Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version’s total and six subdomains’ scores (‘mobility’, ‘life activities’, ‘cognition’, ‘participation’, ‘self-care’, ‘getting along’) as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in ‘mobility’ and ‘participation’, followed by ‘life activities’ and ‘cognition’. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in ‘participation’, while past events of being close to death were associated with fewer issues with ‘self-care’. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.

OBJECTIVE:Evidence on the optimal "dose" of cognitive behavioral therapy (CBT) for treating major depressive disorder is sparse. This analysis aimed to evaluate the dose-response curve in CBT using a nonlinear approach, whereby "dose" was defined as number of treatment sessions. The dose-response curve of CBT was compared to other psychotherapies and pharmacological treatments for depression. METHOD:A systematic review and metaregression analysis of randomized controlled trials (RCTs) examining the efficacy of CBT in adults with acute depression was conducted. Treatment arms examining other psychosocial or pharmacological interventions were also analyzed. Cubic spline metaregression techniques were used to model nonlinear dose-response curves. RESULTS:Seventy-two studies and 7,377 participants were included. Modeling the dose-response curve between change of depression symptom severity and the number of CBT sessions resulted in a nonlinear curve characterized by a strong improvement in symptom severity from baseline within the first eight sessions. Symptom reduction continues in the further course of the treatment, but at a slower pace. A similar pattern of symptom development was found for other therapies as well, although the prominence of early improvement and overall effect sizes vary across treatment arms. CONCLUSION:Results imply a general tendency for the strongest alleviation of depressive symptom severity in early stages of CBT treatment, thus, if aiming at symptom alleviation, speak for short CBT interventions. However, these findings have to be discussed in the light of the limited data regarding the sustainability of treatment effects in short-term therapies and effects beyond symptomatic changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Digital Mental Health Technologies (DMHTs) have the potential to close treatment gaps in settings where mental healthcare is scarce or even inaccessible. For this, DMHTs need to be affordable, evidence-based, justice-oriented, user-friendly, and embedded in a functioning digital infrastructure. This viewpoint discusses areas crucial for future developments of DMHTs. Drawing back on interdisciplinary scholarship, questions of health equity, consumer-, patient- and developer-oriented legislation, and requirements for successful implementation of technologies across the globe are discussed. Economic considerations and policy implications complement these aspects. We discuss the need for cultural adaptation specific to the context of use and point to several benefits as well as pitfalls of DMHTs for research and healthcare provision. Nonetheless, to circumvent technology-driven solutionism, the development and implementation of DMHTs require a holistic, multi-sectoral, and participatory approach.

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.

Background: In asylum seekers and refugees, the frequency of mental disorders, such as depression, anxiety and post-traumatic stress disorder, is higher than the general population, but there is a lack of data on risk factors for the development of mental disorders in this population. Aim: This study investigated the risk factors for mental disorder development in a large group of asylum seekers and refugees resettled in high- and middle-income settings. Methods: Participant-level data from two randomized prevention studies involving asylum seekers and refugees resettled in Western European countries and in Turkey were pooled. The two studies randomized participants with psychological distress, but without a diagnosis of mental disorder, to the Self-Help Plus psychological intervention or enhanced care as usual. At baseline, exposure to potentially traumatic events was measured using the Harvard Trauma Questionnaire-part I, while psychological distress and depressive symptoms were assessed with the General Health Questionnaire and the Patient Health Questionnaire. After 3 and 6 months of follow-up, the proportion of participants who developed a mental disorder was calculated using the Mini International Neuropsychiatric Interview. Results: A total of 1,101 participants were included in the analysis. At 3- and 6-month follow-up the observed frequency of mental disorders was 13.51% (115/851) and 24.30% (207/852), respectively, while the frequency estimates after missing data imputation were 13.95% and 23.78%, respectively. After controlling for confounders, logistic regression analysis showed that participants with a lower education level ( p = .034), a shorter duration of journey ( p = .057) and arriving from countries with war-related contexts ( p = .017), were more at risk of developing mental disorders. Psychological distress ( p = .004), depression ( p = .001) and exposure to potentially traumatic events ( p = .020) were predictors of mental disorder development. Conclusions: This study identified several risk factors for the development of mental disorders in asylum seekers and refugees, some of which may be the target of risk reduction policies. The identification of asylum seekers and refugees at increased risk of mental disorders should guide the implementation of focused preventative psychological interventions.

PURPOSE:Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigma stress on average. This study examined individual predictors of HOP outcomes and tested the hypothesis that stigma stress reduction at the end of HOP mediates positive HOP effects at follow-up.METHODS:Six RCTs were included with data at baseline, post (after the HOP program) and at 3- or 4-week follow-up. Baseline variables were entered in meta-regression models to predict change in self-stigma, stigma stress, depressive symptoms and quality of life among HOP participants. Mediation models examined change in stigma stress (post) as a mediator of HOP effects on self-stigma, depressive symptoms, and quality of life at follow-up.RESULTS:More shame at baseline, and for some outcomes reduced empowerment, predicted reduced HOP effects on stigma stress, self-stigma, depressive symptoms, and quality of life. Younger age was related to greater improvements in stigma stress after the HOP program. Stigma stress reductions at the end of HOP mediated positive effects on self-stigma, depressive symptoms and quality of life at follow-up.CONCLUSION:Participants who are initially less burdened by shame may benefit more from HOP. Stigma stress reduction could be a key mechanism of change that mediates effects on more distal outcomes. Implications for the further development of HOP are discussed.

This systematic review examines moderators and mediators tested in evaluations of stress management interventions for hospital employees to determine their significance for intervention outcomes. To be included, studies had to comprise a moderator or mediator analysis and a quantitative assessment of stress or mental well-being, and to be published in English or German language. Five databases (APA PsycInfo, APA PsycArticles, Embase, Medline, and Web of Science) were searched. Moderators and mediators were categorised thematically and examined using effect direction plots. Study quality was assessed using RoB 2 and ROBINS-I. In fifteen included studies, 22 moderators and ten mediators were identified. Moderators and mediators were categorised into individual psychological factors (14), socio-economic status (6), work situation (5), intervention (3), and duration of employment (3). Two moderators (perceived stressfulness of residency, job control) had a positive, two a negative impact (spirituality, socially desirable responding). One moderator (years of professional experience) had a positive and negative impact. Three moderators measured on categorical scales (gender, profession, and shiftwork) also had effects, favouring women, physicians and night-shift employees. Five mediators (adherence to intervention, mindfulness, non-reactivity to inner experience, total observing, and self-compassion) had a positive impact, while three (isolation, over-identification, psychological inflexibility) had a negative impact. In conclusion, effects of interventions were predominantly driven by individual psychological factors, while the role of other variables seems to be limited. Interventions focussing on primary or tertiary prevention were rare. Also processes through which organisational-level interventions can be most effective have been hardly investigated. Larger and methodologically robust studies are needed to better understand causal pathways and optimise matching of interventions to target groups.

Background: Longitudinal studies examining mental health trajectories in refugees and asylum seekers are scarce. Objectives: To investigate trajectories of psychological symptoms and wellbeing in refugees and asylum seekers, and identify factors associated with these trajectories. Method: 912 asylum seekers and refugees from the control arm of three trials in Europe (n = 229), Turkey (n = 320), and Uganda (n = 363) were included. We described trajectories of psychological symptoms and wellbeing, and used trauma exposure, age, marital status, education, and individual trial as predictors. Then, we assessed the bidirectional interactions between wellbeing and psychological symptoms, and the effect of each predictor on each outcome controlling for baseline values. Results: Symptom improvement was identified in all trials, and for wellbeing in 64.7% of participants in Europe and Turkey, versus 31.5% in Uganda. In Europe and Turkey domestic violence predicted increased symptoms at post-intervention (ß = 1.36, 95% CI 0.17–2.56), whilst murder of family members at 6-month follow-up (ß = 1.23, 95% CI 0.27–2.19). Lower wellbeing was predicted by murder of family member (ß = −1.69, 95% CI −3.06 to −0.32), having been kidnapped (ß = −1.67, 95% CI −3.19 to −0.15), close to death (ß = −1.38, 95% CI −2.70 to −0.06), and being in the host country ≥2 years (ß = −1.60, 95% CI −3.05 to −0.14). In Uganda at post-intervention, having been kidnapped predicted increased symptoms (ß = 2.11, 95% CI 0.58–3.65), and lack of shelter (ß = −2.51, 95% CI −4.44 to −0.58) and domestic violence predicted lower wellbeing (ß = −1.36, 95% CI −2.67 to −0.05). Conclusion: Many participants adapt to adversity, but contextual factors play a critical role in determining mental health trajectories.

OBJECTIVE:In recent decades, significant numbers of pharmaceutical trials have gradually been relocated to low- and middle-income countries. However, there is little evidence regarding the transferability of trial outcomes across countries. Analysing duloxetine randomised controlled trials (RCTs) conducted in different countries, we investigated whether per capita gross national income (GNI) and healthcare expenditure (HE) are associated with pre-post mean changes of depression severity and differences in duloxetine-placebo effect sizes.METHOD:Meta-analyses included RCTs investigating duloxetine efficacy in patients with depression. Individual participant data (IPD) from multi-centre duloxetine trials were provided by the manufacturer. Data extracted from published reports also entered analyses in case of trials conducted in only one country. A meta-regression approach was applied to analyse associations of GNI and HE with standardised pre-post mean change using raw score standardisation (SMCR) and comparative effect size, that is, the mean differences (MD) in pre-post effect size between duloxetine and placebo treatment.RESULTS:23 trials with 8417 randomised participants entered analyses. Regression coefficients indicated a negative linear relationship of SMCR with GNI (z-standardised β = -3.61, R2  = 14.8%, p < 0.001) and HE (β = -4.72, R2  = 24.8%, p < 0.001) for participants treated with duloxetine. Similar associations were found for placebo treatment (GNI: β = -3.52, R2  = 23.8%, p < 0.001; β = -3.34, R2  = 21.0% p < 0.001). Neither GNI nor HE was associated with the MD between duloxetine and placebo pre-post differences.CONCLUSIONS:Findings challenge the idea of the universal transferability of antidepressant trial outcomes across countries. Understanding the results of antidepressant RCTs demands more sophisticated clarification of context factors involved in determining effectiveness of antidepressant medication and should be discussed with a view to socio-economic context in their countries of origin.

Healthcare professionals’ exposure to work-family conflict negatively affects the health and well-being of the whole family and organizational outcomes. Specified workplace interventions are lacking. Therefore, the aim of the study was to evaluate the feasibility of a two-day group-treatment specifically designed for the needs of healthcare professionals with family responsibilities concerning participation, satisfaction with the intervention and family- and individual-related outcome variables. 24 mostly female (85.7%) participants of a community hospital in southern Germany attended the treatment. Data were collected at baseline (T0), directly after the treatment (T1) and two months later (T2). A two-factor analysis of variance with repeated measures showed a statistically significant time x group effect for self-efficacy (F = 5.29, p = 0.011). Contrasts displayed substantial pre-post (T1-T0, T2-T0) increases of self-efficacy in the intervention group as compared with the control group. Non-parametric Mann-Whitney-U tests are in line with these findings. The results indicate that the group-treatment adapted to the needs of healthcare professionals has the potential to boost self-efficacy among healthcare professionals and that participants were predominantly satisfied. Perspectives for future research and practical implications are discussed in the light of the manifest lack of healthcare professionals.

Background Refugees and asylum seekers face various stressors due to displacement and are especially vulnerable to common mental disorders. To effectively manage psychological distress in this population, innovative interventions are required. The World Health Organization (WHO) Self-Help Plus (SH+) intervention has shown promising outcomes in reducing symptoms of common mental disorders among refugees and asylum seekers. However, individual participant differences in response to SH+ remain largely unknown. The Individual Participant Data (IPD) meta-analysis synthesizes raw datasets of trials to provide cutting-edge evidence of outcomes that cannot be examined by conventional meta-analytic approaches.Objectives This protocol outlines the methods of a series of IPD meta-analyses aimed at examining the effects and potential moderators of SH+ in (a) reducing depressive symptoms at post-intervention and (b) preventing the six-month cumulative incidence of mental disorders in refugees and asylum seekers.Method RCTs on SH+ have been identified through WHO and all authors have agreed to share the datasets of the trials. The primary outcomes of the IPD meta-analyses are (a) reduction in depressive symptoms at post-intervention, and (b) prevention of six-month cumulative incidence of mental disorders. Secondary outcomes include post-traumatic stress disorder symptoms, well-being, functioning, quality of life, and twelve-month cumulative incidence of mental disorders. One-stage IPD meta-analyses will be performed using mixed-effects linear/logistic regression. Missing data will be handled by multiple imputation.Conclusions These results will enrich current knowledge about the response to SH+ and will facilitate its targeted dissemination. The results of these IPD meta-analyses will be published in peer-reviewed journals.

Background: People with long-term unemployment and mental health problems often find it difficult to take active steps toward help-seeking and job search and to navigate the complex system of available services. Likewise, job center staff would welcome interventions to improve the reintegration of long-term unemployed individuals with mental health problems into the labor market. Aim: To examine the efficacy of a peer-led group program that supports unemployed people with mental health problems in terms of help-seeking, job search and recovery. Methods: Based on participatory research, a four-session group program was designed and evaluated in a pilot randomized controlled trial (RCT) with 42 participants, randomized to the program (n=23) or treatment as usual (n=19). Outcomes were assessed at baseline (T0), 3weeks (T1), 6weeks (T2) and 6months later (T3). Results: There were no significant intervention effects on primary outcomes (job search self-efficacy and help-seeking). But compared to the control group, intervention participants showed significant improvements in depressive symptoms (p=.02) and recovery (p=.04) at T2 with medium effect sizes. There were trend-level positive program effects on self-stigma, hopelessness and secrecy. Conclusion: This pilot RCT provides initial evidence for the efficacy of a peer-led group program to improve symptoms and recovery among unemployed participants with mental health problems.

BackgroundIt has been shown that mindfulness practice can be helpful in preventing relapse from depression. However, practicing mindfulness regularly at home is often a challenge for people with depression. Mobile phone text messaging (short message service, SMS) may be a feasible approach to assist regular mindfulness home practice. ObjectiveThe aim of this study was to evaluate the feasibility of text message–based feedback to support mindfulness practice in people with depressive symptoms after inpatient psychiatric treatment. MethodsParticipants received a manualized group introduction to three mindfulness exercises during inpatient treatment and were randomized at hospital discharge. All participants were asked to practice the exercises daily during the 4-month follow-up period. Only participants allocated to the intervention group received reinforcing feedback via mobile phone text messages after reporting their mindfulness practice via text message. Participation rates and satisfaction with the interventions were evaluated, and effects on relevant outcomes were explored. ResultsOf the 176 eligible inpatients invited to participate, 65.9% (116/176) attended the introductory mindfulness group at least once, 33.0% (58/176) were willing to participate in the study, and 41 were randomized. The majority 85% (35/41) of these participants completed the study. Among the participants allocated to the intervention group (n=21), 81% (17/21) used the text message support at least once. The average number of text messages sent during the intervention period was 14 (SD 21, range 0-91). Satisfaction rates were high. Preliminary analyses of the effects of the intervention yielded mixed results. ConclusionsFindings indicate that text messaging following inpatient treatment is feasible for some, but not for all people with depressive symptoms. Modest use of the text messaging intervention and its mixed effects imply that dose and ingredients of the intervention should be increased for this group of patients in a future full-size RCT. Such a larger study should also include a process evaluation to investigate moderators of the effect of mindfulness practice and text message feedback on clinical outcome. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 58808893; http://www.controlled-trials.com/ISRCTN58808893 (Archived by Webcite at http://www.webcitation.org/6pmrDRnGt)

Aim The aim of this study was to estimate the prevalence and predictors of depression among Oman adult population attending primary healthcare clinics (PHCs) in Muscat Governorate in 2011. Methodology A cross-sectional study was conducted on 2005 participants attending 27 different PHCs in Muscat Governorate during 2011. A Patient Health Questionnaire (PHQ-9), together with a socio-demographic and relevant clinical data questionnaire was administered. Results Of the 2005 participants, 61.8% were women and 42.1% were of 25-50 age group. Of the total, 44.4% were employed, of whom 51% were government employees. The prevalence of depression among them was 8.1%. The adjusted odds ratios generated by logistic regression models indicated that depression was significantly associated with age greater than 50 years old (OR = 2.23; 95% CI 1.07, 4.22; P = 0.04), female (OR = 1.34; 95% CI 1.12, 3.82; P = 0.03), married (OR = 1.91; 95% CI 1.11, 3.30; P = 0.02), graduated or attended higher education (OR = 1.40; 95% CI 1.03, 2.66; P = 0.04), working in the private sector if employed (OR = 1.72; 95% CI 1.08, 2.75; P = 0.02), and having chronic illness such as diabetes mellitus, hypertension, asthma, heart, thyroid, and renal diseases (OR = 1.82; 95% CI 1.03, 3.51; P = 0.01). Conclusion The rate of depression appears to be in the lower range compared to rate reported from elsewhere. Some socio-cultural factors that may contribute to the present findings are discussed.