Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey

et al. 2020

Trials

Background: A large proportion of Syrians have been exposed to potentially traumatic events, multiple losses, and breakdown of supportive social networks and many of them have sought refuge in host countries where they also face post-migration living difficulties such as discrimination or integration problems or both. These adversities may put Syrian refugees at high risk for common mental disorders. In response to this, the World Health Organization (WHO) developed a trans-diagnostic scalable psychological intervention called Problem Management Plus (PM+) to reduce psychological distress among populations exposed to adversities. PM+ has been adapted for Syrian refugees and can be delivered by non-specialist peer lay persons in the community. Methods: A randomized controlled trial (RCT) will be conducted with 380 Syrian refugees in Turkey. After providing informed consent, participants with high levels of psychological distress (scoring above 15 on the Kessler-10 Psychological Distress Scale (K10)) and functional impairment (scoring above 16 on the WHO Disability Assessment Schedule 2.0, or WHODAS 2.0) will be randomly assigned to Group PM+/enhanced care as usual (Group PM+/E-CAU) (n = 190) or E-CAU (n = 190). Outcome assessments will take place 1 week after the fifth session (post-assessment), 3 months after the fifth session and 12 months after baseline assessment. The primary outcome is psychological distress as measured by the Hopkins Symptom Checklist (HSCL-25). Secondary outcomes include functional impairment, post-traumatic stress symptoms, self-identified problems, and health system and productivity costs. A process evaluation will be conducted to explore the feasibility, challenges and success of the intervention with 25 participants, including participants, facilitators, policy makers and mental health professionals.

Section: Enhanced Usual Carementioning

confidence: 99%

Protocol for a randomized controlled trial: peer-to-peer Group Problem Management Plus (PM+) for adult Syrian refugees in Turkey

Uygun

İlkkurşun

et al. 2020

Trials

“…Syrians in Turkey have free access to mental health services in public hospitals and migrant health centres [27]. However, due to numerous barriers such as lack of knowledge on available mental health services or (self-)stigma, the use of mental health services is low among Syrian refugees [28,40]. Usual care will be enhanced by providing study participants with a leaflet on publicly available mental health services in the area where they live.…”

Section: Enhanced Usual Carementioning

confidence: 99%

Protocol for a Randomized Controlled Trial: Peer to Peer Group Problem Management Plus (PM+) for Adult Syrian Refugees in Turkey

Uygun

İlkkurşun

et al. 2020

Preprint

Background: A large proportion of Syrians have been exposed to potentially traumatic events, multiple losses, breakdown of supportive social networks and many of them have sought refuge in host countries where they also face post migration living difficulties such as discrimination or/and integration problems. These adversities may put Syrian refugees at high risk for common mental disorders. In response to this, the World Health Organization (WHO) developed a transdiagnostic scalable psychological intervention called Problem Management Plus (PM+) to reduce psychological distress among populations exposed to adversities. PM+ has been adapted for Syrian refugees and can be delivered by non-specialist peer lay persons in the community. Methods: A randomized controlled trial (RCT) will be conducted with 380 Syrian refugees in Turkey. After providing informed consent, participants with high levels of psychological distress (scoring >15 on the Kessler-10 Psychological Distress Scale (K10)) and functional impairment (scoring >16 on the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)) will be randomly assigned to Group PM+/Enhanced Care As Usual (Group PM+/E-CAU) (n = 190) or enhanced-care-as-usual (E-CAU) (n = 190). Outcome assessments will take place 1-week after the 5 th session (post assessment), 3 months after the 5 th session and 12 months after baseline assessment. The primary outcome is psychological distress as measured by the Hopkins Symptom Checklist (HSCL-25). Secondary outcomes include functional impairment, posttraumatic stress symptoms, self-identified problems, as well as health system and productivity costs. A process evaluation will be conducted to explore the feasibility, challenges and success of the intervention with 25 participants including participants, facilitators, policy makers and mental health professionals. Discussion: The treatment manual of the Syrian-Arabic Group PM+ and training materials will be made available through the WHO once the effectiveness and cost-effectiveness of group PM+ has been established. Keywords: Cognitive behavioural therapy, depression, anxiety, posttraumatic stress, refugee, mental health, group interventions, task shifting, trans-diagnostic

“…There is substantial evidence that conflict-affected populations are vulnerable to psychosocial distress and are at risk of considerably higher levels of mental disorders than non-conflict-affected populations [1][2][3]. Recent estimates suggest that the prevalence of mental disorders is 22•1% at any point in time in conflict-affected populations [2].…”

Section: Introductionmentioning

confidence: 99%

“…Recent estimates suggest that the prevalence of mental disorders is 22•1% at any point in time in conflict-affected populations [2]. High rates of symptoms of common mental disorders are understood as a direct consequence of exposure to violent and traumatic events, and ongoing daily stressors in people's lives including poor living conditions, impoverishment, unemployment, social isolation and discrimination [1,[3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…However, the accessibility and availability of MHPSS interventions in countries neighbouring Syria with large refugee populations (such as Turkey, Lebanon Jordan and Egypt) is limited [12]. A broader range of psychological interventions are being offered in European host countries, however access and utilisation is inadequate as well because of socio-cultural barriers to accessing care including language, cultural understanding of mental health, different interpretation of mental disorder symptoms, stigma and discrimination [3,12,13]. Lack of awareness of MHPSS services in European countries have also been reported as barriers to accessing care, in addition to health systems barriers such as long waiting times for treatment, lack of appropriately trained staff (including those who speak Arabic) and lack of interpreters [13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Planning the scale up of brief psychological interventions using theory of change

Fuhr

Acartürk

et al. 2020

BMC Health Serv Res

Self Cite

Background: A large mental health treatment gap exists among conflict-affected populations, and Syrian refugees specifically. Promising brief psychological interventions for conflict-affected populations exist such as the World Health Organization's Problem Management Plus (PM+) and the Early Adolescent Skills for Emotions (EASE) intervention, however, there is limited practical guidance for countries of how these interventions can be taken to scale. The aim of this study was to unpack pathways for scaling up PM+ and EASE for Syrian refugees. Methods: We conducted three separate Theory of Change (ToC) workshops in Turkey, the Netherlands, and Lebanon in which PM+ and EASE are implemented for Syrian refugees. ToC is a participatory planning process involving key stakeholders, and aims to understand a process of change by mapping out intermediate and long-term outcomes on a causal pathway. 15-24 stakeholders were invited per country, and they participated in a one-day interactive ToC workshop on scaling up. Results: A crosscountry ToC map for scale up brief psychological interventions was developed which was based on three country-specific ToC maps. Two distinct causal pathways for scale up were identified (a policy and financing pathway, and a health services pathway) which are interdependent on each other. A list of key assumptions and interventions which may hamper or facilitate the scaling up process were established. Conclusion: ToC is a useful tool to help unpack the complexity of scaling up. Our approach highlights that scaling up brief psychological interventions for refugees builds on structural changes and reforms in policy and in health systems. Both horizontal and vertical scale up approaches are required to achieve sustainability. This paper provides the first theory-driven map of causal pathways to help support the scaling-up of evidence-based brief psychological interventions for refugees and populations in global mental health more broadly.