Effectiveness of self-help plus in preventing mental disorders in refugees and asylum seekers in Western Europe: A multinational randomized controlled trial

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Abstract

Introduction: Self-Help Plus (SH +) is a group-based psychological intervention developed by the World Health Organization for managing stress. Objective: To assess the effectiveness of SH+ in preventing mental disorders in refugees and asylum seekers in Western Europe. Methods: We conducted a randomized controlled trial in 5 European countries. Refugees and asylum seekers with psychological distress (General Health Questionnaire score > 3), but without a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) or ICD/10 diagnosis of mental disorder, as assessed with the Mini International Neuropsychiatric Interview (MINI), were randomized to SH + or enhanced treatment as usual (ETAU). The primary outcome was the frequency of mental disorders with the MINI at 6 months. Secondary outcomes included the frequency of mental disorders at postintervention, self-identified problems, psychological symptoms, and other outcomes. Results: Four hundred fifty-nine individuals were randomly assigned to SH + or ETAU. For the primary outcome, we found no difference in the frequency of mental disorders at 6 months (Cramer V = 0.007, p = 0.90, RR = 0.96; 95% CI 0.52,1.78), while the difference significantly favored SH + at after the intervention (secondary outcome, measured within 2 weeks from the last session; Cramer V = 0.13, p = 0.01, RR = 0.50; 95% CI 0.29,0.87). Conclusions: This is the first randomized indicated prevention study with the aim of preventing the onset of mental disorders in asylum seekers and refugees in Western Europe. As a prevention effect of SH + was not observed at 6 months, but rather after the intervention only, modalities to maintain its beneficial effect in the long term need to be identified.

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About this study

AGE: Adults

DIRECTION OF EVIDENCE: Inconclusive or mixed impact

FULL TEXT AVAILABILITY: Free

GENDER: All

HOST COUNTRY: Multiple countries

HOST COUNTRY INCOME: High

INTERVENTION DURATION: 5 sessions

INTERVENTION: Self-help plus

OUTCOME AREA: General Distress Reduction

POPULATION: Refugees

REGION OF ORIGIN OF PARTICIPANT(S): Multiple Regions

STRENGTH OF EVIDENCE: Moderate

YEAR PUBLISHED: 2021

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