World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Eur J Psychotraumatol. 2024;15(1):2355828. doi: 10.1080/20008066.2024.2355828. Epub 2024 Jun 3.
Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations. We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+. Participants allocated to SH+ who received at least three sessions ( = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested. Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems. Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.
可扩展的心理干预措施，如世界卫生组织的自助加（SH +），已经为需要心理支持的临床和非临床人群开发。SH + 已成功实施，以预防由于被迫迁移而数量不断增加的寻求庇护者和难民中常见的精神障碍。这些人群经常面临多种严重的创伤源，而且关于此类事件对治疗效果的证据不足，特别是对于非临床人群。我们旨在研究创伤后体验（PTE）的影响以及创伤后应激障碍（PTSD）症状的中介作用对 SH + 后的改善。从涉及寻求庇护者和难民的两项大型随机欧洲预防试验中提取了至少接受了三个疗程（ = 345）的 SH + 分配参与者。在基线和干预后 6 个月时，使用困扰、抑郁、功能障碍和创伤后应激症状的测量值以及幸福感和生活质量的测量值进行评估。构建了调整模型来检查 PTE 对干预后改善的影响。然后测试了 PTSD 症状在这种关系中的可能中介作用。PTE 数量的增加减少了 SH + 对所有测量值的有益效果。当分析幸福感和生活质量的测量值时，这种关系由 PTSD 症状介导。但是，对于心理健康问题的测量值则不适用。暴露于 PTE 可能会大大降低 SH + 的益处。PTSD 症状在经历 PTE 的参与者的心理幸福感和生活质量方面起着特定的中介作用。医疗保健专业人员和研究人员应考虑 PTE 和 PTSD 症状在移民和难民治疗中的作用，并探索针对暴露于多种 PTE 的病例的可行附加解决方案。
