Self Help Plus: Study Protocol for a Cluster-randomised Controlled Trial of Guided Self-help with South Sudanese Refugee Women in Uganda

Overview

Journal Glob Ment Health (Camb)

Publisher Cambridge University Press

Specialty Public Health

Date 2018 Aug 22

PMID 30128163

Citations 12

Authors

F L Brown

K Carswell

J Augustinavicius

A Adaku

M R Leku

R G White

P Ventevogel

C S Kogan

C Garcia-Moreno

R A Bryant

R J Musci

M van Ommeren

W A Tol

Affiliations

Soon will be listed here.

Abstract

Background: Exposure to armed conflict and forced displacement constitute significant risks for mental health. Existing evidence-based psychological interventions have limitations for scaling-up in low-resource humanitarian settings. The WHO has developed a guided self-help intervention, Self Help Plus (SH+), which is brief, implemented by non-specialists, and designed to be delivered to people with and without specific mental disorders. This paper outlines the study protocol for an evaluation of the SH+ intervention in northern Uganda, with South Sudanese refugee women.

Methods: A two-arm, single-blind cluster-randomised controlled trial will be conducted in 14 villages in Rhino Camp refugee settlement, with at least 588 women experiencing psychological distress. Villages will be randomly assigned to receive either SH+ with enhanced usual care (EUC), or EUC alone. SH+ is a five-session guided self-help intervention delivered in workshops with audio-recorded materials and accompanying pictorial guide. The primary outcome is reduction in overall psychological distress over time, with 3 months post-treatment as the primary end-point. Secondary outcomes are self-defined psychosocial concerns, depression and post-traumatic stress disorder symptoms, hazardous alcohol use, feelings of anger, interethnic relations, psychological flexibility, functional impairment and subjective wellbeing. Psychological flexibility is a hypothesised mediator, and past trauma history and intervention attendance will be explored as potential moderators.

Discussion: This trial will provide important information on the effectiveness of a scalable, guided self-help intervention for improving psychological health and wellbeing among people affected by adversity.

Trial Registration: ISRCTN50148022; registered 13/03/2017.

Citing Articles

Effectiveness of a WHO self-help psychological intervention to alleviate stress among healthcare workers in the context of COVID-19 in China: a randomised controlled trial.

Li J, Luo R, Guo P, Zhang D, Mo P, Wu A Epidemiol Psychiatr Sci. 2024; 33:e11.

PMID: 38450478 PMC: 10940054. DOI: 10.1017/S2045796024000106.

Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India.

Shrivastava R, Singh A, Khan A, Choubey S, Haney J, Karyotaki E SSM Ment Health. 2024; 4.

PMID: 38188869 PMC: 10769151. DOI: 10.1016/j.ssmmh.2023.100230.

Community based sociotherapy for depressive symptomatology of Congolese refugees in Rwanda and Uganda (CoSTAR): a protocol for a cluster randomised controlled trial.

Kagabo D, Bangirana P, Burnside G, Chiumento A, Duarte R, Gishoma D Eur J Psychotraumatol. 2023; 14(1):2151281.

PMID: 37052106 PMC: 9869985. DOI: 10.1080/20008066.2022.2151281.

PROTOCOL: Social interventions to improve well-being of people with mental disorders: Global evidence and gap map.

Dsouza S, Saran A, Krishnan J Campbell Syst Rev. 2023; 17(3):e1182.

PMID: 37051453 PMC: 8988804. DOI: 10.1002/cl2.1182.

We need to build the evidence: A systematic review of psychological first aid on mental health and well-being.

Hermosilla S, Forthal S, Sadowska K, Magill E, Watson P, Pike K J Trauma Stress. 2022; 36(1):5-16.

PMID: 36300605 PMC: 10624106. DOI: 10.1002/jts.22888.

References

Nakimuli-Mpungu E, Alderman S, Kinyanda E, Allden K, Betancourt T, Alderman J . Implementation and scale-up of psycho-trauma centers in a post-conflict area: a case study of a private-public partnership in northern Uganda. PLoS Med. 2013; 10(4):e1001427. PMC: 3627641. DOI: 10.1371/journal.pmed.1001427. View

Kane J, Ventevogel P, Spiegel P, Bass J, van Ommeren M, Tol W . Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps. BMC Med. 2014; 12:228. PMC: 4269097. DOI: 10.1186/s12916-014-0228-9. View

Murray L, Dorsey S, Haroz E, Lee C, Alsiary M, Haydary A . A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries. Cogn Behav Pract. 2015; 21(2):111-123. PMC: 4304666. DOI: 10.1016/j.cbpra.2013.06.005. View

