Spanhel Kerstin, Hovestadt Eva, Lehr Dirk, Spiegelhalder Kai, Baumeister Harald, Bengel Juergen, Sander Lasse B
Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
Department of Health Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany.
Front Psychiatry. 2022 Feb 23;13:832196. doi: 10.3389/fpsyt.2022.832196. eCollection 2022.
Refugees are exposed to multiple stressors affecting their mental health. Given various barriers to mental healthcare in the arrival countries, innovative healthcare solutions are needed. One such solution could be to offer low-threshold treatments, for example by culturally adapting treatments, providing them in a scalable format, and addressing transdiagnostic symptoms. This pilot trial examined the feasibility, acceptance, and preliminary effectiveness of a culturally adapted digital sleep intervention for refugees. Sixty-six refugees participated, with 68.2% of them seeking psychological help for the first time. Only three participants did not show clinically significant insomnia severity, 93.9% reported past traumatic experiences. Participants were randomly assigned to the intervention group (IG) or the waitlist control group (CG). Insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, fear of sleep, fatigue, depression, wellbeing, mental health literacy) were assessed at baseline, 1 and 3 months after randomization. The self-help intervention included four modules on sleep hygiene, rumination, and information on mental health conditions associated with sleep disturbances. 66.7% of the IG completed all modules. Satisfaction with the intervention and its perceived cultural appropriateness were high. Linear multilevel analyses revealed a small, non-significant intervention effect on insomnia severity of Hedge's g = 0.28 at 3-months follow-up, comparing the IG to the CG [ = 0.88, = 0.421]. This non-confirmatory pilot trial suggests that low-threshold, viable access to mental healthcare can be offered to multiple burdened refugees by culturally adapting an intervention, providing it in a scalable format, and addressing a transdiagnostic symptom.
难民面临多种影响其心理健康的压力源。鉴于抵达国在心理保健方面存在各种障碍，需要创新的医疗保健解决方案。一种这样的解决方案可能是提供低门槛治疗，例如通过对治疗进行文化调适、以可扩展的形式提供治疗以及解决跨诊断症状。这项试点试验研究了一种针对难民进行文化调适的数字睡眠干预措施的可行性、可接受性和初步有效性。66名难民参与了试验，其中68.2%的人首次寻求心理帮助。只有3名参与者没有表现出临床上显著的失眠严重程度，93.9%的人报告有过去的创伤经历。参与者被随机分配到干预组（IG）或等待名单对照组（CG）。通过失眠严重程度指数测量的失眠严重程度以及次要结果（睡眠质量、对睡眠的恐惧、疲劳、抑郁、幸福感、心理健康素养）在基线、随机分组后1个月和3个月进行评估。自助干预包括关于睡眠卫生、反刍思维以及与睡眠障碍相关的心理健康状况信息的四个模块。干预组中有66.7%的人完成了所有模块。对干预措施的满意度及其在文化上的适宜性评价很高。线性多层次分析显示，在3个月的随访中，将干预组与对照组进行比较，干预对失眠严重程度的影响较小且无统计学意义，Hedge's g = 0.28 [P = 0.88，95%CI = 0.421]。这项非验证性试点试验表明，通过对干预措施进行文化调适、以可扩展的形式提供并解决跨诊断症状，可以为难民提供低门槛、可行的心理保健服务。
