An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial


Autoři: Alvin Kuowei Tay aff001;  Hau Khat Mung aff001;  Mohammad Abdul Awal Miah aff003;  Susheela Balasundaram aff004;  Peter Ventevogel aff005;  Mohammad Badrudduza aff001;  Sanjida Khan aff006;  Karen Morgan aff007;  Susan Rees aff001;  Mohammed Mohsin aff001;  Derrick Silove aff001
Působiště autorů: School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia aff001;  Perdana University-Centre for Global Health and Social Change (PU-GHSC), Selangor, Malaysia aff002;  Perdana University-Centre for Research Excellence (PU-CRE), Selangor, Malaysia aff003;  Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia aff004;  Public Health Section/ Division of Programme Support & Management, United Nations High Commissioner for Refugees (UNHCR), Geneva, Switzerland aff005;  Department of Psychology, Jagannath University, Dhaka, Bangladesh aff006;  Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia aff007
Vyšlo v časopise: An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial. PLoS Med 17(3): e1003073. doi:10.1371/journal.pmed.1003073
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003073

Souhrn

Background

This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience.

Methods and findings

We conducted a single-blind RCT (October 2017 –May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1–27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants’ treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor–Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were −0.08 (95% CI: −0.14 to −0.02, p = 0.012) for PTSD, −0.07 (95% CI: −0.14 to −0.01) for CPTSD, −0.07 for MDD (95% CI: −0.13 to −0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06–0.026, p ≤ 0.001), −0.12 (95% CI: −0.20 to −0.03, p ≤ 0.001) for ASI-1 (safety/security), −0.10 for ASI-2 (traumatic losses; 95% CI: −0.18 to −0.02, p = 0.02), −0.03 for ASI-3 (injustice; (95% CI: −0.11 to 0.06, p = 0.513), −0.12 for ASI-4 (role/identity disruptions; 95% CI: −0.21 to −0.04, p ≤ 0.001), and −0.18 for ASI-5 (existential meaning; 95% CI: −0.19 to −0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up.

Conclusions

Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings.

Trial registration

The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381

Klíčová slova:

Anxiety – Depression – Chin – Mental health and psychiatry – Mental health therapies – Post-traumatic stress disorder – Psychological stress – Psychotherapy


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