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      Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries Translated title: 标题:加强对中东和欧洲叙利亚难民的心理健康关怀系统:在八个国家中整合的可量化的心理干预 Translated title: El fortalecimiento de los sistemas de atención de salud mental para refugiados sirios en Europa y Oriente Medio: La integración de intervenciones psicológicas escalables en 8 países

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      , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
      European Journal of Psychotraumatology
      Taylor & Francis
      Refugees, Syria, psychological interventions, implementation, task-shifting, common mental disorders, cognitive behavioural therapy (CBT), problem solving treatment (PST), e-mental health interventions, Refugiados, Siria, intervenciones psicológicas, implementación, cambio de tareas, trastornos mentales comunes, terapia cognitivo-conductual (TCC), tratamiento de resolución de problemas (PST), intervenciones electrónicas de salud mental, 难民, 叙利亚, 心理干预, 执行, 任务切换, 常见心理障碍, 认知行为疗法(CBT), 问题解决疗法(PST), 网络心理健康干预, • Syrian refugees are at risk of developing common mental disorders, including depression and posttraumatic stress disorder. • Evidence-based interventions for refugees are available, but refugees have limited access to mental health services for these problems because of limited availability of mental health professionals in Europe and the Middle East. • STRENGTHS will translate and adapt a scalable set of World Health Organization interventions including the evidence-based PM+ for use with Syrian refugees with elevated levels of distress and reduced functioning.• The programmes will be delivered in individual, group or smartphone formats and will be supported by either peer-refugees or local non-professional helpers who will receive training and supervision.

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          ABSTRACT

          The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria’s neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training,

          We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.

           

          La crisis en Siria ha dado lugar a un gran número de refugiados que buscan asilo en países vecinos a Siria, así como en Europa. Los refugiados corren un riesgo considerable de desarrollar trastornos mentales comunes, como depresión, ansiedad y trastorno por estrés postraumático (TEPT). La mayoría de los refugiados no tienen acceso a servicios de salud mental para estos problemas debido a las múltiples barreras existentes en los sistemas de salud nacionales y específicos para refugiados, incluida una limitada disponibilidad de profesionales de salud mental. Para contrarrestar algunos de los retos derivados de la limitada capacidad del sistema de salud mental, la Organización Mundial de la Salud (OMS) ha desarrollado una gama de intervenciones psicológicas escalables dirigidas a reducir la angustia psicológica y mejorar el funcionamiento de las personas afectadas por la adversidad. Estas intervenciones, que incluyen Problem Management Plus (Gestión de problemas plus, PM+) y sus variantes, están pensadas para ser aplicadas en formatos cara a cara o mediante teléfonos inteligentes a individuos o grupos por personas no profesionales que no han recibido formación especializada en salud mental,

          Proporcionamos una justificación basada en la evidencia para el uso de programas escalables orientados a la PM+ que están siendo adaptados para refugiados sirios y proporcionamos información sobre el programa STRENGTHS recientemente lanzado para adaptar, probar y ampliar la PM+ en diversas modalidades, tanto en los países vecinos como en los europeos que reciben refugiados de Siria.

           

          叙利亚危机导致了海量的难民到周边国家和欧洲寻求避难所。难民们发展出常见心理障碍的风险非常大,其中包括抑郁,焦虑,创伤后应激障碍(PTSD)。大多数难民没有渠道向心理健康机构寻求帮助,这主要是因为国家医疗和难民健康系统的种种阻碍,包括心理健康专家的数量不足。为了应对心理健康系统容量有限所产生的问题,世界卫生组织(WHO)发展出了一系列的可量化心理干预方法,用来减少心理障碍和提高社区中处于逆境里的人们的生活功能。这些干预方法中就有《问题应对量表Plus》(PM+)和它的其他变型,用来给未经过专业心理健康训练的非专业新手以面对面的或智能手机的形式向个人或群体使用。我们为针对叙利亚难民改良的可量化的PM+为基础的项目提供了有证据支持的原理,并且提供了关于新近运行的STRENGTHS项目的信息,该项目旨在在接受叙利亚难民的周边国家和欧洲国家中适应、测试、扩大PM+的多种形式。

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          Mental health and psychosocial wellbeing of Syrians affected by armed conflict.

          This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.
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            A critical review of psychological treatments of posttraumatic stress disorder in refugees.

            Despite much research evidence that refugees suffer from elevated rates of posttraumatic stress disorder (PTSD), relatively few studies have examined the effectiveness of psychological treatments for PTSD in refugees. The field of refugee mental health intervention is dominated by two contrasting approaches, namely trauma-focused therapy and multimodal interventions. This article firstly defines these two approaches, then provides a critical review of 19 research studies that have been undertaken to investigate the efficacy of these treatments. Preliminary research evidence suggests that trauma-focused approaches may have some efficacy in treating PTSD in refugees, but limitations in the methodologies of studies caution against drawing definitive inferences. It is clear that research assessing the treatment of PTSD in refugees is lagging behind that available for other traumatized populations. The review examines important considerations in the treatment of refugees. A theoretical framework is offered that outlines contextual issues, maintaining factors, change mechanisms and the distinctive challenges to traditional trauma-focused treatments posed by the needs of refugees with PTSD. Copyright © 2010 Elsevier Ltd. All rights reserved.
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              Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial

