Group problem management plus for decreasing psychological distress in Syrian refugees in Turkey

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Acarturk ◽  
Z İlkkurşun ◽  
T Yurtbakan ◽  
J Troian ◽  
E Uygun

Abstract Background The crisis in Syria has caused millions of Syrians to seek refuge in neighboring countries and Europe. Refugees often experience war related traumatic events and other various adversities during war and flight. These traumatic events increase the risk for common mental health disorders such as depression, anxiety, posttraumatic stress disorder and related somatic symptoms compared to that of host populations. However, despite the high prevalence rates of mental health disorders, refugees' access to mental health services are low. As a public health priority, it is essential to address the mental health needs of refugees. The World Health Organization has developed evidence-based short psychosocial interventions to bridge this gap and Problem Management Plus (PM+) is one of them. PM+ is under investigation within the STRENGTHS project and in Turkey, which is a partner country to the project, the group version of the intervention has been implemented with Syrian refugees. This presentation will provide an overview of the pilot study in Turkey. Methods A randomized controlled trial with 46 Syrian refugees in a community sample was conducted. Participants with elevated levels of distress measured by Kessler 10 (K10 > 15) and self-reported functional impairment (WHODAS 2.0 > 16) were randomly allocated in a 1:1 ratio either to Group PM + (N= 24) or enhanced care as usual (E-CAU, N = 22). Results No adverse events were reported during the trial and assessments. There was no significant difference between control and experiment group with respect to anxiety (d = .14, p=.63), depression (d = .27, p=.36) and symptoms of posttraumatic stress disorder (d = .18, p=.55) at 3 months follow-up. The main trial will be conducted with a larger sample (N = 380) to detect any significant effect and provide more generalizable results. Conclusions The challenges of implementation of group PM+ in a community sample of Syrian refugees in Turkey will be discussed.

Author(s):  
Kathryn Basham

Traumatic events have permeated our lives throughout history and across the globe, inflicting profound losses on individuals, families, and communities during warfare, armed conflict, natural disasters, and relational violence. Although many survivors of these events harness their resilience and cope without long-term negative mental health effects, others experience a range of physical and mental health conditions, including trauma- and stress-related disorders. With an emphasis placed on adult trauma survivors, the conditions of posttraumatic stress disorder, acute stress disorder, adjustment disorders, complex trauma, and other stress-related conditions have been explored within a social context. Starting with a historical context, the following topics were addressed. The typologies of trauma were introduced including the definitions of Type I trauma—a single discrete event including natural catastrophes; Type II trauma—chronic and repetitive traumatic physical, sexual, and/or emotional abuse; and Type IIII—severe and multiple abusive events with multiple perpetrators. Historical and intergenerational trauma reflect a collective of complex traumatic events throughout generations that resonate in subsequent generations in terms of ungrieved losses and survivor guilt, among other psychosocial issues. Cultural and racial trauma include chronic verbal and/or physical assaults that involve racialized bigotry. Combat trauma involves a combination of deployment stressors that have affected servicemembers in distinct ways with “signature injuries” associated with different wartime conflicts. The next section addresses the current typology of the Diagnostic and Statistical Manual of Mental Disorders—V, noting the changes in diagnostic criteria, in particular related to the diagnosis of posttraumatic stress disorder (PTSD). Mental health responses to trauma vary a great deal based on a balance of risk and protective factors, often revealing noteworthy resilience and the absence of negative aftereffects. The neurobiological effects of trauma are addressed along with mental health conditions or disorders (e.g., acute stress response, PTSD, complex trauma, and anxiety disorders). Specific phase-oriented and multimodality treatment interventions are reviewed that focus specifically on the mental health conditions presented. These approaches are research-informed, culturally responsive, and theoretically grounded Finally, the responses experienced by clinicians who work with traumatized clients are outlined along with recommendations for ways to minimize the effects of secondary, or vicarious, traumatization. Clinical vignettes based on case composites have been utilized to illustrate central points.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Sijbrandij ◽  
A de Graaff ◽  
P Cuijpers ◽  
B Kieft

