Can a Self-Help Program Prevent Mental Health Problems in Refugees and Asylum Seekers?

What you need to know

• Researchers tested whether a brief self-help program called Self-Help Plus (SH+) could prevent mental disorders in refugees and asylum seekers over 12 months.
• The study did not find clear evidence that SH+ prevented mental disorders at 12 months in the overall group.
• However, SH+ did improve psychological distress, depression symptoms, and well-being at 12 months.
• More research is needed to determine if SH+ can have long-term preventive effects, especially if people attend most of the sessions.

Background

Refugees and asylum seekers often face many stressful and traumatic experiences before, during, and after migration. These experiences put them at higher risk of developing mental health problems. While there are treatments available for existing mental disorders in refugees, less is known about how to prevent mental health problems from developing in the first place.

Researchers wanted to test whether a brief self-help program could help prevent mental disorders from developing in refugees and asylum seekers who were at risk but did not yet have a diagnosed disorder. They studied a program called Self-Help Plus (SH+), which was developed by the World Health Organization.

What is Self-Help Plus?

Self-Help Plus is a stress management program that aims to reduce stress and improve well-being in people who have experienced difficult life events. It involves:

• Five 2-hour group sessions
• Audio recordings that teach key concepts
• An illustrated self-help book
• Guided exercises and small group discussions
• Skills based on acceptance and commitment therapy, which helps people cope with difficult thoughts and feelings

SH+ was designed to be delivered by facilitators with minimal training, making it potentially scalable in different settings.

The Study

The researchers conducted a randomized controlled trial with refugees and asylum seekers in several European countries. They recruited 459 participants who:

• Were experiencing psychological distress
• Did not have a diagnosed mental disorder

Half the participants were randomly assigned to receive SH+, while the other half received enhanced usual care (information about available services). The researchers then followed up with participants over 12 months to see if they developed any mental disorders.

Results After 12 Months

The main findings after 12 months were:

• There was no clear difference between the SH+ and control groups in rates of mental disorders overall.

• However, among participants who attended at least 3 out of 5 SH+ sessions, rates of mental disorders were about half that of the control group. But this difference was not statistically significant due to the small number of participants.

• Participants who received SH+ had greater improvements in:

  • Psychological distress
  • Depression symptoms
  • Well-being

These improvements in symptoms and well-being suggest SH+ may have some long-term benefits, even if it did not clearly prevent diagnosed disorders in this study.

Challenges in the Study

The researchers faced some important challenges:

• Many participants (46%) did not complete the 12-month follow-up assessment. This was often due to moving locations or having other pressing life priorities.

• The COVID-19 pandemic disrupted some of the follow-up procedures.

• It was not possible to “blind” participants to whether they received SH+ or not, which can sometimes influence results.

These challenges made it harder to detect potential effects of the program and may have impacted the results.

Implications

While this study did not find clear evidence that SH+ prevented mental disorders at 12 months, there are some encouraging signs:

• Improvements in psychological symptoms and well-being lasted up to 12 months.
• There were hints of preventive effects in those who attended most of the SH+ sessions.

This suggests SH+ may have potential as a preventive program, but more research is needed. Future studies could:

• Find ways to increase participation and reduce dropout rates
• Test “booster” sessions to help maintain effects
• Focus on refugees at highest risk of developing mental disorders
• Explore using SH+ as part of stepped care models

Conclusions

• SH+ did not clearly prevent mental disorders at 12 months in the overall group of refugees and asylum seekers.
• However, it did improve psychological distress, depression, and well-being up to 12 months later.
• More research is needed to determine if SH+ can have long-term preventive effects, especially if people attend most of the sessions.
• Brief, scalable interventions like SH+ may be a promising approach to support the mental health of refugees, but we need to learn more about how to maximize their impact.