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Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial.
Cuijpers, Pim; Heim, Eva; Abi Ramia, Jinane; Burchert, Sebastian; Carswell, Kenneth; Cornelisz, Ilja; Knaevelsrud, Christine; Noun, Philip; van Klaveren, Chris; Van't Hof, Edith; Zoghbi, Edwina; van Ommeren, Mark; El Chammay, Rabih.
Affiliation
  • Cuijpers P; Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
  • Heim E; Babes-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
  • Abi Ramia J; Department of Psychology, University of Lausanne, Lausanne, Switzerland.
  • Burchert S; Institute of Psychology, University of Zurich, Zurich, Switzerland.
  • Carswell K; Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
  • Cornelisz I; National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon.
  • Knaevelsrud C; Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.
  • Noun P; Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
  • van Klaveren C; Department of Educational and Family Studies, Amsterdam Center for Learning Analytics, Vrije Universiteit Amsterdam, the Netherlands.
  • Van't Hof E; Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.
  • Zoghbi E; Department of Psychology, University of Lausanne, Lausanne, Switzerland.
  • van Ommeren M; Department of Educational and Family Studies, Amsterdam Center for Learning Analytics, Vrije Universiteit Amsterdam, the Netherlands.
  • El Chammay R; Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
PLoS Med ; 19(6): e1004025, 2022 06.
Article in En | MEDLINE | ID: mdl-35737665
BACKGROUND: Most displaced people with mental disorders in low- and middle-income countries do not receive effective care, and their access to care has deteriorated during the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health interventions are scalable when digital access is adequate, and they can be safely delivered during the COVID-19 pandemic. We examined whether a new WHO-guided digital mental health intervention, Step-by-Step, in which participants were supported by a nonspecialist helper, was effective in reducing depression among displaced people in Lebanon. METHODS AND FINDINGS: We conducted a single-blind, 2-arm pragmatic randomized clinical trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among displaced Syrians suffering from depression and impaired functioning in Lebanon. Primary outcomes were depression (Patient Health Questionnaire, PHQ-9) and impaired functioning (WHO Disability Assessment Schedule-12, WHODAS) at posttreatment. Secondary outcomes included subjective well-being, anxiety, post-traumatic stress, and self-described problems. A total of 569 displaced people from Syria with depression (PHQ-9 ≥ 10) and impaired functioning (WHODAS > 16) were randomized to Step-by-Step (N = 283; lost to follow-up: N = 167) or ECAU (N = 286; lost to follow-up: 133). Participants were considered to be lost to follow-up when they did not fill in the outcome measures at posttest or follow-up. Recruitment started on December 9, 2019 and was completed on July 9, 2020. The last follow-up assessments were collected in December 2020. The study team had access to the online platform, where they could see treatment arm assignment for each participant. All questionnaires were completed by participants online. Intention-to-treat (ITT) analyses showed intervention effects on depression (standardized mean differences [SMDs]: 0.48; 95% CI: 0.26; 0.70; p < 0.001), impaired functioning (SMD: 0.35; 95% CI: 0.14; 0.56; p < 0.001), post-traumatic stress (SMD: 0.36; 95% CI: 0.16; 0.56; p < 0.001), anxiety (SMD: 0.46; 95% CI: 0.24; 0.68; p < 0.001), subjective well-being (SMD: 0.47; 95% CI: 0.26; 0.68; p < 0.001), and self-identified personal problems (SMD: 0.49; 95% CI 0.28; 0.70; p < 0.001). Significant effects on all outcomes were maintained at 3 months follow-up. During the trial, one serious adverse event occurred, unrelated to the intervention. The main limitation of the current trial is the high dropout rate. CONCLUSIONS: In this study, we found that a guided, digital intervention was effective in reducing depression in displaced people in Lebanon. The guided WHO Step-by-Step intervention we examined should be made available to communities of displaced people that have digital access. TRIAL REGISTRATION: ClinicalTrials.gov NCT03720769.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Refugees / Depression / Internet-Based Intervention Type of study: Clinical_trials / Prognostic_studies / Qualitative_research Limits: Humans Country/Region as subject: Asia Language: En Journal: PLoS Med Journal subject: MEDICINA Year: 2022 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Refugees / Depression / Internet-Based Intervention Type of study: Clinical_trials / Prognostic_studies / Qualitative_research Limits: Humans Country/Region as subject: Asia Language: En Journal: PLoS Med Journal subject: MEDICINA Year: 2022 Document type: Article Affiliation country: Country of publication: