Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis

Emily Peckham; Eirini Karyotaki; Marit Sijbrandij; Marianna Purgato; Ceren Acarturk; Daniel Lakin; Della Bailey; Ersin Uygun; Federico Tedeschi; Johannes Wancata; Jura Augustinavicius; Ken Carswell; Maritta Välimäki; Mark van Ommeren; Markus Kösters; Mariana Popa; Marx Ronald Leku; Minna Anttila; Rachel Churchill; Ross G. White; Sarah Al-Hashimi; Tella Lantta; Teresa Au; Thomas Klein; Wietse A Tol; Pim Cuijpers; Pim Cuijpers

doi:10.1136/bmjment-2023-300672

Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis

Emily Peckham, Eirini Karyotaki, Marit Sijbrandij, Marianna Purgato, Ceren Acarturk, Daniel Lakin, Della Bailey, Ersin Uygun, Federico Tedeschi, Johannes Wancata, Jura Augustinavicius, Ken Carswell, Maritta Välimäki, Mark van Ommeren, Markus Kösters, Mariana Popa, Marx Ronald Leku, Minna Anttila, Rachel Churchill, Ross G. WhiteSarah Al-Hashimi, Tella Lantta, Teresa Au, Thomas Klein, Wietse A Tol, Pim Cuijpers, Pim Cuijpers

School of Health Sciences

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Abstract

QUESTION: Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers.

STUDY SELECTION AND ANALYSIS: Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm).

FINDINGS: There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90).

CONCLUSIONS: Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.

Original language	English
Journal	BMJ Mental Health
Volume	26
Issue number	1
DOIs	https://doi.org/10.1136/bmjment-2023-300672
Publication status	Published - 1 Jul 2023

Keywords

Health Behavior
Humans
Mental Health
Psychological Well-Being
Refugees/psychology
Stress Disorders, Post-Traumatic/therapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjment-2023-300672Licence: CC BY

e300672.fullFinal published version, 687 KBLicence: CC BY

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Peckham, E., Karyotaki, E., Sijbrandij, M., Purgato, M., Acarturk, C., Lakin, D., Bailey, D., Uygun, E., Tedeschi, F., Wancata, J., Augustinavicius, J., Carswell, K., Välimäki, M., van Ommeren, M., Kösters, M., Popa, M., Leku, M. R., Anttila, M., Churchill, R., ... Cuijpers, P. (2023). Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis. BMJ Mental Health, 26(1). https://doi.org/10.1136/bmjment-2023-300672

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title = "Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis",

abstract = "QUESTION: Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers.STUDY SELECTION AND ANALYSIS: Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm).FINDINGS: There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90).CONCLUSIONS: Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.",

keywords = "Health Behavior, Humans, Mental Health, Psychological Well-Being, Refugees/psychology, Stress Disorders, Post-Traumatic/therapy",

author = "Emily Peckham and Eirini Karyotaki and Marit Sijbrandij and Marianna Purgato and Ceren Acarturk and Daniel Lakin and Della Bailey and Ersin Uygun and Federico Tedeschi and Johannes Wancata and Jura Augustinavicius and Ken Carswell and Maritta V{\"a}lim{\"a}ki and {van Ommeren}, Mark and Markus K{\"o}sters and Mariana Popa and Leku, {Marx Ronald} and Minna Anttila and Rachel Churchill and White, {Ross G.} and Sarah Al-Hashimi and Tella Lantta and Teresa Au and Thomas Klein and Tol, {Wietse A} and Pim Cuijpers and Pim Cuijpers",

year = "2023",

month = jul,

day = "1",

doi = "10.1136/bmjment-2023-300672",

language = "English",

volume = "26",

journal = "BMJ Mental Health",

issn = "2755-9734",

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number = "1",

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Peckham, E, Karyotaki, E, Sijbrandij, M, Purgato, M, Acarturk, C, Lakin, D, Bailey, D, Uygun, E, Tedeschi, F, Wancata, J, Augustinavicius, J, Carswell, K, Välimäki, M, van Ommeren, M, Kösters, M, Popa, M, Leku, MR, Anttila, M, Churchill, R, White, RG, Al-Hashimi, S, Lantta, T, Au, T, Klein, T, Tol, WA, Cuijpers, P & Cuijpers, P 2023, 'Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis', BMJ Mental Health, vol. 26, no. 1. https://doi.org/10.1136/bmjment-2023-300672

TY - JOUR

T1 - Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis

AU - Peckham, Emily

AU - Karyotaki, Eirini

AU - Sijbrandij, Marit

AU - Purgato, Marianna

AU - Acarturk, Ceren

AU - Lakin, Daniel

AU - Bailey, Della

AU - Uygun, Ersin

AU - Tedeschi, Federico

AU - Wancata, Johannes

AU - Augustinavicius, Jura

AU - Carswell, Ken

AU - Välimäki, Maritta

AU - van Ommeren, Mark

AU - Kösters, Markus

AU - Popa, Mariana

AU - Leku, Marx Ronald

AU - Anttila, Minna

AU - Churchill, Rachel

AU - White, Ross G.

AU - Al-Hashimi, Sarah

AU - Lantta, Tella

AU - Au, Teresa

AU - Klein, Thomas

AU - Tol, Wietse A

AU - Cuijpers, Pim

PY - 2023/7/1

Y1 - 2023/7/1

N2 - QUESTION: Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers.STUDY SELECTION AND ANALYSIS: Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm).FINDINGS: There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90).CONCLUSIONS: Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.

AB - QUESTION: Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers.STUDY SELECTION AND ANALYSIS: Three randomised trials were identified with 1795 individual participant data (IPD). We performed an IPD meta-analysis to estimate the effects of SH+, primarily on depressive symptoms and second on post-traumatic stress, well-being, self-identified problems and functioning. Effects were also estimated at 5-6 months postrandomisation (midterm).FINDINGS: There was no evidence of a difference between SH+ and ECAU+ in reducing depressive symptoms at postintervention. However, SH+ had significantly larger effects among participants who were not employed (β=1.60, 95% CI 0.20 to 3.00) and had lower mental well-being levels (β=0.02, 95% CI 0.001 to 0.05). At midterm, SH+ was significantly more effective than ECAU in improving depressive symptoms (β=-1.13, 95% CI -1.99 to -0.26), self-identified problems (β=-1.56, 95% CI -2.54 to -0.59) and well-being (β=6.22, 95% CI 1.60 to 10.90).CONCLUSIONS: Although SH+ did not differ significantly from ECAU in reducing symptoms of depression at postintervention, it did present benefits for particularly vulnerable participants (ie, unemployed and with lower mental well-being levels), and benefits were also evident at midterm follow-up. These results are promising for the use of SH+ in the management of depressive symptoms and improvement of well-being and self-identified problems among refugees and asylum seekers.

KW - Health Behavior

KW - Humans

KW - Mental Health

KW - Psychological Well-Being

KW - Refugees/psychology

KW - Stress Disorders, Post-Traumatic/therapy

U2 - 10.1136/bmjment-2023-300672

DO - 10.1136/bmjment-2023-300672

M3 - Article

C2 - 37524517

SN - 2755-9734

VL - 26

JO - BMJ Mental Health

JF - BMJ Mental Health

IS - 1

ER -

Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis

Abstract

Keywords

UN SDGs

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