Department of Psychology, University of Washington, Seattle.
Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle.
JAMA Netw Open. 2024 Aug 1;7(8):e2429661. doi: 10.1001/jamanetworkopen.2024.29661.
The global refugee crisis disproportionately affects the Muslim world. Forced displacement often results in trauma-related mental health issues. Effective psychotherapy exists, but there are barriers to uptake by refugee groups as well as a lack of culturally appropriate interventions.
To examine the efficacy of a brief, lay-led, mosque-based intervention, Islamic Trauma Healing (ITH), adapting empirically supported cognitive behavioral principles to improve mental health and well-being.
DESIGN, SETTING, AND PARTICIPANTS: In a randomized clinical trial, 101 participants received ITH or active assessment but delayed intervention (waiting list [WL]) in mosques and virtually in Seattle, Washington, and Columbus, Ohio, and were assessed through 12-week follow-up. Data were collected from July 14, 2018, through July 14, 2022, and data analysis was conducted from March 13 to July 31, 2023. United States-based refugees from Somalia who experienced a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Criterion A trauma exposure and posttraumatic stress disorder (PTSD) reexperiencing or avoidance. Analyses were intention-to-treat, using full information likelihood for missing data.
Islamic Trauma Healing included psychoeducation, discussion of the lives of prophets who had undergone trauma, and informal prayer turning to Allah about the trauma, incorporating cognitive restructuring and imaginal exposure. Lay-leader training is purposely brief: two 4-hour sessions with weekly supervision.
The primary outcome was PTSD severity (measured with the Posttraumatic Diagnostic Scale for DSM-5 [PDS-5]). Secondary outcomes included depression (Patient Health Questionnaire-9), somatic symptoms (Somatic Symptoms Severity-8), and quality of well-being (World Health Organization Five Well-Being Index). Analyses were intention-to-treat.
Analyses were based on all 101 randomized participants (92 [91.1%] women; 9 [8.9%] men; mean [SD] age, 46.5 [12.02] years) with baseline mean (SD) PDS-5 score of 31.62 (16.55) points. There were significant differences in PTSD severity (d = -0.67), depression (d = -0.66), and well-being (d = 0.71), comparing ITH vs WL after the intervention. Gains were maintained through 12-week follow-up. Islamic Trauma Healing was consistent with religious and cultural practices (mean [SD], 3.8 [0.43]) and promoted community reconciliation (mean [SD], 3.8 [0.42]).
In this randomized clinical trial of a brief, lay-led mental health intervention, ITH proved superior to WL. The findings suggest that ITH has the potential to provide an easily trainable and scalable intervention, incorporating Islam and empirically supported principles, that addresses the psychological wounds of war and refugee trauma.
ClinicalTrials.gov Identifier: NCT03502278.
全球难民危机不成比例地影响着穆斯林世界。被迫流离失所通常会导致与创伤相关的心理健康问题。虽然存在有效的心理治疗方法，但难民群体在接受治疗方面存在障碍，并且缺乏文化上合适的干预措施。
研究一种简短的、由外行领导的、基于清真寺的干预措施——伊斯兰创伤疗愈（ITH）的疗效，该方法将经验支持的认知行为原则进行改编，以改善心理健康和幸福感。
设计、地点和参与者：在一项随机临床试验中，101 名参与者在华盛顿州西雅图和俄亥俄州哥伦布的清真寺和虚拟环境中接受了 ITH 或积极评估但延迟干预（等待名单[WL]），并在 12 周的随访中进行评估。数据于 2018 年 7 月 14 日收集至 2022 年 7 月 14 日，数据分析于 2023 年 3 月 13 日至 7 月 31 日进行。参与者为来自索马里的美国难民，经历了《精神疾病诊断与统计手册》第五版（DSM-5）A 类创伤暴露和创伤后应激障碍（PTSD）再体验或回避。分析采用意向治疗，使用完全信息似然法处理缺失数据。
ITH 包括心理教育、讨论经历过创伤的先知的生活，以及非正式的向真主祈祷以减轻创伤，同时融入认知重构和想象暴露。外行领导者的培训故意简短：两个 4 小时的课程，每周进行一次监督。
主要结局是 PTSD 严重程度（采用 DSM-5 创伤后诊断量表[PDS-5]测量）。次要结局包括抑郁（患者健康问卷-9）、躯体症状（躯体症状严重程度-8）和幸福感（世界卫生组织五维健康指数）。分析采用意向治疗。
分析基于所有 101 名随机参与者（92 名[91.1%]女性；9 名[8.9%]男性；平均[SD]年龄 46.5[12.02]岁），基线 PDS-5 平均（SD）得分为 31.62（16.55）分。与 WL 相比，ITH 在干预后 PTSD 严重程度（d = -0.67）、抑郁（d = -0.66）和幸福感（d = 0.71）方面存在显著差异。在 12 周的随访中，疗效得以维持。ITH 与宗教和文化实践一致（平均[SD]，3.8[0.43]），并促进社区和解（平均[SD]，3.8[0.42]）。
在这项针对简短的、由外行领导的心理健康干预措施的随机临床试验中，ITH 优于 WL。研究结果表明，ITH 有可能提供一种易于培训和扩展的干预措施，将伊斯兰教和经验支持的原则相结合，以解决战争和难民创伤造成的心理创伤。
ClinicalTrials.gov 标识符：NCT03502278。
