Background The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited. Objective 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. Methods 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. Findings 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). Conclusions 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. Data are available on reasonable request. The Vrije Universiteit Amsterdam (VU) will keep a central data repository of all data collected in the STRENGTHS project. The data will be available on reasonable request to the STRENGTHS consortium. Data access might not be granted to third parties when this would interfere with relevant data protection and legislation in the countries participating in this project and any applicable European Union legislation regarding data protection. The PM+ training manual and intervention manual are available through the consortium. Interested researchers can contact prof. dr. Marit Sijbrandij at e.m.sijbrandij@vu.nl to initiate the process.

中文翻译：

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同伴为叙利亚难民提供的心理干预：关于问题管理+有效性的随机对照试验的结果

背景 高收入国家 (HIC) 难民的心理健康负担很高，而获得心理保健的机会可能有限。目的 研究同伴提供的心理干预（问题管理升级版；PM+）在减少荷兰叙利亚难民常见精神障碍 (CMD) 症状方面的有效性。方法 我们在 2019 年 3 月至 2021 年 12 月招募的成年叙利亚难民中进行了一项单盲、随机对照试验（编号 NTR7552）。患有心理困扰（凯斯勒心理困扰量表 (K10) > 15）和功能障碍（世界卫生组织残疾评估表 (WHODAS 2.0) > 16）的个体除了照常护理 (PM+/CAU) 或仅 CAU 之外，还被分配到 PM+。参与者在 1 周和 3 个月的随访中接受重新评估。主要结局是 3 个月随访时的抑郁/焦虑综合症状（霍普金斯症状检查表；HSCL-25）。次要结局包括抑郁 (HSCL-25)、焦虑 (HSCL-25)、创伤后应激障碍 (PTSD) 症状（精神障碍诊断和统计手册 PTSD 检查表，第五版；PCL-5）、损伤 (WHODAS 2.0) ）和自我发现的问题（PSYCHLOPS；心理结果概况）。主要分析是意向治疗。研究结果 参与者（n=206；平均年龄=37 岁，62% 为男性）被随机分为 PM+/CAU (n=103) 或 CAU (n=103)。在 3 个月的随访中，相对于 CAU，PM+/CAU 的抑郁/焦虑程度有更大的降低（平均差 -0.25；95% CI -0.385 至 -0.122；p=0.0001，Cohen's d =0.41）。PM+/CAU 还显示出抑郁症（p=0.0002，Cohen's d =0.42）、焦虑（p=0.001，Cohen's d =0.27）、PTSD 症状（p=0.0005，Cohen's d =0.39）和自我识别问题（p=0.0005，Cohen's d =0.39）的显着减少。 p=0.03，Cohen's d =0.26），但不适用于损伤（p=0.084，Cohen's d =0.21）。结论 PM+ 有效减轻叙利亚难民的 CMD 症状。一个优势是后续的高保留率。普遍性受到限制，因为主要包括拥有居留许可的难民。临床意义 应考虑在高收入国家中扩大同伴提供的心理干预措施。可根据合理要求提供数据。阿姆斯特丹自由大学 (VU) 将保留一个中央数据库，其中包含 STRENGTHS 项目中收集的所有数据。这些数据将根据 STRENGTHS 联盟的合理请求提供。当数据访问会干扰参与该项目的国家的相关数据保护和立法以及任何适用的欧盟有关数据保护的立法时，可能不会向第三方授予数据访问权限。PM+ 培训手册和干预手册可通过联盟获取。有兴趣的研究人员可以联系教授。博士。Marit Sijbrandij（电子邮件 emsijbrandij@vu.nl）启动该流程。