REMAIN: Feasibility and Acceptability of Problem Management Plus (PM+) for Refugee Youth Living in the Netherlands

In recent years, due to wars, conflicts, and natural disasters many people forcedly displaced from their countries of origin. According to the United Nations High Commissioner for Refugees (UNHCR), there are 68.5 million people forcibly displaced people worldwide and almost half of the displaced people are minors under eighteen years old. This massive human movements not only affect individuals’ psychological well-being but also created a need for new solutions for the responsiveness of health care systems of the hosting countries. With this need, World Health Organization (WHO) has developed Problem Management Plus (PM+), a brief, scalable, psychological intervention that can be delivered by trained non-professionals and addressing common mental health problems.

The main objective of this study is to evaluate the feasibility and acceptability of the culturally and contextually adapted WHO’s PM+ intervention for Syrian, Eritrean, and Iraqi refugee youth living in the Netherlands. Additionally, this study aims to develop and incorporate a new Emotional Processing module (PM+ EP) to the adapted PM+. Another objective is to evaluate the feasibility and acceptability of PM+ with this new module.

Study participants (n= 90) include Syrian, Eritrean, and Iraqi refugee youth (age: 16 to 25) living in the Netherlands, with self-reported functional impairment (WHODAS 2.0>16) and elevated levels of psychological distress (K10>15). Participants will be randomized into one of the three study groups (PM+ intervention, PM+ intervention with emotional processing module, or Care-as-Usual). Participants in the first group (n= 30) will receive six sessions of Problem Management Plus (PM+) as well as care as usual (CAU). The second group (n= 30) will receive six-sessions of an adapted version of PM+, which includes an emotional processing module (PM+ EP) as well as CAU. The third group (n= 30) will receive CAU only.

The main study parameter will be the feasibility and acceptability of PM+ interventions. The feasibility criteria are composed of recruitment and consent rates, attendance, fidelity to the protocols, adverse events, and the perceptions about the PM+ interventions.

We expect to see that Problem Management Plus is a feasible and acceptable intervention for Syrian, Eritrean and Iraqi refugee youth.

- Baseline

- 1 week post-intervention assessment (7 weeks after baseline)

- 3 month post-intervention assessment (4.5-5 months after baseline)

There are three arms in this study.

Treatment Group 1: Problem Management Plus (PM+) Program
The first treatment group will receive WHO´s Problem Management Plus (PM+) program in addition to care-as-usual (CAU). PM+ is a brief, scalable psychological intervention developed by WHO and the University of New South Wales, Australia and delivered by trained non-professionals. It is based on cognitive behavioural therapy (CBT) techniques which are empirically supported and recommended by WHO (Dua et al., 2011). The manual involves the following techniques: stress management, problem-solving, behavioural activation, and accessing social support (WHO, 2016).

Up to today, different studies proved the effectiveness of PM+ in individual (Bryant et al., 2017; De Graaf et al., 2020; Rahman, Riaz, et al., 2016) and group format (Rahman et al., 2019). Even though the intervention mainly designed for LMIC, its feasibility has been evaluated for high resource countries as well (eg. De Graaf et al., 2020).

For this study, an adapted version of PM+ will be used and there will be six individual sessions.

Treatment Group 2: Problem Management Plus (PM+) Program with an additional Emotional Processing Module
The second treatment group will receive CAU and PM+ with a newly developed Emotional Processing Module included. This new module will include psychoeducation about traumatic experiences, emotional processing of positive and negative life events and positive imagination about their future selves.

The comparison group: Care-as-usual (CAU)
The comparison group will receive CAU only. CAU for refugee adolescents in the Netherlands corresponds to primary health care, education, social protection services, and specialized psychological treatment programs.