Effectiveness of self-help plus in preventing mental disorders in refugees and asylum seekers in Western Europe: a multinational randomized controlled trial
Open accessAbstract
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.
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The pilot showed promising results for SH+, consistent with studies of SH+ in other countries in the prevention and treatment of common mental disorders in refugees and asylum seekers.
“Importantly, the pilot showed promising results for SH+, which were consistent with studies of SH+ in other countries in the prevention and treatment of common mental disorders in refugees and asylum seekers (34–36).”
From Translation, adaptation, and initial evaluation of a guided self-help intervention to reduce psychological distress among nurses during COVID-19 in China (2023) · cites this paper as [35]
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- Authors
- Purgato, M., Carswell, K., Tedeschi, F., Acarturk, C., Anttila, M., Au, T., Bajbouj, M., Baumgartner, J., Biondi, M., Churchill, R., Cuijpers, P., Koesters, M., Gastaldon, C., Ilkkursun, Z., Lantta, T., Nosè, M., Ostuzzi, G., Papola, D., Popa, M., Roselli, V., Sijbrandij, M., Tarsitani, L., Turrini, G., Välimäki, M., Walker, L., Wancata, J., Zanini, E., White, R., van Ommeren, M., & Barbui, C.
- Affiliations
- University of Verona (IT)
- World Health Organization (CH)
- University of Turku (FI)
- Charité – Universitätsmedizin Berlin (DE)
- Medical University of Vienna (AT)
- Sapienza University of Rome (IT)
- University of York (GB)
- Amsterdam Public Health (NL)
- Universität Ulm (DE)
- University of Liverpool (GB)
- ORCID
- Purgato, Marianna
- Carswell, Kenneth
- Tedeschi, Federico
- Anttila, Minna
- Au, Teresa
- Bajbouj, Malek
- Baumgartner, Josef
- Biondi, Massimo
- Churchill, Rachel
- Cuijpers, Pim
- Koesters, Markus
- Gastaldon, Chiara
- Lantta, Tella
- Nosè, Michela
- Ostuzzi, Giovanni
- Papola, Davide
- Sijbrandij, Marit
- Tarsitani, Lorenzo
- Turrini, Giulia
- Walker, Lauren
- Wancata, Johannes
- Zanini, Elisa
- White, Ross
- Barbui, Corrado
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2021
- Volume
- 90
- Issue
- 6
- Pages
- 403-414
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- PMC
- PMC8619740
- OpenAlex
- W3187299524
- Cited by
- 132
- References
- 40
- Citations by year
- 2026: 15 · 2025: 30 · 2024: 20 · 2023: 36 · 2022: 28 · 2021: 3
- FWCI
- 14.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychotherapy and Psychosomatics (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion, other-oa)
- Research Portal (Queen's University Belfast) (submittedVersion, cc-by-nc)
- Digital Collections portal (Koç University) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- mental disorder prevention, refugees, asylum seekers, psychological distress, stress management, indicated prevention, Western Europe
- MeSH terms
- Psychological Distress, Mental Disorders, Europe, Humans, Refugees, Stress Disorders, Post-Traumatic
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