Maddock Alan, Heang Thearith, Ean Nil, Kheng Sisary, Best Paul, Ramstrand Nerrolyn
Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
Exceed Worldwide, Phnom Penh, Cambodia.
Int J Ment Health Syst. 2025 Aug 21;19(1):28. doi: 10.1186/s13033-025-00681-x.
Mental health disorders are major public health challenges, particularly in low- and middle-income countries such as Cambodia, where chronic shortages in mental health services and human resources exist. These issues are compounded for marginalized groups such as persons with physical disabilities due to their being at a higher risk of psychological distress and PTSD symptoms. The development of effective and accessible mental health systems in Cambodia will require evidence-based culturally appropriate mental health interventions. There are insufficient good-quality studies which have been completed to draw firm conclusions about the effectiveness of culturally appropriate mental health interventions in Cambodia. The aim of this study was to evaluate the effectiveness of a task shifted multi-component mental health intervention (named 'Friendship groups') at reducing psychological distress and PTSD, worry, rumination and increasing mindfulness among cohort of prosthetic and orthotic (P&O) service users.
From March 2023 to June 2024 data (N = 465) were collected as part of a mental health screening programme for P&O service users across Cambodia. Participants experiencing mild to moderate psychological distress were screened and invited to participate in this study. Due to ethical considerations a non-randomised controlled trial design with repeated measures (pre-post intervention) was conducted to evaluate the effects of Friendship groups (N = 33) against a non-active control condition (N = 39).
When compared to the control condition the Friendship groups were found to have a moderate to large effect on psychological distress, and a small to moderate effect on rumination. The Friendship group participants experienced reduced PTSD symptoms, worry and improved mindfulness post group but these changes were not significant when compared to the control condition.
The results from this study evidence the acceptability and effectiveness of Friendship groups at reducing psychological distress. Our results also provide clear guidance that if Friendship groups are implemented across P&O services in Cambodia, P&O service users are likely to experience reduced psychological distress. These findings also add to the growing literature supporting the need for culturally adapted task shifted mental health interventions in low- and middle-income countries, where access to specialised care remains limited.
心理健康障碍是重大的公共卫生挑战，在柬埔寨等低收入和中等收入国家尤为如此，这些国家存在心理健康服务和人力资源长期短缺的问题。对于身体残疾者等边缘化群体而言，这些问题更加复杂，因为他们出现心理困扰和创伤后应激障碍症状的风险更高。在柬埔寨建立有效且可及的心理健康系统需要基于证据且符合文化背景的心理健康干预措施。目前尚未完成足够多的高质量研究以就符合文化背景的心理健康干预措施在柬埔寨的有效性得出确凿结论。本研究的目的是评估一项任务转移的多成分心理健康干预措施（名为“友谊小组”）在减轻假肢和矫形器（P&O）服务使用者群体的心理困扰、创伤后应激障碍、担忧、沉思以及提高正念方面的有效性。
2023年3月至2024年6月期间，作为柬埔寨全国P&O服务使用者心理健康筛查项目的一部分收集了数据（N = 465）。对经历轻度至中度心理困扰的参与者进行筛查并邀请其参与本研究。出于伦理考虑，采用了重复测量（干预前后）的非随机对照试验设计，以评估“友谊小组”（N = 33）相对于非活动对照条件（N = 39）的效果。
与对照条件相比，发现“友谊小组”对心理困扰有中度至较大影响，对沉思有小至中度影响。“友谊小组”的参与者在小组活动后创伤后应激障碍症状、担忧减轻，正念提高，但与对照条件相比，这些变化并不显著。
本研究结果证明了“友谊小组”在减轻心理困扰方面的可接受性和有效性。我们的结果还提供了明确指导，即如果在柬埔寨的P&O服务中实施“友谊小组”，P&O服务使用者的心理困扰可能会减轻。这些发现也为越来越多支持在低收入和中等收入国家开展符合文化背景的任务转移心理健康干预措施的文献增添了内容，在这些国家，获得专科护理的机会仍然有限。
