Interpersonal Therapy for Refugee Parents in Community Settings

Worldwide an unprecedented number of people are forcibly displaced due to
persecution, conflict, violence, human rights violations and events seriously
disturbing public order. As a result of different stressful life events, both
pre-flight, during the flight and in the resettlement phase, refugees face an
increased risk of developing mental health problems
When psychological problems are left untreated, this could lead to long-term
and severe symptoms. Stressful life events can also impact refugees on a family
level. Generally, displacement has an adverse impact on the parent-child
relationship. It can lead to diminished feelings of parental self-efficacy,
lack of parental warmth and emotional availability and more harsh and
controlling parenting
Despite high mental health needs of refugees, there is underutilisation of care
services in European host countries. Refugee families experience difficulties
when accessing mental health care in the Netherlands. Integrating mental health
care in community settings and primary health care, engaging in outreach and
providing care in the native language can improve access to mental health care
for refugees. More research is needed on the effectiveness of interventions
that match these needs.

The aim of this research project is to assess the feasibility and acceptability
of an adapted version of Group Interpersonal Therapy [IPT] for parents from
refugee backgrounds in primary care in The Netherlands. Moreover, the potential
effectiveness of Group IPT to reduce mental health problems and improve quality
of life for refugee parents and their children will be assessed.

The study is a mixed-methods pilot cluster randomised controlled trial [RCT].
The participants will be randomly assigned in clusters to the experimental
group or the waitlist control group. Measurements will take place at baseline,
1-week post-intervention and 3-month follow-up. Questionnaires on symptoms of
PTSD, anxiety and depression, quality of life, parent-child relationship,
parental stress and perceived social support will be administered to parents in
interview format. Questionnaires on psychosocial symptoms, quality of life and
parent-child relationship will be administered to the participating child in
interview format. Furthermore, parents will be invited to participate in
semi-structured interviews 1-week post-intervention.

The experimental group will receive 10 weekly sessions of an adapted version of
Group IPT with an additional module focusing on parent-child interaction.
IPT was originally developed as a form of psychotherapy to treat depression,
however, it has proven to be effective for other psychological problems (e.g.
PTSD, grief and anxiety disorders) and can therefore be considered a
transdiagnostic intervention. Moreover, IPT works both curative and preventive.
The World Health Organization [WHO] has developed a modified version of IPT to
become a brief and basic group version of the evidence-based psychological
treamtent that can be delivered by non-specialists. Due to the briefness of the
intervention and the fact that the intervention can be provided by lay
therapists, IPT is a suitable intervention to be provided in low- and
middle-income countries as well as in community settings and primary health
care in the Netherlands.
The rationale behind IPT is that mental health is dependent on interpersonal
relationships. Interpersonal problems could cause the development of mental
distress and vice versa. IPT focusses on four problem areas, namely grief,
disputes, life changes or role transitions, and loneliness or interpersonal
deficits. The goal of IPT is to increase awareness on how these problem areas
influence psychological problems and to promote interpersonal skills. IPT fits
in well with the explanatory models of many refugees, who often view the causes
and solutions of mental health problems in societal, familial and interpersonal
domain. Furthermore, the problem areas of IPT are in line with many of the
experiences of refugees.
Previous research with a different population has shown that group IPT could
reduce mental health symptoms in both parents and their children.
The current study employs an adapted version of Group IPT, which combines two
interrelated mechanisms to improve parents* and children*s mental health: (a)
parenting skills and (b) reduce psychological problems of parents.

The burden and risks associated with participation in this study are minimal.
Participants will have a screening (T0) and three assessments at baseline (T1),
1-week post-intervention (T2) and 3-month follow-up (T3) lasting approximately
60 to 90 minutes. Questionnaires on symptoms of anxiety, depression,
posttraumatic stress disorder and quality of life, perceived social support,
parental distress, and parent-childrelationship will be administered as an
interview. Participating children will have interviews with questrionnaires on
psychosocial symptoms, quality of life and parent-child relationship.
Parents in the experimental group will be asked for a semi-structured interview
lasting approximately 90 minutes.
Parents will receive 10 sessions of Group IPT, while their participating child
will receive no intervention. IPT will also be offered to parents in the
control group, upon completion of the waiting period. Mental health benefits
are expected as a result of the intervention for both parents and children.
Data collected will be handled with confidentiality.