Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM+EP) for refugee youth living in the Netherlands: study protocol

Abstract

Background Refugee youth experience hardships associated with exposure to trauma in their homelands and during and after displacement, which results in higher rates of common mental disorders. The World Health Organization (WHO) developed Problem Management Plus (PM+), a non-specialist-delivered brief psychological intervention, for individuals who have faced adversity. PM+ comprises problem-solving, stress management, behavioural activation and strengthening social support. However, it does not include an emotional processing component, which is indicated in trauma-exposed populations. Objective This pilot randomized controlled trial (RCT) aims to evaluate the feasibility and acceptability of PM+, adapted to Syrian, Eritrean and Iraqi refugee youth residing in the Netherlands, with and without a newly developed Emotional Processing (EP) Module. Methods Refugee youth ( N = 90) between 16 and 25 years of age will be randomized into PM+ with care-as-usual (CAU), ( n = 30), PM+ with Emotional Processing (PM+EP) with CAU ( n = 30) or CAU only ( n = 30). Inclusion criteria are self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 > 16). Participants will be assessed at baseline, one-week post-intervention and three-month follow-up. The main outcome is the feasibility and acceptability of the adapted PM+ and PM+EP. The secondary outcomes are self-reported psychological distress, functional impairment, post-traumatic stress disorder (PTSD) symptom severity and diagnosis, social support, and self-identified problems. The pilot RCT will be succeeded by a process evaluation including trial participants, participants’ significant others, helpers, and mental health professionals ( n = 20) to evaluate their experiences with the PM+ and PM+EP programmes. Results and Conclusion This is the first study that evaluates the feasibility of PM+ for this age range with an emotional processing module integrated. The results may inform larger RCTs and implementation of PM+ interventions among refugee youth. Trial Registration Registered to Dutch Trial Registry, NL8750, on 3 July 2020. Medical Ethical Committee of the Amsterdam University Medical Centre, location Vrije Universiteit Medical Centre, Protocol ID: 2020.224, 1 July 2020.

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

“…Eligible studies were (cluster) randomized controlled trials (RCTs) examining the effects of PM+ or SbS in stress-exposed populations of all ages. Studies were eligible if PM+ or SbS was delivered as initially proposed 6,9 or amended with additional components (e.g., targeting alcohol consumption 20 or emotion processing 21 ), but ineligible if they examined stepped-care programs employing PM+/SbS as second step. All comparators were eligible, including waitlist, (enhanced) care-as-usual, and active control conditions.…”

Systematic Review and Meta-Analysis of Interventions to Improve Children's Social Information-Processing Skills

“…Subsequent to applying the eligibility criteria and screening rules, 74 unique articles were selected for full-text review. Of those, 32 articles were further excluded: 22 were not explicitly guided by the SIP model (Amador Buenabad et al, 2020; Axford et al, 2020; Cheung et al, 2021; Gengoux et al, 2021; Hu et al, 2021; Huitsing et al, 2020; Johnstone et al, 2020; Karmaliani et al, 2020; Løvaas et al, 2020; Navsaria et al, 2020; Olweus et al, 2020; Ossa et al, 2021; Perkins et al, 2021; Rapee et al, 2020; Roux & Philippot, 2020; Schoneveld et al, 2020; Stichter et al, 2010; Tajik-Parvinchi et al, 2020; Taylor et al, 2020; Venturo-Conerly et al, 2021; Voith et al, 2020; Zambuto et al, 2022), 4 were not focused on children or adolescents (Kasperzack et al, 2020; Kivity et al, 2021; Schweden et al, 2020; Serin et al, 2009), 5 did not include target outcomes (i.e., behavioral, educational, or mental health outcomes) (Alozkan Sever et al, 2021; Arzamarski et al, 2021; Clarkson et al, 2022; Pedrini et al, 2021; Riggs et al 2006), and 1 was excluded due to its nonempirical study design (Verhees et al, 2017). This process resulted in 42 articles that were retained for the final full-text review (see Figure 1).…”

“…Roux & Philippot, 2020;Schoneveld et al, 2020;Stichter et al, 2010;Tajik-Parvinchi et al, 2020;Taylor et al, 2020;Venturo-Conerly et al, 2021;Voith et al, 2020;Zambuto et al, 2022), 4 were not focused on children or adolescents(Kasperzack et al, 2020;Kivity et al, 2021;Schweden et al, 2020;Serin et al, 2009), 5 did not include target outcomes (i.e., behavioral, educational, or mental health outcomes) (AlozkanSever et al, 2021;Arzamarski et al, 2021;Clarkson et al, 2022;Pedrini et al, 2021;Riggs et al 2006), and 1 was excluded due to its nonempirical study design(Verhees et al, 2017). This process resulted in 42 articles that were retained for the final full-text review (see Figure1).…”

A qualitative evaluation of the use of Problem Management Plus (PM+) among Arabic-speaking migrants with psychological distress in France – The APEX study

“…Adaptations of PM + in other contexts, (e.g. Rwanda, Peru, Malawi), have also recommended modifying the language (including idioms), images, and diagrams used in the PM + protocol to fit participant literacy level (Alozkan Sever et al, 2021 ; Coleman et al, 2021 ).…”

“…PM + is a low-intensity psychosocial intervention for the management of psychological distress that has been implemented with multiple migrant populations (Akhtar et al, 2020 ; Alozkan Sever et al, 2020 ; Alozkan Sever et al, 2021 ; Coleman et al, 2021 ; Rahman et al, 2016 ; Sijbrandij et al, 2017 ; Sijbrandij et al, 2020 ; Uygun et al, 2020 ). It combines problem management with targeted behavioural activation strategies and draws on CBT (Dawson et al, 2015 ).…”