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Research Article: Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda

Date Published: 2023-09-12

Abstract:
Introduction Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda. Methods This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus?EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative?to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores. Results A single factor for mental health problems was identified with all factor loadings >0.30?and acceptable internal consistency (?=0.70). We excluded 161?women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative?to EUC (Risk ratio =0.16, 95%?CI: 0.05 to 0.53). Participation in SH+ versus?EUC was also associated with increased subjective well-being (?=2.62, 95%?CI: 1.63 to 3.60) and psychological flexibility (?=4.55, 95%?CI: 2.92 to 6.18) at post-intervention assessment. Conclusions These results support the use and further testing of SH+ as?a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings. Trial registration number ISRCTN50148022 .

Introduction:
Exposure to potentially traumatic events alongside ongoing stressors contributes to a high burden of psychological distress, mental health and substance use problems among refugees and other populations affected by humanitarian crises. 1–3 These mental health and psychosocial impacts affect day-to-day functioning amidst ongoing adversity. Many mental health and psychosocial problems that are associated with significant functional impairment are likely preventable. 4 5 Despite increasing calls for prioritising…

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