Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA.
Arua, Uganda.
Lancet Glob Health. 2020 Feb;8(2):e254-e263. doi: 10.1016/S2214-109X(19)30504-2.
Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help intervention (Self-Help Plus) to reduce psychological distress in female refugees.
We did a cluster randomised trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cutoff ≥5 on the Kessler 6). The intervention comprised access to usual care and five 2-h audio-recorded stress-management workshops (20-30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomly assigned to either intervention (Self-Help Plus or enhanced usual care) on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20-30 eligible participants were identified per site. The primary outcome was individual psychological distress, assessed using the Kessler 6 symptom checklist 1 week before, 1 week after, and 3 months after intervention, in the intention-to-treat population. All outcomes were measured at the individual (rather than cluster) level. Secondary outcomes included personally identified problems, post-traumatic stress, depression symptoms, feelings of anger, social interactions with other ethnic groups, functional impairment, and subjective wellbeing. Assessors were masked to allocation. This trial was prospectively registered at ISRCTN, number 50148022.
Of 694 eligible participants (331 Self-Help Plus, 363 enhanced usual care), 613 (88%) completed all assessments. Compared with controls, we found stronger improvements for Self-Help Plus on psychological distress 3 months post intervention (β -1·20, 95% CI -2·33 to -0·08; p=0·04; d -0·26). We also found larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range -0·30 to -0·36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. With regard to safety considerations, the independent data safety management board responded to six adverse events, and none were evaluated to be concerns in response to the intervention.
Self-Help Plus is an innovative, facilitator-guided, group-based self-help intervention that can be rapidly deployed to large numbers of participants, and resulted in meaningful reductions in psychological distress at 3 months among South Sudanese female refugees.
Research for Health in Humanitarian Crises (R2HC) Programme.
需要创新性的解决方案来大规模地为资源匮乏的人道主义环境中的人们提供心理健康支持。我们旨在评估一种由指导员引导、基于小组的自助干预（自助加）是否能有效减少女性难民的心理困扰。
我们在乌干达北部的农村难民营进行了一项集群随机试验。参与者为南苏丹女性难民，其心理困扰程度至少为中度（Kessler 6 得分≥5）。该干预措施包括提供常规护理和五次由经过简短培训的指导员带领的 2 小时音频录制的压力管理讲习班（每次 20-30 名难民），并配有插图的自助手册。村庄按照 1:1 的比例随机分配到干预组（自助加或增强的常规护理）。在 14 个村庄内，随机选择家庭进行接触。在干预前一周、干预后一周和 3 个月对每个地点的 20-30 名符合条件的参与者进行个人心理困扰的筛查。主要结局是个体心理困扰，采用 Kessler 6 症状清单进行评估，在意向治疗人群中进行。所有结局均在个体（而非集群）水平上进行测量。次要结局包括个人确定的问题、创伤后应激、抑郁症状、愤怒感、与其他族裔群体的社会互动、功能障碍和主观幸福感。评估人员对分配情况不知情。该试验在 ISRCTN 进行了前瞻性注册，编号为 50148022。
在 694 名符合条件的参与者（自助加组 331 名，增强常规护理组 363 名）中，有 613 名（88%）完成了所有评估。与对照组相比，我们发现自助加组在干预后 3 个月时心理困扰的改善更显著（β-1.20，95%CI-2.33 至-0.08；p=0.04；d-0.26）。我们还发现，在干预后 3 个月时，自助加组在八项次要结局中有五项的改善更大（效应大小范围-0.30 至-0.36）。经历不同创伤暴露、在难民营中居住时间不同和初始心理困扰程度不同的难民都同样受益。关于安全性考虑，独立的数据安全管理委员会对 6 起不良事件做出了回应，没有一起被评估为与干预有关的问题。
自助加是一种创新性的、指导员引导的、基于小组的自助干预措施，可以快速应用于大量参与者，可显著降低南苏丹女性难民 3 个月时的心理困扰。
人道主义危机中的健康研究（R2HC）计划。
