Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial

Abstract

Abstract: Background: Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an efective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul, Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-efectiveness of the intervention. Methods: Refugees with psychological distress (Kessler Psychological Distress Scale, K10>15) and impaired psycho? social functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0>16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n=24) or E-CAU only (n=22). gPM+ comprised of fve weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identifed problems (Psychological Outcomes Profles, PSY? CHLOPS) were included as secondary outcomes. A modifed version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. Results: There were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an efect. No signifcant diference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. Conclusions: gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe inter? vention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT