Group problem management plus (gPM+) in the treatment of common mental disorders in Syrian refugees in a Jordanian camp: study protocol for a randomized controlled trial

Aemal Akhtar,Hadeel Naser,Richard A. Bryant,Luana Giardinelli,Claire Whitney,Mark J. D. Jordans,Marit Sijbrandij,Ahmad Bawaneh,Manar Awwad

doi:10.1186/s12889-020-08463-5

Abstract

BackgroundAccessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce. To mitigate this, the World Health Organization has developed group problem management plus (gPM+), a low-intensity psychological intervention for adults experiencing psychological distress. gPM+ is a group-based intervention consisting of five-sessions, and can be delivered by non-specialist providers. This paper outlines the study protocol for a trial of gPM+ in Jordan.MethodsWe will conduct a single-blind, two-arm, randomized controlled trial in a Syrian refugee camp in Jordan. We aim to enrol 480 adults into the trial. Participants will be eligible for the trial if they screen positive for levels of psychological distress. Following screening, those eligible will be randomly assigned to receive the gPM+ intervention or enhanced treatment as usual. The primary outcome is reduction in levels of psychological distress at 3-months post-treatment. Secondary outcomes include anxiety, depression, prodromal psychotic symptoms, posttraumatic stress disorder, prolonged grief, daily functioning, economic effectiveness, and change in parenting behaviour. Secondary outcomes also include the reduction in psychological distress of the participant’s child.DiscussionThe trial aims to deliver a template for affordable and scalable psychosocial interventions that can readily be implemented in refugee settings, and that can benefit both the participant and their child.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12619001386123. Registered prospectively on 10/10/2019.

Highlights

Accessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce
Evidence-based mental health programs have been shown to be efficacious in refugee populations [7,8,9], with meta-analysis indicating they have a moderate effect [10]
The primary aim of this study is to evaluate the effectiveness of a locally adapted version of gPM+ on symptoms of psychological distress in male and female Syrian refugee adults in Jordan

Summary

Introduction

Accessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce. The World Health Organization has developed group problem management plus (gPM+), a low-intensity psychological intervention for adults experiencing psychological distress. It is not surprising that refugees have been shown to experience elevated rates of mental health problems, including depression, anxiety, suicide risk, posttraumatic stress disorder (PTSD), and somatic conditions [2,3,4]. UNHCR projections indicate that 15–20% of Syrians will experience mental health conditions in the aftermath of the adversity they have faced, highlighting a need for effective interventions for conflict-affected populations [5, 6]. Evidence-based mental health programs have been shown to be efficacious in refugee populations [7,8,9], with meta-analysis indicating they have a moderate effect [10]

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