Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model

Abstract

Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs. Increasing numbers of potentially traumatic experiences can decrease the beneficial effect of a manualized group psychotherapeutic intervention in migrants and refugees across multiple countries.In absence of a full threshold diagnosis of post-traumatic stress disorder, post-traumatic stress symptoms still mediate the relation between potentially traumatic experiences and some outcome improvements at follow-up.While the moderating role of number of potentially traumatic experiences applies to all outcomes (depression symptoms, psychological distress, functional impairment, well-being, and quality of life), the mediating role of post-traumatic stress symptoms in this relation only applies to well-being and quality of life. Antecedentes: Se han desarrollado intervenciones psicol & oacute;gicas escalables, como Self-Help Plus (SH+) de la OMS, para poblaciones cl & iacute;nicas y no cl & iacute;nicas que necesitan apoyo psicol & oacute;gico. SH+ se ha implementado con & eacute;xito para prevenir trastornos mentales frecuentes entre los solicitantes de asilo y refugiados, cuyo n & uacute;mero est & aacute; aumentando debido a los crecientes niveles de migraci & oacute;n forzada. Estas poblaciones a menudo est & aacute;n expuestas a m & uacute;ltiples y graves fuentes de traumatizaci & oacute;n, y la evidencia del efecto de tales eventos en el tratamiento es insuficiente, especialmente para las poblaciones no cl & iacute;nicas.Objetivo: Nuestro objetivo es estudiar el efecto de las experiencias potencialmente traum & aacute;ticas (EPTs) y el papel mediador de los s & iacute;ntomas del trastorno de estr & eacute;s postraum & aacute;tico (TEPT) en la mejora despu & eacute;s de SH+.M & eacute;todo: Los participantes asignados al programa de intervenci & oacute;n SH+ que recibieron al menos tres sesiones (N = 345) fueron extra & iacute;dos de dos grandes ensayos de prevenci & oacute;n europeos, aleatorizados, que involucraron a personas que solicitaron asilo y refugiados. Se administraron medidas de angustia, depresi & oacute;n, deterioro funcional y s & iacute;ntomas de estr & eacute;s postraum & aacute;tico al inicio del estudio y 6 meses despu & eacute;s de la intervenci & oacute;n, junto con medidas de bienestar y calidad de vida. Se construyeron modelos ajustados para examinar el efecto de las EPTs en la mejora posterior a la intervenci & oacute;n. A continuaci & oacute;n se comprob & oacute; el posible papel mediador de los s & iacute;ntomas del trastorno de estr & eacute;s postraum & aacute;tico en esta relaci & oacute;n.Resultados: Un n & uacute;mero creciente de EPTs disminuy & oacute; el efecto beneficioso de SH+ para todas las medidas. Esta relaci & oacute;n estuvo mediada por los s & iacute;ntomas del TEPT al analizar medidas de bienestar y calidad de vida. Sin embargo, esto no se aplica a las medidas de problemas de salud mental.Conclusiones: La exposici & oacute;n a EPTs puede reducir en gran medida los beneficios de SH+. La sintomatolog & iacute;a TEPT desempe & ntilde;a un papel mediador espec & iacute;fico en el bienestar psicol & oacute;gico y la calidad de vida de los participantes que experimentaron EPTs. Los profesionales de la salud y los investigadores deben considerar el papel de las EPTs y los s & iacute;ntomas de TEPT en el tratamiento de migrantes y refugiados, y explorar posibles soluciones factibles complementarias para los casos expuestos a m & uacute;ltiples EPTs.