Twelve-month follow-up of a randomised clinical trial of a brief group psychological intervention for common mental disorders in Syrian refugees in Jordan

Abstract

Aims There is increasing evidence that brief psychological interventions delivered by lay providers can reduce common mental disorders in the short-term. This study evaluates the longer-term impact of a brief, lay provider delivered group psychological intervention (Group Problem Management Plus; gPM+) on the mental health of refugees and their children's mental health. Methods This single-blind, parallel, controlled trial randomised 410 adult Syrians in Azraq Refugee Camp in Jordan who screened positive for distress and impaired functioning to either five sessions of gPM+ or enhanced usual care (EUC). Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL-25; depression and anxiety scales) assessed at baseline, 6 weeks, 3 months and 12 months Secondary outcomes included disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behaviour and children's mental health. Results Between 15 October 2019 and 2 March 2020, 204 participants were assigned to gPM + and 206 to EUC, and 307 (74.9%) were retained at 12 months. Intent-to-treat analyses indicated that although participants in gPM + had greater reductions in depression at 3 months, at 12 months there were no significant differences between treatment arms on depression (mean difference −0.9, 95% CI −3.2 to 1.3; p = 0.39) or anxiety (mean difference −1.7, 95% CI −4.8 to −1.3; p = 0.06). There were no significant differences between conditions for secondary outcomes except that participants in gPM + had greater increases in positive parenting. Conclusions The short-term benefits of a brief, psychological programme delivered by lay providers may not be sustained over longer time periods, and there is a need for sustainable programmes that can prolong benefits gained through gPM + .

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

“…Table 1 presents the characteristics of the 23 studies, comprising 5,298 participants (range of sample sizes: 8 to 680), included in our review [10][11][12][13][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] . These were performed in Pakistan (four studies); Lebanon, Kenya (three studies each); Jordan, The Netherlands, Nepal (two studies each); Australia, Austria, China, Colombia, Switzerland, Turkey and the UK (one study each).…”

“…Seventeen studies (73.9%) were conducted in low-to-middle income countries. Fifteen studies included follow-up assessments between 3 and 6 months; a longer follow-up interval of 12 months was only reported for one study 37 . Six studies (26.1%) were performed within the STRENGTHS project and examined effects of PM+ in refugee populations 10,34,35,37,38,42,52 .…”

“…Other outcome categories were only examined in a small number of studies. Two studies 35,37,38 investigated effects of group PM+ on child mental distress, with heterogeneous results. However, one study 38 found favorable symptom changes in children to be asso ciated with more consistent disciplinary behavior in parents who received group PM+.…”

Scalable interventions for refugees

“…Considering the ongoing stressors experienced by many refugees and the deleterious effects these can have on their mental health, it is important to determine if recommended treatments are beneficial in the long term. Initial evidence from a 12-month follow-up of PM+ with Syrian refugees found that initial benefits in reducing depression and personally identified problems observed at three months were not maintained at 12 months (Bryant et al, in press ). There is a need to gain further understanding of the longer-term effects of scalable interventions because it is possible that booster sessions or other ongoing supports may be needed to sustain the benefits of initial provision of an intervention.…”

The social determinants of mental health and disorder: evidence, prevention and recommendations

“…There is systematic review evidence from RCTs that providing psychosocial interventions to refugees is effective in reducing PTSD symptoms 382 . Encouragingly, brief in dividual 383 or groupbased 384,385 psychological and behavioural interventions appear to reduce depressive and internalizing symp toms in refugees, including children 386 and adolescents 384 , though these may not be sustained in the longterm postinter vention 385 , and some evidence is of low quality 386 . A recent systematic review also found evidence that communitybased inter ventions which provided refugees with greater bridging and linking social capital (i.e., building ties with others in the community, helping them nav igate new structures, systems and institutions) may be most effec tive in reducing mental health symptoms in this population 387 .…”