Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial
Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial
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DOI：
10.1159/000517504
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发表时间：
2021-07-20
影响因子：
22.8
通讯作者：
Barbui, Corrado
中科院分区：
文献类型：
--
作者：
Purgato, Marianna;Carswell, Kenneth;Barbui, Corrado
自我帮助+（SH+）是世界卫生组织为管理压力而开发的一种基于团体的心理干预。目的：评估SH+预防西欧难民和寻求庇护者精神障碍的有效性。方法：我们在5个欧洲国家进行了一项随机对照试验。难民和寻求庇护者有心理困扰（一般健康问卷评分>= 3），但没有精神障碍诊断和统计手册，第5版（DSM-5）或ICD/10诊断的精神障碍，通过迷你国际神经精神访谈（MINI）进行评估，被随机分配到SH+或增强治疗（ETAU）。主要结局是6个月时MINI的精神障碍频率。次要结果包括干预后精神障碍的频率、自我识别的问题、心理症状和其他结果。结果：459人被随机分配到SH+或ETAU。对于主要结局，我们发现6个月时精神障碍的发生率没有差异（Cramer V = 0.007，p = 0.90，RR = 0.96; 95%CI 0.52-1.78），而干预后差异显著有利于SH+（次要结局，在末次治疗后2周内测量; Cramer V = 0.13，p = 0.01，RR = 0.50; 95% CI 0.29-0.87）。结论：这是第一项旨在预防西欧寻求庇护者和难民精神障碍发作的随机指示性预防研究。由于SH+的预防作用在6个月时未观察到，而是仅在干预后观察到，因此需要确定长期维持其有益作用的方式。
Introduction: Self-Help Plus (SH+) is a group-based psychological intervention developed by the World Health Organization for managing stress. Objective: To assess the effectiveness of SH+ in preventing mental disorders in refugees and asylum seekers in Western Europe. Methods: We conducted a randomized controlled trial in 5 European countries. Refugees and asylum seekers with psychological distress (General Health Questionnaire score >= 3), but without a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) or ICD/10 diagnosis of mental disorder, as assessed with the Mini International Neuropsychiatric Interview (MINI), were randomized to SH+ or enhanced treatment as usual (ETAU). The primary outcome was the frequency of mental disorders with the MINI at 6 months. Secondary outcomes included the frequency of mental disorders at postintervention, self-identified problems, psychological symptoms, and other outcomes. Results: Four hundred fifty-nine individuals were randomly assigned to SH+ or ETAU. For the primary outcome, we found no difference in the frequency of mental disorders at 6 months (Cramer V = 0.007, p = 0.90, RR = 0.96; 95% CI 0.52-1.78), while the difference significantly favored SH+ at after the intervention (secondary outcome, measured within 2 weeks from the last session; Cramer V = 0.13, p = 0.01, RR = 0.50; 95% CI 0.29-0.87). Conclusions: This is the first randomized indicated prevention study with the aim of preventing the onset of mental disorders in asylum seekers and refugees in Western Europe. As a prevention effect of SH+ was not observed at 6 months, but rather after the intervention only, modalities to maintain its beneficial effect in the long term need to be identified.