Self-Help Plus for refugees and asylum seekers: an individual participant data meta-analysis
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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.
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Self-Help Plus has been evaluated among refugee populations, showing overall beneficial effects in improving self-identified problems and well-being.
“So far, SH + has been evaluated among refugee populations, showing overall beneficial effects in improving self-identified problems and well-being [25].”
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- Authors
- Karyotaki, E., Sijbrandij, M., Purgato, M., Acarturk, C., Lakin, D., Bailey, D., Peckham, E., Uygun, E., Tedeschi, F., Wancata, J., Augustinavicius, J., Carswell, K., Välimäki, M., van Ommeren, M., Koesters, M., Popa, M., Leku, M. R., Anttila, M., Churchill, R., White, R. G., Al-Hashimi, S., Lantta, T., Au, T., Klein, T., Tol, W. A., Cuijpers, P., & Barbui, C.
- Affiliations
- Amsterdam Public Health (NL)
- University of Verona (IT)
- Department of Psychology, Koc University, Istanbul, Turkey
- Johns Hopkins University (US)
- University of York (GB)
- Yüksek İhtisas Üniversitesi (TR)
- Medical University of Vienna (AT)
- World Health Organization (CH)
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Universität Ulm (DE)
- Queen's University Belfast (GB)
- HealthRight Uganda, Arua, Uganda
- University of Turku (FI)
- Central South University (CN)
- Corresponding author
- Karyotaki, Eirini
- ORCID
- Karyotaki, Eirini
- Sijbrandij, Marit
- Purgato, Marianna
- Lakin, Daniel
- Bailey, Della
- Peckham, Emily
- Uygun, Ersin
- Tedeschi, Federico
- Wancata, Johannes
- Augustinavicius, Jura
- Carswell, Kenneth
- Koesters, Markus
- Leku, Marx Ronald
- Anttila, Minna
- Churchill, Rachel
- White, Ross G
- Lantta, Tella
- Au, Teresa
- Klein, Thomas
- Tol, Wietse A
- Cuijpers, Pim
- Barbui, Corrado
- Venue
- BMJ Mental Health
- Publisher
- BMJ
- Published
- 2023-07
- Volume
- 26
- Issue
- 1
- Pages
- e300672
- ISSN
- 2755-9734 (ISSN-L)
- PMC
- PMC10391800
- OpenAlex
- W4385412084
- Cited by
- 30
- References
- 32
- Citations by year
- 2026: 12 · 2025: 10 · 2024: 7 · 2023: 1
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- BMJ Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (publishedVersion, cc-by)
- VU Research Portal (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- HighWire Press Open Archive (submittedVersion)
- Bangor University Research Portal (Bangor University) (submittedVersion, other-oa)
- Funders
- World Health Organization
- European Commission (779255)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- refugees, asylum seekers, depressive symptoms, post-traumatic stress, psychological well-being, psychological distress, forced displacement, employment status
- MeSH terms
- Psychological Well-Being, Humans, Mental Health, Refugees, Stress Disorders, Post-Traumatic, Health Behavior
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