Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial

Abstract

<b><i>Introduction:</i></b> Self-Help Plus (SH+) is a group-based psychological intervention developed by the World Health Organization for managing stress. <b><i>Objective:</i></b> To assess the effectiveness of SH+ in preventing mental disorders in refugees and asylum seekers in Western Europe. <b><i>Methods:</i></b> We conducted a randomized controlled trial in 5 European countries. Refugees and asylum seekers with psychological distress (General Health Questionnaire score ≥3), but without a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) or ICD/10 diagnosis of mental disorder, as assessed with the Mini International Neuropsychiatric Interview (MINI), were randomized to SH+ or enhanced treatment as usual (ETAU). The primary outcome was the frequency of mental disorders with the MINI at 6 months. Secondary outcomes included the frequency of mental disorders at postintervention, self-identified problems, psychological symptoms, and other outcomes. <b><i>Results:</i></b> Four hundred fifty-nine individuals were randomly assigned to SH+ or ETAU. For the primary outcome, we found no difference in the frequency of mental disorders at 6 months (Cramer <i>V</i> = 0.007, <i>p</i> = 0.90, RR = 0.96; 95% CI 0.52–1.78), while the difference significantly favored SH+ at after the intervention (secondary outcome, measured within 2 weeks from the last session; Cramer <i>V</i> = 0.13, <i>p</i> = 0.01, RR = 0.50; 95% CI 0.29–0.87). <b><i>Conclusions:</i></b> This is the first randomized indicated prevention study with the aim of preventing the onset of mental disorders in asylum seekers and refugees in Western Europe. As a prevention effect of SH+ was not observed at 6 months, but rather after the intervention only, modalities to maintain its beneficial effect in the long term need to be identified.

Effectiveness of self-help plus (SH+) in reducing anxiety and post-traumatic symptomatology among care home workers during the COVID-19 pandemic: a randomized controlled trial

“…Our target population was composed of workers from NCH with higher educational levels and with lower levels of symptoms at baseline, so that the effect of a low-intensity intervention might be less emphasized. On the other hand, our results appear to be relatively more aligned with those of a recent RCT testing the standard SH+ intervention in Europe with a preventative aim [ 63 ]. In this trial, 459 asylum seekers and refugees, resettled in five European countries, with increased psychological distress but without a formal psychiatric diagnosis, were randomized to receive the SH+ or enhanced usual care (i.e.…”

“…However, the authors did report, as a secondary result, a positive effect for psychological distress, depressive symptoms, perceived problems and well-being at post-intervention. For well-being (as measured with the WHO-5, like in our study), the estimate was still significant at the six-month follow-up [63].…”

“…This design has the advantage of enabling firm conclusions on the possible effects of the intervention based on its specific ACT-based contents [14,15], rather than on non-specific components like receiving attention, or being involved in generic activities [62]. The present findings would suggest that the positive effects of the SH+ observed in previous trials [18,63,64], that did not employ a control condition with similar quality and quantity of interactions and stimulation given to participants, might be related to non-specific factors. These factors were similar to the so-called 'common factors' of psychotherapeutic interventions, such as the provision of structured and interactive activities, contents that stimulate reflection and expression of emotions, guided exercises and the stimulation of multiple senses through visual and auditory channels [65] (see §2.2).…”

Editorial: The Nine Grand Challenges in Global Mental Health

“…The best health infrastructure and the largest mental health care resources are of no value if affected populations are stigmatized or if no knowledge exists regarding diseases or treatment options on the caretakers' side. Equally important, health literacy needs to be present on the caregivers' side with respect to cultural differences in idioms of distress or concerning culture-sensitive treatment modifications (10,11). (12,13).…”

Moving beyond a ‘one-size-fits-all’ rationale in global mental health: prospects of a precision psychology paradigm

“…Recently, two large RCTs evaluated a new psychological intervention called Self-Help Plus (SH+) and developed by the WHO, with the aim of preventing the onset of mental disorders in asylum seekers and refugees. These trials identified a beneficial effect of SH+ in preventing the frequency of mental disorders at post-intervention (Purgato et al ., 2021 ) and at 6-month follow-up (Acarturk et al ., in press ).…”