Effectiveness and cost-effectiveness for the treatment of depressive symptoms in refugees and asylum seekers: A multi-centred randomized controlled trial

Böge, Kerem; Karnouk, Carine; Hoell, Andreas; Tschorn, Mira; Kamp‐Becker, Inge; Padberg, Frank; Übleis, Aline; Hasan, Alkomiet; Falkai, P.; Salize, Hans-Joachim; Meyer‐Lindenberg, Andreas; Banaschewski, Tobias; Schneider, Frank; Habel, Ute; Plener, Paul L.; Hahn, Eric; Wiechers, Maren; Strupf, Michael; Jobst, Andrea; Millenet, Sabina; Hoehne, Edgar; Sukale, Thorsten; Dinauer, Raphael; Schuster, Martin; Mehran, Nassim; Kaiser, Franziska; Bröcheler, Stefanie; Lieb, Klaus; Heinz, Andreas; Rapp, Michael A.; Bajbouj, Malek

doi:10.1016/j.lanepe.2022.100413

Cited by 18 publications

(24 citation statements)

References 35 publications

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“…In contrast to our hypothesis and to existing evidence for anxiety and depression in non-migrant adults [20], SCM was not superior to TAU in terms of symptom reduction. Nonetheless, within the overall MEHIRA study, including both adult and adolescent refugees, SCM significantly reduced depressive symptoms compared to TAU [25]. A reason for the missing differences between SCM and TAU in terms of symptom change in this study might be that the TAU group made use of a considerable amount of support by health authorities and other caretakers.…”

Section: Discussionmentioning

confidence: 68%

“…Since patients with low PTSD severity tend to improve less by psychological treatments [45], smartphone applications can serve as a promising treatment alternative [46]. However, in line with the primary MEHIRA study [25], the smartphone intervention did not improve mild depressive symptoms. Similar observations were reported in a meta-analysis, which found a tendency for reduced effects of low-intensity intervention on mild depressive symptoms [47].…”

Section: Discussionmentioning

confidence: 87%

“…For this, we used data of four child and adolescent mental health clinics which took part in the "Mental Health in Refugees and Asylum Seekers (MEHIRA)" study, which investigated clinical and patient-reported outcomes as well as cost-utility of a stepped and collaborative care model for refugees in Germany [24]. Since the primary MEHIRA study did not differentiate between adolescent and adult refugees in their analyses [25], we explicitly wanted to investigate the effect of SCM on ARAS. According to the study protocol, we defined the following hypotheses: we assumed that a culturally sensitive SCM leads to a significant reduction of depressive symptoms between preand post-treatment compared to treatment as usual (TAU).…”

Section: Aims Of the Studymentioning

confidence: 99%

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Culturally sensitive stepped care for adolescent refugees: efficacy and cost–utility of a multicentric randomized controlled trial

Höhne

Böge

Karnouk

et al. 2023

Eur Child Adolesc Psychiatry

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Adolescent refugees and asylum seekers (ARAS) are highly vulnerable to mental health problems. Stepped care models (SCM) and culturally sensitive therapies offer promising treatment approaches to effectively provide necessary medical and psychological support. To our knowledge, we were the first to investigate whether a culturally sensitive SCM will reduce symptoms of depression and PTSD in ARAS more effectively and efficiently than treatment as usual (TAU). We conducted a multicentric, randomized, controlled and rater-blinded trial across Germany with ARAS between the ages of 14 to 21 years. Participants (N = 158) were stratified by their level of depressive symptom severity and then equally randomized to either SCM or TAU. Depending on their severity level, SCM participants were allocated to tailored interventions. Symptom changes were assessed for depression (PHQ) and PTSD (CATS) at four time points, with the primary end point at post-intervention after 12 weeks. Based on an intention-to-treat sample, we used a linear mixed model approach for the main statistical analyses. Further evaluations included cost–utility analyses, sensitivity analyses, follow-up-analyses, response and remission rates and subgroup analysis. We found a significant reduction of PHQ (d = 0.52) and CATS (d = 0.27) scores in both groups. However, there was no significant difference between SCM and TAU. Cost–utility analyses indicated that SCM generated greater cost–utility when measured as quality-adjusted life years compared to TAU. Subgroup analysis revealed different effects for the SCM interventions depending on the outcome measure. Although culturally sensitive, SCMs did not prove to be more effective in symptom change and represent a more cost-effective treatment alternative for mentally burdened ARAS. Our research contributes to the optimization of clinical productivity and the improvement of therapeutic care for ARAS. Disorder-specific interventions should be further investigated.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 87%

Section: Aims Of the Studymentioning

confidence: 99%

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Culturally sensitive stepped care for adolescent refugees: efficacy and cost–utility of a multicentric randomized controlled trial

