Peer-provided psychological intervention for Syrian refugees : results of a randomised controlled trial on the effectiveness of Problem Management Plus


The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited.



To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands.



We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019–December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat.



Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference −0.25; 95% CI −0.385 to −0.122; p=0.0001, Cohen’s d=0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen’s d=0.42), anxiety (p=0.001, Cohen’s d=0.27), PTSD symptoms (p=0.0005, Cohen’s d=0.39) and self-identified problems (p=0.03, Cohen’s d=0.26), but not on impairment (p=0.084, Cohen’s d=0.21).



PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit.


Clinical implications

Peer-provided psychological interventions should be considered for scale-up in HICs.

Anne M de Graaff, Pim Cuijpers, Jos W R Twisk, Barbara Kieft, Sam Hunaidy, Mariam Elsawy, Noer Gorgis, Theo K Bouman, Miriam J J Lommen, Ceren Acarturk, Richard Bryant, Sebastian Burchert, Katie S Dawson, Daniela C Fuhr, Pernille Hansen, Mark Jordans, Christine Knaevelsrud, David McDaid, Naser Morina, Hanspeter Moergeli, A-La Park, Bayard Roberts, Peter Ventevogel, Nana Wiedemann, Aniek Woodward, Marit Sijbrandij | 2023
In: BMJ Mental Health ; ISSN: 2755-9734 | 26 | 1 | february | e300637
Adults, Anxiety Disorders, Depressive Symptoms, Effectiveness, Interventions, Mental health, Mental health care, Mood Disorders, Psychological distress, Psychosocial support, Randomized Clinical Trial, Refugees, Syrians
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