A brief psychological intervention for Afghan asylum seekers

Refugees and asylum seekers are at great risk to develop mental disorders. Afghan refugees are a particularly vulnerable group with a low-average education and low-average knowledge about mental health treatment options. Traumatic experiences and hardship before and during migration contribute to mental health problems. Despite these traumatic events, post-migration living difficulties (PMLDs) such as loss of culture, stigmatization, and poor living conditions diminish mental health. Treatment manuals mostly do not consider these aspects. Studies investigating the efficacy of interventions for refugees have mostly focused on posttraumatic stress disorder (PTSD). However, refugees may likely suffer from other mental health problems such as depression or anxiety as well. There is almost no evidence on the efficacy of psychosocial interventions in this population except for PTSD. We aim to evaluate for the first time the efficacy of a short psychological treatment manual that addresses mental health problems and PMLDs (adapted Problem Management Plus, PM+), for treatment-seeking Afghan refugees. We further aim to assess the subjective experiences with this treatment manual and evaluate the applicability for a broader implementation. This includes several steps: (1) the adaptation of PM+ to address PMLDs, (2) a trial to investigate the efficacy of the adapted PM+ manual, (3) in depth interviews with participants from the treatment group, and (4) the development and evaluation of an online training tool for mental health professionals. The adaptation will be based on interviews with several experts working with refugees (psychologists, psychiatrists, and social workers). For the trial, we will invite treatment-seeking Afghan refugees who are on a waiting list for psychotherapy to participate. One hundred and twenty persons will be invited to either get the treatment or be in a control group. Group allocation will be made by chance. All treatment sessions will take place with a Dari interpreter, and clinical psychologists will conduct the treatment. The protocol includes six 90-minute sessions. The main outcome is the general symptom distress six months post-treatment as assessed with a questionnaire. Secondary outcome measures include the checklist for PMLDs, a PTSD questionnaire, and a quality of life questionnaire. A sub-sample of the treatment group (n = 20) will be invited for in-depth interviews about their subjective experiences and appraisal of the treatment. In the final phase, we will develop an online training tool to assess primary mental health care professionals opinion about the treatment manual. With this project, we intend to contribute to the treatment of the mental health burden experienced by Afghan refugees.

Post-migration living difficulties and general mental health problems were found to be the most troubling problems for Afghan refugees in Austria. Approximately two thirds of the participants reported functional impairment concerning performance-oriented activities, language acquisition, and activities of daily living. The psychological short intervention adapted Problem Management (aPM)+ manual could effectively reduce general mental health problems, and also eased the experience of burdens caused by these difficulties. Furthermore, it was well received by participants. Additionally, mental health professionals, who took part in an online training with (aPM+) also appreciated this intervention. For participants particularly, the breathing exercise as helpful, while mental health professionals emphasized the importance of making situation-specific adaptations. No significant differences in the burden of various forms of PMLDs were found, however, individuals with severe Complex PTSD were identified as a risk group for increased burdens related to language acquisition problems and language barriers. Trauma-associated re-experiencing (e.g. exposure to war trauma or traumatic experiences during the flight) and affective dysregulation were identified as central symptom clusters in the interplay between CPTSD and PMLDs. Our results underscore the importance of psychological treatments to integrate PMLDs into the treatment process. The results demonstrate the significance of considering culture-sensitive treatment offerings for refugees, aiming to increase mental health service utilization and literacy in order to improve mental health, life satisfaction, and well-being in the long term. Therefore, participants subjective needs and perceptions must be considered in future research and clinical work. Given the complex interplay between mental health, daily life impairments, PMLDs, and the successful adaptation in Austria, there is a clear need for further psychological interventions. Specifically, enhancing the availability of language interpreters to reduce language barriers may promote mental health, thus improve language acquisition and social inclusion.