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Guided self-help intervention reduces psychological distress among refugees
A guided self-help intervention meaningfully reduced psychological distress among a group of refugees and may thus provide individuals in low-resource humanitarian settings with a first-line strategy for mental health support, according to results of a cluster randomized trial published in The Lancet Global Health.
“By targeting psychological distress, regardless of whether people have mental disorders, while reducing reliance on scarce specialists and tripling the number of participants reached per sessions, guided self-help has enormous potential to improve reach and access to psychological support for people affected by adversity,” Mark van Ommeren, PhD, of the WHO’s department of mental health and substance abuse, said in a press release.
According to van Ommeren and colleagues, conflict-affected populations are at greater risk for psychological distress and developing symptoms of common mental disorders. Prior interventions in these regions involved psychological treatments that targeted single mental disorders, required a substantial clinical workforce and reached only individuals or small groups of people at a time, they noted. In the present study, they assessed the effectiveness of a group-based, facilitator-guided, self-help intervention called Self-Help Plus to reduce psychological distress among South Sudanese female refugees with at least moderate levels of psychological distress. The intervention was developed by the WHO, combines a five-session, pre-recorded audio course with an illustrated self-help book tailored to populations with low literacy, and can be delivered to groups of up to 30 individuals.
The researchers included 613 refugees from 14 villages, with 331 receiving Self-Help Plus and 363 receiving enhanced usual care. Those who received Self-Help Plus experienced stronger improvement on psychological distress at 3 months after intervention (beta = –1.2; 95% CI, –2.33 to –0.08) compared with controls. Further, those in the Self-Help Plus group reported improvements in PTSD and depression symptoms, explosive anger, functioning and subjective well-being. The intervention was equally beneficial among women with different levels of distress, trauma histories and levels of exposure to gender-based violence. Although an independent data safety management board responded to six adverse events, they determined that none were concerns in response to the intervention.
“Our findings indicate that [Self-Help Plus] offers sizeable immediate benefits, which is very promising for an intervention that has high potential for scale-up, and can be delivered in areas with limited access to care,” study author Marx Leku, MA, of HealthRight International in Uganda, said in the release.
In a related editorial, Charlotte Hanlon, PhD, and Mark Jordans, PhD, both of the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, discussed the potential for scaling up this intervention.
“The mechanisms of action of the intervention should be further investigated, particularly to understand how to achieve greater psychological flexibility, which might be a more enduring benefit of the intervention,” they wrote. “Future trials should investigate whether emergence of mental health disorders is diminished by guided self-help. Lastly, although guided self-help was evaluated in a humanitarian setting, there is arguable as much need and potential for benefit in non-humanitarian settings, where social adversity is a fact of daily life — again increasing the potential of guided self-help to achieve real scale.” – by Joe Gramigna
Disclosures: The study authors and Jordans report no relevant financial disclosures. Hanlon reports funding from the National Institutes of Health Research Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, as well as support from the African Mental Health Research Initiative.