Pluess Michael, McEwen Fiona S, Biazoli Claudinei, Chehade Nicolas, Bosqui Tania, Skavenski Stephanie, Murray Laura, Weierstall-Pust Roland, Bolton Paul, Karam Elie
School of Psychology, University of Surrey, Lewis Carrol Building, Guildford, GU2 7XH, UK.
Biological and Experimental Psychology, School of Biological and Behavioural Science, Queen Mary University of London, Mile End Road, London, UK.
Confl Health. 2024 Sep 20;18(1):58. doi: 10.1186/s13031-024-00616-2.
In recent years, the number of forcibly displaced persons has risen worldwide, with approximately 40% being children and adolescents. Most of them are hosted in low- and middle-income countries (LMICs). Many individuals meet the criteria for mental health issues, which can also be exacerbated by a number of risk factors, including low socioeconomic status, displacement, and stressors linked to conflicts in their country or region of origin. However, the vast majority never receive treatment for their psychological problems due to multiple reasons, including a shortage of mental health professionals in LIMCs, transportation challenges in accessing clinics, and clinic hours conflicting with family commitments. In the current study we investigated whether individual psychotherapy delivered by trained lay counsellors over telephone to Syrian refugee children living in Lebanon is effective and overcomes barriers to treatment access.
After adaptation of Common Elements Treatment Approach (CETA) to remote delivery over telephone (t-CETA), preliminary effectiveness of the treatment modality was assessed with a pilot single blind randomised controlled trial including a total sample of 20 refugee children with diagnosed mental health problems. Data was analysed applying a Bayesian approach.
There was a significant session-by-session decrease in self-reported mental health symptoms over the course of treatment. Independent assessments showed that t-CETA resulted in a greater reduction of symptoms than standard in-person treatment as usual. There was no difference between groups for impairment. Importantly, the majority of children allocated to t-CETA completed treatment whilst no children in the treatment as usual condition were able to do so.
The study provides preliminary evidence that telephone-delivered psychotherapy in a humanitarian setting, delivered by lay counsellors under supervision, works and significantly increases access to treatment compared to traditional in-person treatment. However, findings remain to be replicated in larger trials.
Clinical Trials. gov ID: NCT03887312; registered 22nd March 2019.
近年来，全球被迫流离失所者的数量不断增加，其中约40%为儿童和青少年。他们中的大多数人生活在低收入和中等收入国家（LMICs）。许多人符合心理健康问题的标准，一些风险因素也会加剧这些问题，包括社会经济地位低下、流离失所，以及与他们原籍国或地区冲突相关的压力源。然而，绝大多数人由于多种原因从未接受过心理问题的治疗，这些原因包括低收入和中等收入国家心理健康专业人员短缺、前往诊所面临交通挑战，以及诊所营业时间与家庭事务冲突。在本研究中，我们调查了由经过培训的非专业咨询师通过电话为居住在黎巴嫩的叙利亚难民儿童提供的个体心理治疗是否有效，以及是否克服了治疗获取方面的障碍。
在将通用要素治疗方法（CETA）调整为通过电话远程提供（t-CETA）后，通过一项试点单盲随机对照试验评估了该治疗方式的初步有效性，该试验共纳入了20名被诊断患有心理健康问题的难民儿童。采用贝叶斯方法对数据进行分析。
在治疗过程中，自我报告的心理健康症状逐次显著下降。独立评估表明，与标准的面对面常规治疗相比，t-CETA导致的症状减轻更为明显。两组在功能损害方面没有差异。重要的是，分配到t-CETA组的大多数儿童完成了治疗，而常规治疗组中没有儿童能够完成治疗。
该研究提供了初步证据表明，在人道主义环境中，由非专业咨询师在监督下通过电话提供的心理治疗是有效的，并且与传统的面对面治疗相比，显著增加了治疗的可及性。然而，研究结果仍有待在更大规模的试验中进行重复验证。
ClinicalTrials.gov标识符：NCT03887312；于2019年3月22日注册。
