The self-help psychological intervention developed by the World Health Organization, Self-Help Plus, has been effective in preventing the occurrence of mental disorders among Syrian refugees in Turkey, according to a study published today in World Psychiatry. The study, the first randomized controlled trial on the prevention of mental disorders conducted among Syrian refugees experiencing mental stress but without a diagnosis of mental disorder, found that the probability of having a mental disorder six months after the intervention was approximately half for participants receiving Self-Help Plus compared to those in the control arm.
Almost all of the 642 adults involved in the trial, which ended in June 2020, were from Syria and the rest from Iraq, the Occupied Palestinian Territory and Yemen. The average age of the participants was 31 years, with almost 63% women. Half of the participants received Self-Help Plus and Enhanced Care As Usual (ECAU, which consists of routine social support and / or care), and half received only ECAU.
Format performed by trained leaders in a group environment
Self-Help Plus (SH +) is based on acceptance and commitment therapy, a form of cognitive behavioral therapy. It consists of a pre-recorded audio course, conducted by unprofessionally trained leaders in a group environment and supplemented with an illustrated self-help book tailored to the target cultural group. The audio material provides information on stress management and guides participants through individual exercises and discussions in small groups. The self-help book covers all important contents and concepts. In accordance with the structure of the intervention, at the trial in Turkey, the course was held through five two-hour sessions.
In a study in Turkey, supported by the European Commission, Self-Help Plus participants were significantly less likely to have any mental disorders after a six-month follow-up compared to the ECAU group (22% vs. 41%). Risk reduction seemed to be similar for the most common diagnoses of mental disorders – depression, post-traumatic stress disorder (PTSD) and anxiety disorders. Accordingly, Self-Help Plus participants also showed improvement in depressive symptoms, self-identified psychological outcomes, and quality of life after six months of follow-up.
Potential to expand to other large refugee populations
Given the magnitude of the effect observed in the study and that Self-Help Plus can be provided in large groups of up to 30 participants at a time by non-specialist facilitators after a short training, the study results suggest that intervention could be extended as a public health strategy a large number of refugees exposed to constant adversity. However, as the intervention does not address the determinants of refugees’ psychological problems, it should be implemented in conjunction with strong advocacy for the protection of those facing adversity and services that address their social, physical and wider mental health needs.
Significant need to support mental health among the refugee population
In 2020, the number of IDPs in the world, 80 million, was the highest since World War II. Among them, 26 million fled their countries due to violence or persecution. The largest group of refugees was from Syria, 6.6 million people. It is estimated that 3.6 million Syrian refugees now live in Turkey. The WHO estimates that the rates of depression, PTSD and any mental disorder among people exposed to conflict in the past 10 years are 11%, 15% and 22% respectively.
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