The study, found that a group in the study who had been experiencing ‘psychological distress’ but who had not been formally diagnosed, and who had been using Self-Help Plus for six months were 50% less likely to still be experiencing psychological distress, when compared to a control group.

The study, having taken place in June 2020, involved 642 adults from Syria, Iraq, Palestine and Yemen. The average age of the participants was 31 and over half were women (63%). Splitting the overall number of participants into two halves, one half was received Self-Help Plus and Enhanced Care as Usual (ECAU), a routinely delivered method of social support and/or care, while the other half received only the ECAU.

What is the Self-Help Plus intervention based on?

WHO have based Self-Help Plus (SH+) on acceptance and commitment therapy (ACT), which is a variation on cognitive behavioural therapy (CBT), you can read our article on ACT here. SH+ is formed around a ‘pre-recorded audio course’ which also involves a culturally relevant, illustrated self-help book.

The audio material guides a listener through stress coping and management strategies, through individual exercises as well as small group discussions. Through learning these strategies, those involved in the study who had accessed SH+ were ‘significantly less likely’ to be experiencing the distress from a range of mental disorders, including: depression, post-traumatic stress disorder (PTSD) and anxiety disorders.

The study also found that those participants who had accessed Self-Help Plus had a ‘better quality of life’ after a six month follow up.

What does the success of this study mean for refugee populations elsewhere?

WHO note the potential for ‘scale-up’ in the roll out of SH+ as a standardised intervention for refugee populations across the globe. This is especially possible as SH+ does not require highly qualified facilitators, and instead used non-specialist facilitators who had undergone a short training course.

WHO note that SH+ should be considered as a ‘public health strategy to prevent mental disorders in large refugee populations exposed to ongoing adversity.’ However, they emphasise that as the intervention does not address refugees mental health to a psychiatric or medical level, it should be used in conjunction with and not as a replacement of, services that ‘address their social, physical and broader mental health needs.’

Finally WHO acknowledged the dire need for a worldwide recognition of the mental health crisis facing many displaced peoples, they said:

‘In 2020, the number of forcibly displaced people in the world, 80 million, was the highest since World War II. Among them, 26 million fled their countries due to violence or persecution. The largest group of refugees was from Syria, accounting for 6.6 million people. An estimated 3.6 million Syrian refugees are now living in Turkey. WHO estimates that rates of depression, PTSD and any mental disorder among people exposed to conflict in the previous 10 years are 11%, 15% and 22% respectively.’