Predictors of symptom change in the mental health of refugees and asylum seekers (MEHIRA) study examining the effects of a stepped and collaborative care model – A multicentered rater-blinded randomized controlled trial

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2024-10-28 DOI:10.1016/j.jad.2024.10.103

Solveig Kemna , Max Bringmann , Carine Karnouk , Andreas Hoell , Mira Tschorn , Inge Kamp-Becker , Frank Padberg , Aline Übleis , Alkomiet Hasan , Peter Falkai , Hans-Joachim Salize , Andreas Meyer-Lindenberg , Tobias Banaschewski , Frank Schneider , Ute Habel , Paul Plener , Eric Hahn , Maren Wiechers , Michael Strupf , Andrea Jobst , Kerem Böge

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引用次数: 0

Abstract

Background

Predictors of symptom improvement are an essential starting point for tailoring psychological treatments to each individual and, in turn, increasing treatment efficacy overall. However, such research regarding refugees/asylum seekers from Arabic-/Farsi-speaking countries is lacking. The current study aimed to characterize predictors for symptom improvement in the Mental Health in Refugees and Asylum Seekers (MEHIRA) study, one of the most extensive multicentered controlled trials on a nationwide stepped and collaborative care model compared to routine German mental health care.

Methods

Variables characterizing symptom change were chosen using backward elimination and inserted into logistic regression models for two depression endpoints, namely the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Asberg Depression Rating Scale (MADRS).

Results

Six variables were found to be at least marginally significantly associated with symptom decrease in both outcomes: baseline depressive symptom load, comorbid post-traumatic stress disorder, identifying as a refugee, years of schooling, physical health, and post-migration social status difference. Additionally, psychological health and resilience were marginally significant for one of the models.

Limitations

Some predictor constructs - such as social support - were not adequately measured to replicate previous findings. Additionally, the study was underpowered for symptom change prediction of individual treatments beyond the group intervention.

Conclusions

These outcomes indicate that trauma-related elements as well as content on refugee identity and post-migration social status changes should be included in depression interventions for refugees. Further, recommendations for future outcome prediction studies are made.

查看原文本刊更多论文

难民和寻求庇护者心理健康症状变化的预测因素（MEHIRA）研究--检查阶梯式协作护理模式的效果--多中心评分者盲法随机对照试验。

背景：症状改善的预测因素是为每个人量身定制心理治疗方案的重要起点，反过来也能提高整体治疗效果。然而，针对来自阿拉伯语/波斯语国家的难民/寻求庇护者的此类研究却十分缺乏。本研究旨在确定难民和寻求庇护者心理健康（MEHIRA）研究中症状改善的预测因素，该研究是关于全国范围内的阶梯式协作护理模式与德国常规心理健康护理相比最广泛的多中心对照试验之一：采用反向排除法选择症状变化的特征变量，并将其插入两个抑郁终点（即患者健康问卷-9（PHQ-9）和蒙哥马利-阿斯伯格抑郁评定量表（MADRS））的逻辑回归模型中：结果发现，有六个变量与这两项结果中症状的减少至少有微弱的相关性：基线抑郁症状负荷、合并创伤后应激障碍、难民身份、受教育年限、身体健康和移民后的社会地位差异。此外，在其中一个模型中，心理健康和复原力也略有显著性：局限性：一些预测因素（如社会支持）没有得到充分测量，因此无法复制之前的研究结果。此外，该研究对小组干预之外的个体治疗的症状变化预测能力不足：这些结果表明，在对难民进行抑郁干预时，应纳入与创伤相关的内容以及有关难民身份和移民后社会地位变化的内容。此外，还对未来的结果预测研究提出了建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.