Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial
Open accessAbstract
Background: Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an effective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul, Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-effectiveness of the intervention. Methods: Refugees with psychological distress (Kessler Psychological Distress Scale, K10 > 15) and impaired psychosocial functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n = 24) or E-CAU only (n = 22). gPM+ comprised of five weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identified problems (Psychological Outcomes Profiles, PSYCHLOPS) were included as secondary outcomes. A modified version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. Results: There were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an effect. No significant difference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. Conclusions: gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe intervention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT. Trial registration: ClinicalTrials.gov Identifier NCT03567083; date: 25/06/2018.
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Global mental health frameworks, knowledge, and interventions have increasingly been directed into refugee contexts across the Global South.
“global mental health frameworks, knowledge, and interventions have been increasingly channelled in refugee contexts across the Global South”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Acarturk et al. 2022
The Introduction (page not available) describes WHO-developed PM+ and studies in Pakistan and Kenya; the Methods describe its adaptation for Syrian refugees in Turkey. These passages support the use of a global mental health intervention in a refugee context, but they do not establish an increasing trend across refugee contexts in the Global South. (LLM, conf=0.85)
Experimental — accuracy not yet measuredProblem Management Plus (PM+) has been shown to be effective and cost-effective in various countries globally.
“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 [8]
The Introduction reports that PM+ reduced psychological distress in studies in Pakistan and Kenya, supporting effectiveness in more than one country. The Discussion says a larger, longer-term trial is needed to determine whether group PM+ is cost-effective; it does not establish cost-effectiveness across countries. Page numbers are unavailable in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPM+ faces implementation challenges, such as quality control in training, supervision, and delivery.
“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 [8]
The Results (Attendance, follow-up and fidelity; page unavailable) report that 20% of assessed core components were only partially delivered. The Discussion (page unavailable) says two components need to be strengthened in facilitator training. The Methods describe weekly supervision, but do not identify quality control in supervision as a challenge. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrior 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].
“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 [8]
The Results section on acceptability and attendance identifies programme length, work requirements and childcare as barriers to attending gPM+ sessions. However, it does not report interference with domestic duties or finding or maintaining a job. The Methods define treatment completion as attending at least three of five sessions, so the reported 75% completion rate does not establish how commonly participants struggled to finish all five. Page numbers were not supplied. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPM+ is a low-intensity brief psychological and transdiagnostic intervention for common mental health disorders.
“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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Positive Minds for Refugees: A Qualitative Study to Inform Intervention Development
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Implementing Problem Management Plus (PM+) in Haiti: qualitative study
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Self-citation
- Authors
- Acarturk, C., Uygun, E., Ilkkursun, Z., Yurtbakan, T., Kurt, G., Adam-Troian, J., Senay, I., Bryant, R., Cuijpers, P., Kiselev, N., McDaid, D., Morina, N., Nisanci, Z., Park, A. L., Sijbrandij, M., Ventevogel, P., & Fuhr, D. C.
- Affiliations
- Istanbul Bilgi University (TR)
- Istanbul Medipol University (TR)
- Koç University (TR)
- UNSW Sydney (AU)
- Amsterdam Public Health (NL)
- University of Zurich (CH)
- London School of Economics and Political Science (GB)
- Office of the United Nations High Commissioner for Refugees (CH)
- London School of Hygiene & Tropical Medicine (GB)
- ORCID
- Venue
- BMC Psychiatry
- Published
- 2022-01-04
- Volume
- 22
- Issue
- 1
- Pages
- 8-8
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC8728921
- OpenAlex
- W4206242338
- Cited by
- 93
- References
- 46
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 25 · 2023: 21 · 2022: 19
- FWCI
- 18.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion, other-oa)
- 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)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Dspace Repository (Marmara Üniversitesi) (submittedVersion, other-oa)
- 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)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- European Commission (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
- Problem Management Plus, group intervention, Syrian refugees, psychological distress, depression, anxiety, post-traumatic stress disorder, psychosocial functioning, feasibility and acceptability, cost-effectiveness, health care utilization, productivity loss
- MeSH terms
- Psychological Distress, Humans, Pilot Projects, Refugees, Syria, Turkey, Single-Blind Method
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