Höhne

Böge

Karnouk

et al. 2023

Eur Child Adolesc Psychiatry

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“…For instance, smartphone-delivered interventions could be implemented as part of a stepped-care approach where they represent a low threshold intervention in a hierarchy of differently intensive interventions. Such an approach is followed by the Sanadak intervention, where results have to be awaited for future implications (Böge et al, 2020 , 2022 ). Other smartphone-delivered interventions are used as blended-care interventions to complement group interventions (an exclusion criterion in this review; e.g., NESTT and The Happy Helping Hand) or in inpatient mental health care (e.g., Almamar ), revealing promising initial findings (e.g., Raknes et al, 2017 ; Mazzulla et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, since the field of study is constantly growing, new evidence is published frequently. For instance, new evidence on the intervention Step-by-Step and Sanadak has recently been published and could not be included in the systematic review (Böge et al, 2022 ; Cuijpers et al, 2022 ). Third, based on the current state of research, we were unable to look more closely at subgroups of refugees, for example, according to language, home country, or resettlement country.…”

Section: Discussionmentioning

confidence: 99%

Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature

El-Haj-Mohamad

Nohr

Niemeyer

et al. 2022

Camb. prisms Glob. ment. health

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According to the United Nations, an estimated 26.6 million people worldwide were refugees in 2021. Experiences before, during, and after flight increase psychological distress and contribute to a high prevalence of mental disorders. The resulting high need for mental health care is generally not reflected in the actual mental health care provision for refugees. A possible strategy to close this gap might be to offer smartphone-delivered mental health care. This systematic review summarizes the current state of research on smartphone-delivered interventions for refugees, answering the following research questions: (1) Which smartphone-delivered interventions are available for refugees? (2) What do we know about their clinical (efficacy) and (3) non-clinical outcomes (e.g., feasibility, appropriateness, acceptance, barriers)? (4) What are their dropout rates and dropout reasons? (5) To what extent do smartphone-delivered interventions consider data security? Relevant databases were systematically searched for published studies, gray literature, and unpublished information. In total, 456 data points were screened. Twelve interventions were included (nine interventions from eleven peer-reviewed articles and three interventions without published study reports), comprising nine interventions for adult refugees and three for adolescent and young refugees. Study participants were mostly satisfied with the interventions, indicating adequate acceptability. Only one RCT (from two RCTs and two pilot RCTs) founda significant reduction in the primary clinical outcome compared to the control group. Dropout rates ranged from 2.9 -80%. In the discussion, the heterogeneous findings are integrated into the current state of literature. Impact StatementRefugees are a large population with special mental health care needs which are nowadays not adequately addressed by most of the host countries. Experiences before, during, and after flight increase psychological distress and contribute to a high prevalence of mental disorders. The resulting high need for mental health care is generally not reflected in the actual mental health care provision for refugees. Potential reasons for low utilization include language difficulties, limited treatment offer, and lack of knowledge

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Peer‐provided problem management plus (PM+) and case management for Arabic‐speaking and Farsi‐speaking refugees and asylum seekers in Greece

Papathanasiou,

Kougioumtzi

2024

Mental Health Science

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An increasingly common response to the lack of specialist mental health services for refugees and asylum seekers in European host countries is peer‐supported services. This study examined the association between a peer‐provided psychosocial intervention and psychological symptom reduction among refugees and asylum seekers in Greece. The intervention consisted of Problem Management Plus (PM+) and peer case management sessions delivered by a team of Community Psychosocial Workers (trained refugees). The sample consisted of 173 participants, comprising Arabic and Farsi speakers, male and female participants, recognized refugees and asylum seekers. Anxiety, depression, and psychological distress were measured before and after the intervention using the Patient Health Questionnaire‐9, Generalized Anxiety Disorder‐7, and Psychological Outcome Profiles scales, respectively. Repeated measures analysis of variance was adopted to evaluate the difference in the degree of change across patient characteristics over the follow‐up period. The level of statistical significance was set at p < .05, and analyses were conducted using SPSS statistical software (version 26.0). Significant decreases were found in all postintervention scores, indicating significant decreases in anxiety and depression symptoms as well as in psychological distress following the peer‐provided psychosocial intervention, which included emotional support and social care. Large effect sizes were found at all scales. The findings support the notion that there is an association between the implemented intervention and symptom reduction in refugees. For future research, a randomized controlled trial is proposed as a study protocol.

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Effectiveness and cost-effectiveness for the treatment of depressive symptoms in refugees and asylum seekers: A multi-centred randomized controlled trial

Cited by 18 publications

References 35 publications

Culturally sensitive stepped care for adolescent refugees: efficacy and cost–utility of a multicentric randomized controlled trial

Culturally sensitive stepped care for adolescent refugees: efficacy and cost–utility of a multicentric randomized controlled trial

Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature

Peer‐provided problem management plus (PM+) and case management for Arabic‐speaking and Farsi‐speaking refugees and asylum seekers in Greece

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