Abstract Background Refugees are at considerable risk to develop common mental disorders and related somatic health symptoms. In order to meet the mental health needs of individuals affected by crisis worldwide, the World Health Organization has developed a set of transdiagnostic low-intensity psychological interventions. These interventions, including Problem Management Plus (PM+) and its variants, are delivered by trained non-professional counsellors under supervision of local clinicians. The EU H2020 STRENGTHS project evaluates the effectiveness of these interventions across refugee settings in Europe and the Middle East. This presentation will present the results of a pilot randomized controlled trial (RCT) on individual PM+ in the Netherlands. Methods Syrian refugees (N = 60) with elevated levels of psychological distress (10 item-Kessler Psychological Distress Scale >15) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 >16) were randomized into PM + (N=30)) or care-as-usual control (CAU; N = 30). The main outcomes were symptoms of depression and anxiety at 3 months. Secondary outcomes were functioning, symptoms of posttraumatic stress disorder, service utilisation and health costs. Results At 3 months follow-up, the PM+ group had significantly lower scores than control for depression (d=.52?) and anxiety (d=.48), symptoms of posttraumatic stress disorder (d=.66, p = .006?), functional impairment (d=.73, p = .009) and self-identified problems (d=.81, p = .005). PM+ potentially may be cost effective with an ICER of €5,047, (95% CI €0, €19773) per additional recovery achieved. Conclusions PM+ delivered by non-specialist peer-refugee helpers has the potential be effective in reducing depression, anxiety, improving functioning, and reducing health costs. Larger RCTs on the effects of PM+ are currently conducted within the EU STRENGTHS project.


2017 ◽  
Vol 47 (13) ◽  
pp. 2260-2274 ◽  
Author(s):  
K. C. Koenen ◽  
A. Ratanatharathorn ◽  
L. Ng ◽  
K. A. McLaughlin ◽  
E. J. Bromet ◽  
...  

BackgroundTraumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking.MethodsData were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics.ResultsThe cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed.ConclusionsPTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.


2016 ◽  
Vol 37 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Nicole L. Hofman ◽  
Austin M. Hahn ◽  
Christine K. Tirabassi ◽  
Raluca M. Gaher

Abstract. Exposure to traumatic events and the associated risk of developing Posttraumatic stress disorder (PTSD) symptoms is a significant and overlooked concern in the college population. It is important for current research to identify potential protective factors associated with the development and maintenance of PTSD symptoms unique to this population. Emotional intelligence and perceived social support are two identified protective factors that influence the association between exposure to traumatic events and PTSD symptomology. The current study examined the mediating role of social support in the relationship between emotional intelligence and PTSD symptoms. Participants included 443 trauma-exposed university students who completed online questionnaires. The results of this study indicated that social support mediates the relationship between emotional intelligence and reported PTSD symptoms. Thus, emotional intelligence is significantly associated with PTSD symptoms and social support may play an integral role in the relationship between emotional intelligence and PTSD. The current study is the first to investigate the role of social support in the relationship between emotional intelligence and PTSD symptoms. These findings have important treatment and prevention implications with regard to PTSD.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yaru Chen ◽  
Xin Huang ◽  
Chengyuan Zhang ◽  
Yuanyuan An ◽  
Yiming Liang ◽  
...  

Abstract Background Coronavirus disease 2019 (COVID-19) has affected more than 5 million people around the world and killed more than 300,000 people; thus, it has become a global public health emergency. Our objective was to investigate the mental health of hospitalized patients diagnosed with COVID-19. Methods The PTSD checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Trauma Exposure Scale, abbreviated version of the Connor–Davidson Resilience Scale (CD-RISC-10), Perceived Social Support Scale (PSSS) and Demographic Questionnaire were used to examine posttraumatic stress disorder (PTSD), depression, anxiety, trauma exposure, resilience and perceived social support among 898 patients who were hospitalized after being diagnosed with COVID-19 in China. The data were analyzed with t tests, one-way ANOVA and multivariable logistic regression analysis. Results The results showed that the prevalence of PTSD, depression and anxiety was 13.2, 21.0 and 16.4%, respectively. Hospitalized patients who were more impacted by negative news reports, had greater exposure to traumatic experiences, and had lower levels of perceived social support reported higher PTSD, depression and anxiety. Conclusions Effective professional mental health services should be designed to support the psychological wellbeing of hospitalized patients, especially those who have severe disease, are strongly affected by negative news and have high levels of exposure to trauma.


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