Department of Psychology, Koc University, Istanbul, Türkiye.
School of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia.
Epidemiol Psychiatr Sci. 2024 Sep 30;33:e43. doi: 10.1017/S2045796024000453.
Despite high levels of psychological distress, mental health service use among Syrian refugees in urban settings is low. To address the mental healthcare gap, the World Health Organization developed group problem management plus (gPM+), a scalable psychological intervention delivered by non-specialist peer facilitators. The study aimed to evaluate the effectiveness of gPM+ in reducing symptoms of depression and anxiety among Syrian refugees in Istanbul, Türkiye.
A randomized controlled trial was conducted among 368 distressed (Kessler Psychological Distress Scale, K10 > 15) adult Syrian refugees with impaired functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16). Participants were recruited between August 2019 and September 2020 through a non-governmental organization providing services to refugees. Participants were randomly allocated to gPM+ and enhanced care as usual (gPM+/E-CAU) (184 participants) or E-CAU only (184 participants). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist (HSCL-25)) at 3-month follow-up. Secondary outcomes were post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5; PCL-5), functional impairment (WHODAS 2.0), and self-identified problems (psychological outcome profiles).
Intent-to-treat analyses showed no significant effect of gPM+ on symptoms of anxiety, depression, PTSD and self-identified problems. Yet, there was a significant reduction in functional impairment in gPM+/E-CAU compared to E-CAU at 3-month follow-up (adjusted mean difference 1.66, 95 % CI 0.04, 3.27, = 0.045, = 0.19). Post-hoc subgroup analyses among participants with probable baseline depression or anxiety showed that there was a small but significant reduction in depression (adjusted mean difference -0.17, 95 % CI -0.32, -0.02, = 0.028, = 0.27) and anxiety (adjusted mean difference -0.21, 95 % CI -0.37, -0.05, = 0.009, = 0.30) symptoms comparing gPM+/E-CAU to E-CAU only at 1-week post assessment, but not at 3-month follow-up. There was a significant difference between conditions on functional impairment at 3-month follow-up, favouring gPM+/E-CAU condition (adjusted mean difference -1.98, 95 % CI -3.93, -0.02, = 0.048, = 0.26).
In this study in an urban setting in Türkiye, gPM+ did not alleviate symptoms of depression and anxiety among Syrian refugees experiencing psychological distress and daily living difficulties. However, participants with higher distress at baseline seemed to benefit from gPM+, but treatment gains disappeared in the long term. Current findings highlight the potential benefit of tailored psychosocial interventions for highly distressed refugees in volatile low-resource settings.
尽管叙利亚难民的心理困扰程度很高，但他们在城市环境中使用心理健康服务的比例却很低。为了解决心理健康护理差距问题，世界卫生组织开发了团体问题管理加（gPM+），这是一种由非专业同行促进者提供的可扩展的心理干预措施。本研究旨在评估 gPM+在降低土耳其伊斯坦布尔叙利亚难民抑郁和焦虑症状方面的有效性。
这项随机对照试验招募了 368 名有心理困扰（Kessler 心理困扰量表，K10>15）和功能受损（世界卫生组织残疾评估量表，WHODAS 2.0>16）的成年叙利亚难民。参与者通过为难民提供服务的非政府组织招募，招募时间为 2019 年 8 月至 2020 年 9 月。参与者被随机分配到 gPM+和增强的常规护理（gPM+/E-CAU）（184 名参与者）或仅接受 E-CAU（184 名参与者）。主要结局是 3 个月随访时的抑郁和焦虑症状（霍普金斯症状清单（HSCL-25））。次要结局是创伤后应激障碍（PTSD）症状（DSM-5 创伤后应激障碍检查表；PCL-5）、功能障碍（WHODAS 2.0）和自我识别问题（心理结果概况）。
意向治疗分析显示，gPM+对焦虑、抑郁、PTSD 和自我识别问题的症状没有显著影响。然而，与 E-CAU 相比，gPM+/E-CAU 在 3 个月随访时的功能障碍显著减少（调整后的平均差异 1.66，95%置信区间 0.04，3.27， = 0.045， = 0.19）。在有基线抑郁或焦虑可能性的参与者的事后亚组分析中，gPM+/E-CAU 组的抑郁（调整后的平均差异-0.17，95%置信区间-0.32，-0.02， = 0.028， = 0.27）和焦虑（调整后的平均差异-0.21，95%置信区间-0.37，-0.05， = 0.009， = 0.30）症状较基线明显减少，但在 3 个月随访时没有减少。与仅接受 E-CAU 相比，gPM+/E-CAU 条件在 3 个月随访时在功能障碍方面存在显著差异，有利于 gPM+/E-CAU 条件（调整后的平均差异-1.98，95%置信区间-3.93，-0.02， = 0.048， = 0.26）。
在土耳其伊斯坦布尔的这一城市环境中，gPM+并没有减轻有心理困扰和日常生活困难的叙利亚难民的抑郁和焦虑症状。然而，基线时压力较大的参与者似乎从 gPM+中受益，但长期来看，治疗效果消失了。目前的研究结果强调了针对高度困扰的难民在不稳定的资源匮乏环境中量身定制的心理社会干预的潜在益处。
