Department of Clinical, Neuro-, and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
BMJ Ment Health. 2023 Jul;26(1). doi: 10.1136/bmjment-2023-300672.
Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers.
Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm).
There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90).
Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.
难民和寻求庇护者由于在被迫流离失所之前、期间和之后面临各种压力源，他们患有精神障碍的风险很高。世卫组织自助加（SH+）干预措施是为了管理弱势人群的心理困扰和广泛的心理健康症状而开发的。本研究旨在检验 SH+与增强常规护理（ECAU）相比在减少难民和寻求庇护者的抑郁症状方面的效果和调节因素。
确定了三项随机试验，共有 1795 名个体参与者数据（IPD）。我们进行了 IPD 荟萃分析，以估计 SH+的效果，主要是在抑郁症状上，其次是在创伤后应激、幸福感、自我认定的问题和功能上。还在随机分组后 5-6 个月（中期）估计了效果。
在干预后，SH+与 ECAU+在减轻抑郁症状方面没有差异。然而，在未就业的参与者（β=1.60，95%CI 0.20 至 3.00）和心理健康水平较低的参与者中，SH+的效果明显更大（β=0.02，95%CI 0.001 至 0.05）。在中期，SH+在改善抑郁症状（β=-1.13，95%CI -1.99 至 -0.26）、自我认定的问题（β=-1.56，95%CI -2.54 至 -0.59）和幸福感（β=6.22，95%CI 1.60 至 10.90）方面明显优于 ECAU。
尽管 SH+在干预后在减轻抑郁症状方面与 ECAU 没有显著差异，但它确实为特别脆弱的参与者（即失业和心理健康水平较低的参与者）提供了益处，而且在中期随访中也有明显的益处。这些结果为 SH+在管理难民和寻求庇护者的抑郁症状以及改善幸福感和自我认定的问题方面的应用提供了希望。
