The aim of this study is to evaluate the effects of a trauma-focused psychotherapy upon war refugees from Bosnia. Seventy refugees who met the criteria for posttraumatic stress disorder (PTSD) and somatoform disorders were included. The first 35 refugees were offered psychotherapy and the following 35 refugees received usual care. Outcome variables were changes in self-reported PTSD symptoms, psychological symptoms, and health status. At 12-month follow-up, participants in the intervention group reported significantly lower scores on the PTSD scale and the measure of psychological symptoms than the comparison group participants. Our results suggest that psychotherapy reduces symptoms of PTSD and somatoform disorders among war refugees even in the presence of insecure residence status.

ROTATE was efficacious in treating Cambodian patients with high symptom levels of PTSD, emotional distress and impaired functioning. ROTATE is a brief, culturally adaptable intervention focusing on stabilization and strengthening resources rather than trauma confrontation. It can be taught to local professionals and paraprofessionals and enhance access to mental health care for patients in need.

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using computerized software on a 1:1 basis, stratified for gender. Nine out of 60 (15%) -five from the intervention arm and four from the control arm -were lost to follow-up. The groups were well-balanced at baseline for demographic and clinical variables.The primary outcome, assessed by independent raters, was psychological distress, measured by GHQ-12 with scores being the total sum across 12 items (possible range 0-36). Other outcomes included: functioning, measured using the 12-item interviewer-administered screener version of the WHODAS 2.0; and post-traumatic stress symptoms, measured using the PTSD Checklist for DSM-5 (PCL-5) 8 , which is a 20-item checklist corresponding to the twenty DSM-5 PTSD symptoms in the last week, with items rated on a 0-4 scale (possible range 0-80).The intervention had high uptake, with 22/30 (73%) completing all sessions. The intervention arm showed improvement in functioning (mean WHODAS 2.0 scores reduced from 17.7 6 9.2 to 6.6 6 6.1 vs. 17.0 6 10.5 to 11.3 6 10.4 in controls) and in posttraumatic stress symptoms (mean PCL-5 scores reduced from 34.2 6 20.1 to 9.8 6 9.1 vs. 32.3 6 17.1 to 19.5 6 18.5 in controls). Due to skewed distribution and variance heterogeneity of the outcome variable, log-linear regression was carried out. After adjustment of baseline scores, the results showed a reduction of 90% in geometric mean within the intervention group (95% CI: 90.4%-91.7%, p50.04) in WHODAS 2.0 scores and a reduction of 92% (95% CI: 91.2%-92.3%, p50.02) in post-traumatic stress symptoms. There was no significant change in GHQ-12 scores. On qualitative evaluation of a sub-sample of participants and primary care staff, we found that the intervention was perceived as useful, and was successfully integrated into primary care centres.As this was a pilot study with a small sample size, recruited through primary care physician referral, and no power calculations were carried out, the findings and their generalizability warrant a cautious interpretation. However, a successful conduction in challenging settings, with adequate enrolment rate, a low drop-out, and balanced randomization provides evidence that RCTs are feasible in such settings. The intervention delivery through non-specialists with no prior mental health care experience and the encouraging results demonstrate the feasibility of the task shifting approach, and are consistent with previous reports 9, 10 . The results of this pilot study should encourage further adaptation and large-scale fully-powered RCTs of this new, transdiagnostic psychological intervention 4 .

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