Asanov Anastasiya-Mariya, Asanov Igor, Buenstorf Guido
INCHER, University of Kassel, Mönchebergstraße 17, 34125, Kassel, Germany.
Soc Sci Med. 2024 Dec;362:117442. doi: 10.1016/j.socscimed.2024.117442. Epub 2024 Oct 24.
Armed conflicts increase distress levels among affected populations, particularly impacting refugees who often face barriers to accessing psychological support. We evaluate an online version of a previously tested in-person and endorsed for online adaptation by the WHO Self-Help Plus (SH+) program among Ukrainian refugees dispersed across 17 countries, internally displaced and not displaced Ukrainians. This is the first randomized controlled trial to test an online psychological intervention simultaneously on refugees, internally displaced, and non-displaced conflict-affected populations. This study is an online two-arm, individually randomized controlled trial among participants above 18 years old in Ukraine or EU countries who were randomly assigned to receive either the Self-Help Online (SHO) intervention and passive informational resource or the passive informational resource alone. We recruited 652 participants starting the program on July 7th, 2022. The analysis focused on 292 participants who completed the final survey one week after the end of the program. Results indicated significant distress reduction among refugees (β -2.16, 95% CI -4.17 to -0.16; p = 0.03; d -0.47) but not among internally displaced in Ukraine (β 0.56, 95% CI -1.1 to 2.99; p = 0.17; d 0.2) or non-displaced participants in Ukraine (β 0.2, 95% CI -0.95 to 1.35; p = 0.73; d 0.08). The effect size in stress reduction for refugees was comparable to other similar interventions but with lower average costs. The average cost per participant was €11, with €46.16 for each benefiting (refugee) participant, suggesting cost-effectiveness for scale-up. These findings suggest that Self-Help Online is an effective psychological intervention for reducing stress among geographically dispersed refugees at a low cost. We also find that the online delivery format of psychological interventions is feasible for internally displaced and non-displaced conflict-affected populations.
武装冲突加剧了受影响人群的痛苦程度，尤其对难民影响巨大，他们在获取心理支持方面往往面临重重障碍。我们对世界卫生组织自助增强版（SH+）项目之前经过面对面测试且认可可进行在线改编的一个在线版本进行了评估，该评估针对分散在17个国家的乌克兰难民、境内流离失所者以及未流离失所的乌克兰人。这是首次在难民、境内流离失所者以及未流离失所的受冲突影响人群中同时测试在线心理干预的随机对照试验。本研究是一项在线双臂、个体随机对照试验，研究对象为乌克兰或欧盟国家18岁以上的参与者，他们被随机分配接受自助在线（SHO）干预和被动信息资源，或者仅接受被动信息资源。我们从2022年7月7日开始招募了652名参与者。分析集中在项目结束一周后完成最终调查的292名参与者身上。结果表明，难民的痛苦程度显著降低（β -2.16，95%置信区间 -4.17至 -0.16；p = 0.03；d -0.47），但乌克兰境内流离失所者（β 0.56，95%置信区间 -1.1至2.99；p = 0.17；d 0.2）或乌克兰未流离失所的参与者（β 0.2，95%置信区间 -0.95至1.35；p = 0.73；d 0.08）的痛苦程度没有显著降低。难民压力减轻的效应大小与其他类似干预措施相当，但平均成本较低。每位参与者的平均成本为11欧元，每位受益（难民）参与者的成本为46.16欧元，这表明扩大规模具有成本效益。这些发现表明，自助在线是一种有效的心理干预措施，能够以低成本减轻地理上分散的难民的压力。我们还发现，心理干预的在线交付形式对境内流离失所者和未流离失所的受冲突影响人群是可行的。
