Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands.
BMJ Ment Health. 2023 Feb;26(1). doi: 10.1136/bmjment-2022-300637. Epub 2023 Feb 8.
The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited.
To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands.
We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019-December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat.
Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference -0.25; 95% CI -0.385 to -0.122; p=0.0001, Cohen's =0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen's =0.42), anxiety (p=0.001, Cohen's =0.27), PTSD symptoms (p=0.0005, Cohen's =0.39) and self-identified problems (p=0.03, Cohen's =0.26), but not on impairment (p=0.084, Cohen's =0.21).
PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit.
Peer-provided psychological interventions should be considered for scale-up in HICs.
高收入国家（HICs）的难民的心理健康负担很高，而获得心理健康保健的机会可能有限。
评估同伴提供的心理干预（问题管理加；PM+）在减少荷兰叙利亚难民常见精神障碍（CMD）症状方面的有效性。
我们对 2019 年 3 月至 2021 年 12 月招募的成年叙利亚难民进行了一项单盲、随机对照试验（NTR7552）。具有心理困扰（Kessler 心理困扰量表（K10）>15）和功能障碍（世界卫生组织残疾评估表（WHODAS 2.0）>16）的个体被分配到 PM+，外加常规护理（PM+/CAU）或仅 CAU。参与者在 1 周和 3 个月的随访时进行了重新评估。主要结局是 3 个月随访时的抑郁/焦虑合并症（霍普金斯症状清单；HSCL-25）。次要结局包括抑郁（HSCL-25）、焦虑（HSCL-25）、创伤后应激障碍症状（精神疾病诊断和统计手册第五版创伤后应激障碍检查表；PCL-5）、障碍（WHODAS 2.0）和自我识别问题（PSYCHLOPS；心理结果简介）。主要分析为意向治疗。
参与者（n=206；平均年龄 37 岁，62%为男性）被随机分配到 PM+/CAU（n=103）或 CAU（n=103）。在 3 个月随访时，PM+/CAU 与 CAU 相比，抑郁/焦虑的减轻幅度更大（平均差异-0.25；95%CI-0.385 至-0.122；p=0.0001，Cohen's =0.41）。PM+/CAU 还显示出对抑郁（p=0.0002，Cohen's =0.42）、焦虑（p=0.001，Cohen's =0.27）、创伤后应激障碍症状（p=0.0005，Cohen's =0.39）和自我识别问题（p=0.03，Cohen's =0.26）的改善更大，但对障碍（p=0.084，Cohen's =0.21）没有改善。
PM+有效减轻了叙利亚难民的 CMD 症状。一个优点是在随访时保持了较高的保留率。由于主要纳入了有居留许可的难民，因此普遍性受到限制。
在 HICs，同伴提供的心理干预措施应考虑扩大规模。
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