The DOI matches its Crossref record; 42 of the 43 references it cites were found in a registry or an index.
Peer-provided Problem Management Plus (PM+) for adult Syrian refugees: a pilot randomised controlled trial on effectiveness and cost-effectiveness
Open accessAbstract
Aims: Common mental disorders are highly prevalent among Syrian refugees. Problem Management Plus (PM+) is a brief, transdiagnostic, non-specialist helper delivered, psychological intervention targeting psychological distress. This single-blind pilot randomised controlled trial (RCT) on PM+ delivered by peer-refugees examined trial procedures in advance of a definitive RCT, evaluated PM+ 's acceptability and feasibility, and investigated its likely effectiveness and cost-effectiveness among Syrian refugees in the Netherlands. Methods: Adult Syrian refugees (N = 60) with elevated psychological distress (Kessler Psychological Distress Scale (K10) score >15) and reduced pychosocial functioning (WHO Disability Assessment Schedule 2.0 (WHODAS) score >16) were randomised into PM+ in addition to care as usual (CAU) (PM+/CAU; n = 30) or CAU alone (n = 30). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes were pychosocial functioning (WHO Disability Assessment Schedule; WHODAS 2.0), symptoms of posttraumatic stress disorder (PTSD) (PTSD Checklist for DSM 5; PCL-5) and self-identified problems (Psychological Outcomes Profiles; PSYCHLOPS). Changes in service utilisation and time out of employment and/or adult education were estimated (adapted version of the Client Service Receipt Inventory; CSRI). Semi-structured interviews on the implementation of PM+ were conducted with stakeholders (i.e. six PM+ participants, five non-specialist helpers and five key informants). Results: Recruitment, randomization and blinding procedures were successful. PM+ was generally perceived positively by stakeholders, especially regarding the intervention strategies, accommodation of the intervention and the helpers. Two serious adverse events not attributable to the trial were reported. At 3-month follow-up, the HSCL-25 total score was significantly lower for the PM+/CAU group (n = 30) than CAU group (n = 30) (p = 0.004; d = 0.58). Significant differences in favour of PM+/CAU were also found for WHODAS psychosocial functioning (p = 0.009, d = 0.73), PCL-5 symptoms of PTSD (p = 0.006, d = 0.66) and PSYCHLOPS self-identified problems (p = 0.005, d = 0.81). There were no significant differences in mean health service costs (p = 0.191) and the mean costs of lost productive time (p = 0.141). This suggests PM+ may potentially be cost-effective with an incremental cost from a health system perspective of €5047 (95% CI €0–€19 773) per additional recovery achieved. Conclusions: Trial procedures and PM+ delivered by non-specialist peer-refugee helpers seemed acceptable, feasible and safe. Analyses indicate that PM+ may be effective in improving mental health outcomes and psychosocial functioning, and potentially cost-effective. These results support the development of a definitive RCT with a larger sample of refugees and a longer follow-up period.
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“Prior research has indicated that participants commonly had difficulties finishing all 5 sessions of PM+ because of the lengthy sessions, which frequently interfered with finding or maintaining a job, performing domestic duties, or raising children [8-10].”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [9]
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“Problem Management Plus, a World Health Organization–endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [9]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“but faces implementation challenges, such as quality control in training, supervision, and delivery.”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [9]
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“In previous randomized controlled trials (RCTs), PM + has been found to be effective in reducing psychological distress in low-income settings [28, 29] and Syrian refugees in the Netherlands [30, 31].”
From Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial (2023) · cites this paper as [30]
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“PM+ is a low-intensity brief psychological and transdiagnostic intervention for common mental health disorders. It is an evidence-based intervention that can address various mental health issues and address the limitations posed by scarce specialized treatments in low-resource settings [8-14].”