              Background Gender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries (LMICs). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in LMICs. The aim of this study was to test the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver. Methods and findings In this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Secondary outcomes were impaired functioning (measured by the WHO Disability Adjustment Schedule [WHODAS]), symptoms of posttraumatic stress (measured by the Posttraumatic Stress Disorder Checklist [PCL]), personally identified problems (measured by Psychological Outcome Profiles [PSYCHLOPS]), stressful life events (measured by the Life Events Checklist [LEC]), and health service utilisation. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 518 women (37%) screened positive, of whom 421 (81%) were women who had experienced GBV. Of these 421 women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were completed on 16 January 2016. The primary analysis was intention to treat and included 53 women in PM+ (25%) and 49 women in EUC (23%) lost to follow-up. The difference between PM+ and EUC in the change from baseline to 3 months on the GHQ-12 was 3.33 (95% CI 1.86–4.79, P = 0.001) in favour of PM+. In terms of secondary outcomes, for WHODAS the difference between PM+ and EUC in the change from baseline to 3-month follow-up was 1.96 (95% CI 0.21–3.71, P = 0.03), for PCL it was 3.95 (95% CI 0.06–7.83, P = 0.05), and for PSYCHLOPS it was 2.15 (95% CI 0.98–3.32, P = 0.001), all in favour of PM+. These estimated differences correspond to moderate effect sizes in favour of PM+ for GHQ-12 score (0.57, 95% CI 0.32–0.83) and PSYCHLOPS (0.67, 95% CI 0.31–1.03), and small effect sizes for WHODAS (0.26, 95% CI 0.02–0.50) and PCL (0.21, 95% CI 0.00–0.41). Twelve adverse events were reported, all of which were suicidal risks detected during screening. No adverse events were attributable to the interventions or the trial. Limitations of the study include no long-term follow-up, reliance on self-report rather than structured interview data, and lack of an attention control condition. Conclusions Among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioural intervention, compared with EUC, resulted in moderate reductions in psychological distress at 3-month follow-up. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12614001291673
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2017
                07 November 2017
                : 8
                : sup2 , Traumatized Refugees
                : 1388102
                Affiliations
                [ a ] Clinical, Neuro and Developmental Psychology, VU University , Amsterdam, the Netherlands
                [ b ] Department of Psychology, Istanbul Sehir University , Istanbul, Turkey
                [ c ] International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support , Copenhagen, Denmark
                [ d ] School of Psychology, University of New South Wales , Sydney, Australia
                [ e ] Department of Clinical Psychological Intervention, Freie Universität Berlin , Berlin, Germany
                [ f ] Department of Mental Health and Substance Abuse, World Health Organization , Geneva, Switzerland
                [ g ] Faculty of Social and Behavioural Sciences, University of Amsterdam , Amsterdam, the Netherlands
                [ h ] Ministry of Public Health , Beirut, Lebanon
                [ i ] Department of Psychiatry, Faculty of Medicine, Saint Joseph University , Beirut, Lebanon
                [ j ] Grants Desk, VU University Medical Center , Amsterdam, the Netherlands
                [ k ] Department of Research and Development, War Child , Amsterdam, the Netherlands
                [ l ] Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, UK
                [ m ] University Hospital Zurich, University of Zurich , Zurich, Switzerland
                [ n ] Department of Health Policy, Personal Social Services Research Unit, London School of Economics and Political Science , London, UK
                [ o ] Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine , London, UK
                [ p ] Region Netherlands Centre and North, i-Psy Mental Health Care , Almere, the Netherlands
                [ q ] KIT Royal Tropical Institute , Amsterdam, the Netherlands
                [ r ] War Trauma Foundation , Diemen, the Netherlands
                [ s ] Public Health Section, United Nations High Commissioner for Refugees , Geneva, Switzerland
                [ t ] International Medical Corps , London, UK
                Author notes
                CONTACT Marit Sijbrandij e.m.sijbrandij@ 123456vu.nl Clinical, Neuro and Developmental Psychology, VU University , Van der Boechorststraat 1, Amsterdam 1081 BT, the Netherlands
                Author information
                http://orcid.org/0000-0002-8212-6277
                http://orcid.org/0000-0001-5497-2743
                Article
                1388102
                10.1080/20008198.2017.1388102
                5687806
                29163867
                87b4e6ad-7794-4faa-aad3-dd51f1044dbe
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 May 2017
                : 22 September 2017
                Page count
                Figures: 1, References: 80, Pages: 12
                Funding
                Funded by: H2020 Societal Challenges 10.13039/100010676
                Award ID: 733337
                Funded by: Swiss State Secretariat for Education, Research and Innovation (SERI)
                Award ID: REF-1131-52107
                This work was supported by the H2020 Societal Challenges [733337]; Swiss State Secretariat for Education, Research and Innovation (SERI) [REF-1131-52107] and Swiss Nation Science Foundation.
                Categories
                Review Article
                Review Article

                Clinical Psychology & Psychiatry
                refugees,syria,psychological interventions,implementation,task-shifting,common mental disorders,cognitive behavioural therapy (cbt),problem solving treatment (pst),e-mental health interventions,refugiados,siria,intervenciones psicológicas,implementación,cambio de tareas,trastornos mentales comunes,terapia cognitivo-conductual (tcc),tratamiento de resolución de problemas (pst),intervenciones electrónicas de salud mental,难民,叙利亚,心理干预,执行,任务切换,常见心理障碍,认知行为疗法(cbt),问题解决疗法(pst),网络心理健康干预

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