Ventevogel P, van Ommeren M, Schilperoord M, Saxena S . Improving mental health care in humanitarian emergencies. Bull World Health Organ. 2015; 93(10):666-666A. PMC: 4645443. DOI: 10.2471/BLT.15.156919. View

Castro F, Barrera Jr M, Holleran Steiker L . Issues and challenges in the design of culturally adapted evidence-based interventions. Annu Rev Clin Psychol. 2010; 6:213-39. PMC: 4262835. DOI: 10.1146/annurev-clinpsy-033109-132032. View

Kashdan T, Morina N, Priebe S . Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: experiential avoidance as a contributor to distress and quality of life. J Anxiety Disord. 2008; 23(2):185-96. PMC: 2667796. DOI: 10.1016/j.janxdis.2008.06.006. View

Kessler R, Barker P, Colpe L, Epstein J, Gfroerer J, Hiripi E . Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003; 60(2):184-9. DOI: 10.1001/archpsyc.60.2.184. View

Kane J, Adaku A, Nakku J, Odokonyero R, Okello J, Musisi S . Challenges for the implementation of World Health Organization guidelines for acute stress, PTSD, and bereavement: a qualitative study in Uganda. Implement Sci. 2016; 11:36. PMC: 4793547. DOI: 10.1186/s13012-016-0400-z. View

Kim G, Torbay R, Lawry L . Basic health, women's health, and mental health among internally displaced persons in Nyala Province, South Darfur, Sudan. Am J Public Health. 2006; 97(2):353-61. PMC: 1781379. DOI: 10.2105/AJPH.2005.073635. View

10.

Epping-Jordan J, Harris R, Brown F, Carswell K, Foley C, Garcia-Moreno C . Self-Help Plus (SH+): a new WHO stress management package. World Psychiatry. 2016; 15(3):295-296. PMC: 5032500. DOI: 10.1002/wps.20355. View

11.

Murray L, Tol W, Jordans M, Zangana G, Amin A, Bolton P . Dissemination and implementation of evidence based, mental health interventions in post conflict, low resource settings. Intervention (Amstelveen). 2017; 12(Suppl 1):94-112. PMC: 5356225. DOI: 10.1097/WTF.0000000000000070. View

12.

Tol W, Augustinavicius J, Carswell K, Leku M, Adaku A, Brown F . Feasibility of a guided self-help intervention to reduce psychological distress in South Sudanese refugee women in Uganda. World Psychiatry. 2018; 17(2):234-235. PMC: 5980508. DOI: 10.1002/wps.20537. View

13.

Cavanagh K, Strauss C, Forder L, Jones F . Can mindfulness and acceptance be learnt by self-help?: a systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clin Psychol Rev. 2014; 34(2):118-29. DOI: 10.1016/j.cpr.2014.01.001. View

14.

Ventevogel P, Jordans M, Reis R, de Jong J . Madness or sadness? Local concepts of mental illness in four conflict-affected African communities. Confl Health. 2013; 7(1):3. PMC: 3605182. DOI: 10.1186/1752-1505-7-3. View

15.

Silove D, Rees S, Tam N, Mohsin M, Tay A, Tol W . Prevalence and correlates of explosive anger among pregnant and post-partum women in post-conflict Timor-Leste. BJPsych Open. 2016; 1(1):34-41. PMC: 4995583. DOI: 10.1192/bjpo.bp.115.000190. View

16.

Marshall C . The inter-agency standing committee (IASC) guidelines on mental health and psychosocial support (MHPSS) in emergency settings: a critique. Int Rev Psychiatry. 2022; 34(6):604-612. DOI: 10.1080/09540261.2022.2147420. View

17.

Czachowski S, Seed P, Schofield P, Ashworth M . Measuring psychological change during cognitive behaviour therapy in primary care: a Polish study using 'PSYCHLOPS' (Psychological Outcome Profiles). PLoS One. 2011; 6(12):e27378. PMC: 3240620. DOI: 10.1371/journal.pone.0027378. View

18.

Dua T, Barbui C, Clark N, Fleischmann A, Poznyak V, van Ommeren M . Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Med. 2011; 8(11):e1001122. PMC: 3217030. DOI: 10.1371/journal.pmed.1001122. View

19.

Schafer J, Graham J . Missing data: our view of the state of the art. Psychol Methods. 2002; 7(2):147-77. View

20.

Cuijpers P, Munoz R, Clarke G, Lewinsohn P . Psychoeducational treatment and prevention of depression: the "Coping with Depression" course thirty years later. Clin Psychol Rev. 2009; 29(5):449-58. DOI: 10.1016/j.cpr.2009.04.005. View