Predicting treatment outcomes of the Empowerment group intervention for refugees with affective disorders: Findings from the MEHIRA project

Michael Strupf; Maren Wiechers; Malek Bajbouj; Kerem Böge; Carine Karnouk; Stephan Goerigk; Inge Kamp-Becker; Tobias Banaschewski; Michael Rapp; Alkomiet Hasan; Peter Falkai; Andrea Jobst-Heel; Ute Habel; Thomas Stamm; Andreas Heinz; