The effectiveness of Problem Management Plus at 1-year follow-up for Syrian refugees in a high-income setting

Abstract

Aims. Problem Management Plus (PM+) has been effective in reducing mental health problems among refugees at three-month follow-up, but there is a lack of research on its long-term effectiveness. This study examined the effectiveness of PM+ in reducing symptoms of common mental disorders at 12-month follow-up among Syrian refugees in the Netherlands. Methods. This single-blind, parallel, controlled trial randomised 206 adult Syrians who screened positive for psychological distress and impaired functioning to either PM+ in addition to care as usual (PM+/CAU) or CAU alone. Assessments were at baseline, 1 week and 3 months after the intervention and 12 months after baseline. Outcomes were psychological distress (Hopkins Symptom Checklist [HSCL-25]), depression (HSCL-25 subscale), anxiety (HSCL-25 subscale), posttraumatic stress disorder symptoms (PCL-5), functional impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS). Results. In March 2019-December 2022, 103 participants were assigned to PM+/CAU and 103 to CAU of which 169 (82.0%) were retained at 12 months. Intention-to-treat analyses showed greater reductions in psychological distress at 12 months for PM+/CAU compared to CAU (adjusted mean difference -0.17, 95% CI -0.310 to -0.027;p = 0.01, Cohen's d = 0.28). Relative to CAU, PM+/CAU participants also showed significant reductions on anxiety (-0.19, 95% CI -0.344 to -0.047;p = 0.01, d = 0.31) but not on any of the other outcomes. Conclusions. PM+ is effective in reducing psychological distress and symptoms of anxiety over a period up to 1 year. Additional support such as booster sessions or additional (trauma- focused) modules may be required to prolong and consolidate benefits gained through PM+ on other mental health and psychosocial outcomes.