Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial
Tol WA, Leku MR, Lakin DP et al. Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial [Electronic version]. Lancet Global Health 2020; (8), e254-63.
Introduction: Conflict-affected populations carry a high burden of mental disorders. In these violent settings, women are disproportionately affected by gender-based adversities and the subsequent associated psychological trauma. The aim of this study was to assess the effectiveness of a self-help intervention (Self-Help Plus) in reducing psychological distress in female refugees.
Procedures: The study subjects were 694 female South Sudanese refugees living in a settlement in north western Uganda and identified as having at least moderate levels of psychological distress. They were randomised into two groups. One group was allocated to Self-Help Plus and enhanced usual care and the other to enhanced usual care alone. The intervention was delivered to groups of 20-30 women and involved facilitator-led stress-management workshops and access to a self-help book.
Findings: Three months post-intervention, Self-Help Plus resulted in larger improvements for the primary outcome of psychological distress when compared to enhanced usual care. Improvements were also noted in five of eight secondary outcomes related to general mental wellbeing and functioning.
Conclusions: The researchers concluded that Self-Help Plus shows promise as a “first-line intervention for large populations affected by major stressors in low-resource settings.” (p.e621)
Personal comments: The tangible, physical needs of refugees often take precedence over psychological wellbeing in humanitarian settings. However, addressing the mental health of conflict-affected populations is just as crucial and requires creative innovations that can be applied in areas where resources and access to training are limited. This study demonstrates that interventions like guided self-help are effective while also being economically and logistically feasible.
See also ‘I saw so much killing’: the mental health crisis of South Sudan refugees. The Guardian 2 July 2020