly by CHAP and posted online on the CHAP website. In an exploratory study, 90% of those screened for participation met the cutoff on the CRIES-8 (Sarkadi et al, 2018). The treatment retention rate was 59%, with most dropouts occurring right before or just after the start of the group.…”

“…In Sweden, an exploratory trial of TRT with 46 URM youth (mainly male, aged 13-18 years) yielded promising results, with significant decreases in both PTSD and depression reported (Sarkadi et al, 2018). Over a fifth of participants recovered from their PTSD symptoms, while a third recovered from depressive symptoms (Sarkadi et al, 2018).…”

Challenges and opportunities in refugee mental health: clinical, service, and research considerations

“…The review of treatment studies for psychiatrically distressed unaccompanied refugee minors is very revealing in demonstrating the dearth of adequate studies with this group [33], although cognitive behavioural approaches with individuals or groups look promising [34] and interventions that give meaning to the events (psychoeducation, rapport building, and use of narratives) could also be effective [35]. The potential for offering the interventions to large groups and ensuring that the unaccompanied minors find them rewarding and effective and can make sense of the interventions is also important [36].…”