Effectiveness of a peer-refugee delivered psychological intervention to reduce psychological distress among adult Syrian refugees in the Netherlands: study protocol
Open accessAbstract
Background: Syrian refugees face multiple hardships and adversities which put them at risk for the development of mental health problems. However, access to adequate mental health care in host countries is limited. The WHO has developed Problem Management Plus (PM+), a brief, scalable psychological intervention, delivered by non-specialist helpers, that addresses common mental disorders in people affected by adversity. This study is part of the STRENGTHS project, that aims to evaluate peer-refugee delivered psychological interventions for Syrian refugees in Europe and the Middle East.Objective: To evaluate the effectiveness and cost-effectiveness of the peer-refugee delivered PM+ intervention among Syrian refugees with elevated levels of psychological distress in the Netherlands.Methods: PM+ will be tested in a randomized controlled trial (RCT) among Arabic-speaking Syrian refugees in the Netherlands aged 18 years and above with self-reported psychological distress (Kessler Psychological Distress Scale; K10 >15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 >16). Participants (N = 380) will be randomized into care as usual with PM+ (CAU/PM+, n = 190) or CAU only (CAU, n = 190). Baseline, 1-week post-intervention, and 3-month and 12-month follow-up assessments will be conducted. Primary outcomes are symptoms of depression and anxiety. Secondary outcomes are functional impairment, posttraumatic stress disorder symptoms, self-identified problems, anger, health and productivity costs, and hair cortisol concentrations. A process evaluation will be carried out to evaluate treatment dose, protocol fidelity and stakeholder views on barriers and facilitators to implementing PM+.Results and Conclusions: PM+ has proved effectiveness in other populations and settings. After positive evaluation, the adapted manual and training materials for individual PM+ will be made available through the WHO to encourage further replication and scaling up.Trial registration: Trial registration Dutch Trial Registry, NL7552, registered prospectively on March 1, 2019. Medical Ethics Review Committee VU Medical Center Protocol ID 2017.320, 7 September 2017.
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A cut-off score of > 15.9 on the K10 indicates psychological distress.
“In line with previous research [48, 49] a cut-off score of > 15.9 is used, which indicates psychological distress [50].”
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“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-citationde Graaff, A. M., Cuijpers, P., Twisk, J. W. R., Kieft, B., Hunaidy, S., Elsawy, M., Gorgis, N., Bouman, T. K., Lommen, M. J. J., Acarturk, C., et al. (2023) · BMJ Mental Health · doi:10.1136/bmjment-2022-300637 · Cited by 97 · see citing works
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“In line with previous research [48, 49] a cut-off score of > 15.9 is used, which indicates psychological distress [50].”
MethodInfluentialSelf-citation
- Authors
- de Graaff, A. M., Cuijpers, P., Acarturk, C., Bryant, R., Burchert, S., Fuhr, D. C., Huizink, A. C., de Jong, J., Kieft, B., Knaevelsrud, C., McDaid, D., Morina, N., Park, A.-L., Uppendahl, J., Ventevogel, P., Whitney, C., Wiedemann, N., Woodward, A., & Sijbrandij, M.
- Affiliations
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health (NL)
- Department of Psychology, Koç University, Sariyer/Istanbul, Turkey
- UNSW Sydney (AU)
- Freie Universität Berlin (DE)
- London School of Hygiene & Tropical Medicine (GB)
- Amsterdam UMC, Amsterdam, The Netherlands
- i-Psy Mental Health Care, Almere, the Netherlands
- London School of Economics and Political Science (GB)
- University of Zurich (CH)
- Office of the United Nations High Commissioner for Refugees (CH)
- Technical Unit, International Medical Corps, London, UK
- International Federation of Red Cross and Red Crescent Societies (CH)
- Royal Tropical Institute (NL)
- ORCID
- Venue
- European Journal of Psychotraumatology
- Publisher
- Informa UK Limited
- Published
- 2020-01-20
- Volume
- 11
- Issue
- 1
- Pages
- 1694347-1694347
- ISSN
- 2000-8066 (ISSN-L)
- PMC
- PMC7006761
- OpenAlex
- W3002158525
- Cited by
- 57
- References
- 57
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 8 · 2023: 15 · 2022: 12 · 2021: 10 · 2020: 5
- FWCI
- 4.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by-nc)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (submittedVersion)
- Digital Collections portal (Koç University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- H2020 Societal Challenges (733337)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- Syrian refugees, Problem Management Plus, psychological distress, depression, anxiety, post-traumatic stress disorder, functional disability, hair cortisol, cost-effectiveness, Arabic-speaking refugees, non-specialist mental health care
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