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Citations
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“Randomised controlled trials (RCTs) on individual PM+ in violence-affected communities in Pakistan and Kenya showed that participants who received individual PM+ had fewer symptoms of depression, anxiety and PTSD, higher levels of functioning and fewer self-identified problems (Rahman et al., 2016; Bryant et al., 2017…”
BackgroundResultInfluentialSelf-citationSijbrandij, M., Acartürk, C., Bird, M., Bryant, R. A., Burchert, S., Carswell, K., de Jong, J. T. V. M., Dinesen, C., Dawson, K. S., Chammay, R. E., et al. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1388102 · Cited by 315
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“Randomised controlled trials (RCTs) on individual PM+ in violence-affected communities in Pakistan and Kenya showed that participants who received individual PM+ had fewer symptoms of depression, anxiety and PTSD, higher levels of functioning and fewer self-identified problems (Rahman et al., 2016; Bryant et al., 2017…”
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ResultSelf-citationWhen is it too expensive? Cost-effectiveness thresholds and health care decision-making
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BackgroundNidich, S. I., Mills, P. J., Rainforth, M. V., Heppner, P. S., Schneider, R. H., Rosenthal, N. E., Salerno, J. W., Gaylord‐King, C., & Rutledge, T. R. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30384-5 · Cited by 109 · cited 1×
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BackgroundEvaluating the EMDR Group Traumatic Episode Protocol With Refugees: A Field Study
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Backgroundde Graaff, A. M., Cuijpers, P., Acarturk, C., Bryant, R., Burchert, S., Fuhr, D. C., Huizink, A. C., de Jong, J., Kieft, B., Knaevelsrud, C., et al. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1694347 · Cited by 57 · cited 2×
“The PM+ manual was translated/culturally adapted for use among Syrian refugees through qualitative study (cf. Applied Mental Health Research Group, 2013) and by using a framework for the cultural adaptation of psychological interventions (Bernal and Sáez-Santiago, 2006; see de Graaff et al., 2020).”
MethodSelf-citationCommentary: Europe needs a central, transparent, and evidence based regulation process for devices
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“Use of Audio-Computer-Assisted Self-Interview software (e.g. Morina et al., 2017) that does not require administration by an assessor may improve blinding.”
MethodSelf-citationPsychometric Properties of the Online Arabic Versions of BDI-II, HSCL-25, and PDS
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Method
Cited by
Sorted by citations
Arundell, L.-L., Barnett, P., Buckman, J. E. J., Saunders, R., & Pilling, S. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102063 · Cited by 156
“Five studies reported more than one primary mental health outcome measure (de Graaff et al., 2020; Gonyea et al., 2016; Hendriks et al., 2020; Kaltman et al., 2016; Kayrouz et al., 2015).”
BackgroundMethodSchäfer, S. K., Thomas, L. M., Lindner, S., & Lieb, K. (2023) · World Psychiatry · doi:10.1002/wps.21129 · Cited by 115
Global priorities for climate change and mental health research
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Self-citationAcarturk, C., Uygun, E., Ilkkursun, Z., Yurtbakan, T., Kurt, G., Adam-Troian, J., Senay, I., Bryant, R., Cuijpers, P., Kiselev, N., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-021-03645-w · Cited by 93
“The feasibility study demonstrated that the CSRI was well completed and should provide substantial information to inform cost-effectiveness analysis in a subsequent fully-powered trial.”
MethodInfluentialSelf-citation
Metadata
- Authors
- de Graaff, A. M., Cuijpers, P., McDaid, D., Park, A., Woodward, A., Bryant, R. A., Fuhr, D. C., Kieft, B., Minkenberg, E., & Sijbrandij, M.
- Affiliations
- Amsterdam Public Health (NL)
- London School of Economics and Political Science (GB)
- Royal Tropical Institute (NL)
- UNSW Sydney (AU)
- London School of Hygiene & Tropical Medicine (GB)
- Parnassia Groep (NL)
- ORCID
- Venue
- Epidemiology and Psychiatric Sciences
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020
- Volume
- 29
- ISSN
- 2045-7960 (ISSN-L)
- 2045-7979
- PMC
- PMC7443797
- OpenAlex
- W3047469187
- Cited by
- 109
- References
- 43
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 28 · 2023: 31 · 2022: 15 · 2021: 10
- FWCI
- 5.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Epidemiology and Psychiatric Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- VU Research Portal (publishedVersion, other-oa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (submittedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- Problem Management Plus, peer-mediated intervention, Syrian refugees, psychological distress, depression, anxiety, post-traumatic stress disorder, psychosocial functioning, common mental disorders, cost-effectiveness, feasibility and acceptability, refugee mental health services, service utilization, Syria
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