Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial.
Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial.
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DOI：
10.1016/s2214-109x(19)30504-2
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发表时间：
2020-02
影响因子：
34.3
通讯作者：
van Ommeren, Mark
中科院分区：
文献类型：
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作者：
Tol, Wietse A.;Leku, Marx R.;Lakin, Daniel P.;Carswell, Kenneth;Augustinavicius, Jura;Adaku, Alex;Au, Teresa M.;Brown, Felicity L.;Bryant, Richard A.;Garcia-Moreno, Claudia;Musci, Rashelle J.;Ventevogel, Peter;White, Ross G.;van Ommeren, Mark
需要有创新的解决方案，以便在资源匮乏的人道主义情况下大规模提供精神卫生支助。我们的目的是评估辅导员引导的、以小组为基础的自助干预(Self-Help Plus)在减轻女性难民心理痛苦方面的有效性。我们在乌干达北部的农村难民安置点进行了一项整群随机试验。参与者是至少有中等程度心理困扰的南苏丹女性难民(凯斯勒6号上的≥5截止日期)。干预措施包括获得日常护理和5个2小时录音的压力管理讲习班(20-30名难民)，由受过短暂培训的非专业辅导员领导，并附有一本图文并茂的自助书籍。村庄被随机分配到1：1的干预(自助加或加强日常护理)中。在14个村庄中，随机选择了一些家庭。继续对家庭中的妇女进行筛查，直到每个地点确定20-30名符合条件的参与者。主要结果是在干预前1周、干预后1周和干预后3个月使用Kessler 6症状自评量表对意向治疗人群进行个体心理困扰评估。所有结果都是在个人(而不是群体)层面上衡量的。次要结果包括个人识别的问题、创伤后应激障碍、抑郁症状、愤怒情绪、与其他种族的社会互动、功能障碍和主观幸福感。评审员被蒙面分配。这项试验预期在ISRCTN注册，编号50148022。在694名符合条件的参与者中(331名自助，363名加强日常护理)，613名(88%)完成了所有评估。与对照组相比，自助加心理干预3个月后心理困扰的改善更明显(β−1·20，95%CI−2·33至−0·08；p=0·04；d−0·26)。我们还发现，在8个次要结果中的5个(效果大小范围从−0·30到−0·36)方面，自助加干预3个月后有更大的改善。具有不同创伤暴露、定居时间长短和最初心理痛苦的难民也同样受益。在安全考虑方面，独立的数据安全管理委员会对六起不良事件做出了回应，没有一起被评估为对干预措施的担忧。Self-Help Plus是一种创新的、由促进者指导的、以团体为基础的自助干预措施，可迅速部署到大量参与者，使南苏丹女性难民在3个月内的心理痛苦显著减少。人道主义危机中的健康研究(R2HC)方案。
Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help intervention (Self-Help Plus) to reduce psychological distress in female refugees. We did a cluster randomised trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cutoff ≥5 on the Kessler 6). The intervention comprised access to usual care and five 2-h audio-recorded stress-management workshops (20–30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomly assigned to either intervention (Self-Help Plus or enhanced usual care) on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20–30 eligible participants were identified per site. The primary outcome was individual psychological distress, assessed using the Kessler 6 symptom checklist 1 week before, 1 week after, and 3 months after intervention, in the intention-to-treat population. All outcomes were measured at the individual (rather than cluster) level. Secondary outcomes included personally identified problems, post-traumatic stress, depression symptoms, feelings of anger, social interactions with other ethnic groups, functional impairment, and subjective wellbeing. Assessors were masked to allocation. This trial was prospectively registered at ISRCTN, number 50148022. Of 694 eligible participants (331 Self-Help Plus, 363 enhanced usual care), 613 (88%) completed all assessments. Compared with controls, we found stronger improvements for Self-Help Plus on psychological distress 3 months post intervention (β −1·20, 95% CI −2·33 to −0·08; p=0·04; d −0·26). We also found larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range −0·30 to −0·36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. With regard to safety considerations, the independent data safety management board responded to six adverse events, and none were evaluated to be concerns in response to the intervention. Self-Help Plus is an innovative, facilitator-guided, group-based self-help intervention that can be rapidly deployed to large numbers of participants, and resulted in meaningful reductions in psychological distress at 3 months among South Sudanese female refugees. Research for Health in Humanitarian Crises (R2HC) Programme.