University of New South Wales, Sydney, Australia.
Westmead Institute of Medical Research, Sydney, Australia.
PLoS Med. 2022 Mar 17;19(3):e1003949. doi: 10.1371/journal.pmed.1003949. eCollection 2022 Mar.
Common mental disorders are frequently experienced by refugees. This study evaluates the impact of a brief, lay provider delivered group-based psychological intervention [Group Problem Management Plus (gPM+)] on the mental health of refugees in a camp, as well as on parenting behavior and children's mental health.
In this single-blind, parallel, randomized controlled trial, 410 adult Syrian refugees (300 females, 110 males) in Azraq Refugee Camp (Jordan) were identified through screening of psychological distress (≥16 on the Kessler Psychological Distress Scale) and impaired functioning (≥17 on the WHO Disability Assessment Schedule). Participants were randomly allocated to gPM+ or enhanced usual care (EUC) involving referral information for psychosocial services on a 1:1 ratio. Participants were aware of treatment allocation, but assessors were blinded to treatment condition. Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL; depression and anxiety scales) assessed at baseline, 6 weeks, and 3 months follow-up as the primary outcome time point. It was hypothesized that gPM+ would result in greater reductions of scores on the HSCL than EUC. Secondary outcomes were disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behavior, and children's mental health. Between October 15, 2019 and March 2, 2020, 624 refugees were screened for eligibility, 462 (74.0%) screened positive, of whom 204 were assigned to gPM+ and 206 to EUC. There were 168 (82.4%) participants in gPM+ and 189 (91.7%) in EUC assessed at follow-up. Intent-to-treat analyses indicated that at follow-up, participants in gPM+ showed greater reduction on HSCL depression scale than those receiving EUC (mean difference, 3.69 [95% CI 1.90 to 5.48], p = .001; effect size, 0.40). There was no difference between conditions in anxiety (mean difference -0.56, 95% CI -2.09 to 0.96; p = .47; effect size, -0.03). Relative to EUC, participants in gPM+ had greater reductions in severity of personally identified problems (mean difference 0.88, 95% CI 0.07 to 1.69; p = .03), and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < .001). There were no significant differences between conditions for changes in PTSD, disability, grief, prodromal symptoms, or childhood mental health outcomes. Mediation analysis indicated the change in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE .07; 95% CI .003 to .274) and internalizing (β = 0.08, SE .05; 95% CI .003 to 0.19) problems in children. No adverse events were attributable to the interventions or the trial. Major limitations included only one-quarter of participants being male, and measures of personally identified problems, grief, prodromal psychotic symptoms, inconsistent parenting behavior, and children's mental health have not been validated with Syrians.
In camp-based Syrian refugees, a brief group behavioral intervention led to reduced depressive symptoms, personally identified problems, and disciplinary parenting compared to usual care, and this may have indirect benefits for refugees' children. The limited capacity of the intervention to reduce PTSD, disability, or children's psychological problems points to the need for development of more effective treatments for refugees in camp settings.
Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619001386123.
常见的精神障碍经常在难民中出现。本研究评估了一种简短的、由非专业人员提供的小组式基于心理的干预措施（小组问题管理加[gPM+]）对难民营中难民的心理健康的影响，以及对育儿行为和儿童心理健康的影响。
在这项单盲、平行、随机对照试验中，通过对心理困扰（Kessler 心理困扰量表≥16）和功能受损（世界卫生组织残疾评估表≥17）进行筛查，在约旦的阿兹拉克难民营中确定了 410 名成年叙利亚难民（300 名女性，110 名男性）。参与者被随机分配到 gPM+或增强的常规护理（EUC），比例为 1:1，涉及心理社会服务的转介信息。参与者知道治疗分配，但评估者对治疗情况不知情。主要结局是在基线、6 周和 3 个月随访时使用 Hopkins 症状清单-25（HSCL；抑郁和焦虑量表）评估的分数，这是主要的结局时间点。假设 gPM+将导致 HSCL 分数的降低大于 EUC。次要结局是残疾、创伤后应激、个人确定的问题、长期悲伤、前驱精神病症状、育儿行为和儿童心理健康。2019 年 10 月 15 日至 2020 年 3 月 2 日，对 624 名难民进行了资格筛查，462 名（74.0%）筛查阳性，其中 204 名被分配到 gPM+，206 名被分配到 EUC。有 168 名（82.4%）接受 gPM+的参与者和 189 名（91.7%）接受 EUC 的参与者在随访时接受了评估。意向治疗分析表明，在随访时，接受 gPM+的参与者在 HSCL 抑郁量表上的降低幅度大于接受 EUC 的参与者（平均差异，3.69[95%置信区间 1.90 至 5.48]，p=.001；效应量，0.40）。两种情况下的焦虑差异无统计学意义（平均差异-0.56，95%置信区间-2.09 至 0.96；p=.47；效应量，-0.03）。与 EUC 相比，接受 gPM+的参与者在个人确定的问题的严重程度上有更大的降低（平均差异 0.88，95%置信区间 0.07 至 1.69；p=.03），以及不一致的纪律性育儿（平均差异 1.54，95%置信区间 1.03 至 2.05；p<.001）。两种情况下 PTSD、残疾、悲伤、前驱症状或儿童心理健康结局的变化均无显著差异。中介分析表明，不一致的纪律性育儿的变化与儿童注意力（β=0.11，SE.07；95%置信区间.003 至.274）和内化（β=0.08，SE.05；95%置信区间.003 至 0.19）问题的减少有关。干预或试验没有引起不良事件。主要限制包括只有四分之一的参与者是男性，以及个人确定的问题、悲伤、前驱精神病症状、不一致的育儿行为和儿童心理健康的测量方法尚未与叙利亚人进行验证。
在难民营中的叙利亚难民中，与常规护理相比，简短的小组行为干预导致抑郁症状、个人确定的问题和纪律性育儿行为减少，这可能对难民的儿童有间接的益处。干预措施减少创伤后应激障碍、残疾或儿童心理问题的能力有限，这表明需要为难民营中的难民开发更有效的治疗方法。
在澳大利亚和新西兰临床试验注册处前瞻性注册：ACTRN12619001386123。
