Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevaenget 21, 2750 Ballerup, Denmark.
Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark.
J Affect Disord. 2021 Mar 1;282:194-202. doi: 10.1016/j.jad.2020.12.095. Epub 2020 Dec 28.
Treatment effects in trials with trauma-affected refugees vary considerably between studies, but the variability in outcome between individual patients is often overlooked. Consequently, we know little about why some patients benefit more from treatment than others. The aim of the study was therefore to identify predictors of treatment outcome for refugees with Posttraumatic Stress Disorder (PTSD).
Data was derived from two randomised trials including 321 refugees, who had all participated in a 6-7 months bio-psycho-social treatment programme. Outcome measures were the Harvard Trauma Questionnaire (PTSD, self-rating), Hopkins Symptom Checklist-25 (depression and anxiety, self-rating) and Hamilton Depression and Anxiety rating scales (observer-ratings). Using hierarchical regressions models, associations were analysed between pre- to post treatment score changes (dependent variable) and a range of variables including sociodemographics, pre-migration trauma, post-migratory stressors, baseline symptom scores and level of functioning.
A high baseline score (=more symptoms) and a high level of functioning were found to be associated with improvement on all ratings. Additionally, the following variables were associated with symptom improvement on at least one outcome measure: short time in host country, full time occupation, young age and status as family reunified (in contrast to refugee status). Being Muslim was inversely correlated with improvement.
Translated self-ratings were used, which could impact reliability.
These results call for screening and early interventions for arriving refugees. For clinical populations, level of functioning should be included in assessments of refugees, to possibly begin stratifying samples to different interventions based on their likelihood of responding.
创伤后应激障碍（PTSD）难民的试验治疗效果在不同研究之间差异很大，但个体患者之间的结果差异往往被忽视。因此，我们对为什么有些患者比其他人从治疗中获益更多知之甚少。本研究的目的是确定创伤后应激障碍难民治疗结果的预测因素。
数据来自两项随机试验，共纳入 321 名难民，他们均参加了 6-7 个月的生物心理社会治疗计划。结局指标为哈佛创伤问卷（PTSD，自评）、霍普金斯症状清单-25（抑郁和焦虑，自评）和汉密尔顿抑郁和焦虑量表（观察者评定）。采用分层回归模型，分析了治疗前至治疗后评分变化（因变量）与一系列变量之间的相关性，包括社会人口统计学、前迁移创伤、后迁移压力源、基线症状评分和功能水平。
基线得分较高（=症状较多）和功能水平较高与所有评分的改善相关。此外，以下变量与至少一种结局测量的症状改善相关：在东道国的时间短、全职工作、年轻和家庭团聚（与难民身份相反）的身份。穆斯林身份与改善呈负相关。
使用的是翻译后的自评量表，这可能会影响可靠性。
这些结果呼吁对抵达的难民进行筛查和早期干预。对于临床人群，应在评估难民时纳入功能水平，以便根据其可能的反应，将样本分层为不同的干预措施。
