Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda

Brown, Felicity L.; Carswell, Kenneth; Augustinavicius, Jura; Adaku, Alex; Leku, Marx R.; White, Ross; Ventevogel, Peter; Kogan, Cary S.; García‐Moreno, Claudia; Bryant, Richard A.; Musci, Rashelle J.; Ommeren, Mark van; Tol, Wietse A.

doi:10.1017/gmh.2018.17

Cited by 18 publications

(12 citation statements)

References 70 publications

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“…WHO and UN High Commissioner for Refugees have designed the mhGAP Humanitarian Intervention Guide, 14 which addresses the assessment and management of moderate and severe mental disorders in non-specialised health-care settings, such as general hospitals and primary health care. Moreover, a variety of packages designed to address multiple mental disorders, such as Problem Management Plus, Common Elements Treatment Approach and Self-Help Plus, have been used with promising results among conflict-affected Pakistanis, Burmese refugees, and South Sudanese refugees 40, 41, 42. It should be noted that there is wide consensus that mental health and psychosocial support for affected populations should go beyond psychological and medical treatments for mental disorders, and that such support should include psychosocial intervention that strengthens community self-help and support 13 and advocacy for security and protection and for adequate humanitarian aid, including basic health services and livelihood support.…”

Section: Discussionmentioning

confidence: 99%

New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

et al. 2019

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Background Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. Methods In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. Findings We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22•1% (95% UI 18•8-25•7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13•0% (95% UI 10•3-16•2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4•0% (95% UI 2•9-5•5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5•1% (95% UI 4•0-6•5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. Interpretation The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. Funding WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.

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Section: Discussionmentioning

confidence: 99%

New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

et al. 2019

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“…Especially for patients with trauma-related disorders, web-based CBT [ 22 - 28 ], coping strategy programs [ 29 , 30 ], as well as computer games to re-consolidate traumatic intrusive memories [ 31 , 32 ], have been shown to have promising effects in reducing trauma symptoms [ 33 ]. Further, app-based self-help interventions using image- and audio-based formats show encouraging effects on distress, PTSD, and depression symptoms [ 16 , 34 - 37 ]. Therefore, digital psychosocial interventions are a promising approach for asylum seekers and refugees.…”

Section: Introductionmentioning

confidence: 99%

Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study

Zehetmair¹,

Nagy²,

Leetz³

et al. 2020

J Med Internet Res

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Background Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees’ emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. Objective This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. Methods From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. Results At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique “The Inner Safe Place” was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. Conclusions The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, “The Inner Safe Place” technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.

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“…Rahman and colleagues have examined the cost-effectiveness of a multicomponent behavioral intervention delivered by lay helpers with conflict-affected adults in Pakistan [ 16 ]. Tol and colleagues have evaluated a guided self-help intervention with South Sudanese female refugees in northern Uganda [ 17 – 20 ], and are adapting and evaluating this intervention for use with male refugees.…”

Section: R2hc-funded Mhpss Researchmentioning

confidence: 99%

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

et al. 2020

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Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC’s research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).

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Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda

Cited by 18 publications

References 70 publications

New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

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