Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.
Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.
J Affect Disord. 2023 Feb 15;323:241-250. doi: 10.1016/j.jad.2022.11.050. Epub 2022 Nov 23.
Research on outcome predictors in the field of transcultural treatment for refugees and asylum seekers (RAS) is scarce. We aimed to evaluate predictors of outcome of a group intervention (Empowerment) for RAS with affective disorders which was incorporated at level three of the stratified stepped-care model within the Mental Health in Refugees and Asylum Seekers (MEHIRA) project.
A predictor analysis was performed at level three of the MEHIRA project, where 149 refugees with moderate depressive symptoms were treated either with Empowerment or Treatment-as-usual (TAU). Outcome measures were depression severity as assessed by patient-rated Patient Health Questionnaire 9 (PHQ-9) and clinician-rated Montgomery Asberg Depression Rating Scale (MADRS). Regression models with change scores (T1-T0) of PHQ-9 and MADRS as dependent variables were fit. Predictor selection was a mixed-method approach combining testing of literature-based hypotheses and explorative hypothesis-generating analyses of multiple baseline variables.
Intention-to-treat (ITT) analyses revealed significant linear relationships between change in PHQ-9 and baseline depression severity (β = -0.35, t = -3.27, p = .002) and perceived self-efficacy (β = -0.24, t = -2.26, p = .027) in the treatment (verum) condition. MADRS change scores were predicted by baseline depression severity (β = -0.71, t = -8.65, p < .001) in the treatment (verum) condition.
Due to small cell numbers, single predictors could not be evaluated reliably.
Severity of depression and self-efficacy at baseline were predictors of symptom improvement at level three (Empowerment) of the MEHIRA project. Comorbidity and trauma indicators did not predict outcomes in the treatment (verum) condition, pointing towards broad applicability of the Empowerment intervention in refugee populations.
在跨文化难民和寻求庇护者治疗领域，有关预后预测因素的研究很少。我们旨在评估一项针对情感障碍难民和寻求庇护者（RAS）的团体干预（赋权）的结果预测因素，该干预已纳入分层分步护理模型的三级，即难民和寻求庇护者心理健康项目（MEHIRA）。
在 MEHIRA 项目的三级进行了预测因素分析，其中 149 名中度抑郁症状的难民接受了赋权或常规治疗（TAU）。评估结果的测量是患者自评的患者健康问卷 9（PHQ-9）和临床医生评定的蒙哥马利抑郁评定量表（MADRS）的抑郁严重程度。使用 PHQ-9 和 MADRS 的变化分数（T1-T0）作为因变量的回归模型进行拟合。预测因素的选择是一种混合方法，结合了基于文献的假设检验和对多个基线变量的探索性假设生成分析。
意向治疗（ITT）分析显示，在治疗（真实）条件下，PHQ-9 的变化与基线抑郁严重程度（β=-0.35，t=-3.27，p=0.002）和感知自我效能（β=-0.24，t=-2.26，p=0.027）之间存在显著的线性关系。MADRS 变化分数由基线抑郁严重程度预测（β=-0.71，t=-8.65，p<0.001）在治疗（真实）条件下。
由于细胞数量少，单个预测因素不能可靠评估。
基线时的抑郁严重程度和自我效能是 MEHIRA 项目三级（赋权）症状改善的预测因素。合并症和创伤指标在治疗（真实）条件下不能预测结果，这表明赋权干预在难民人群中具有广泛的适用性。
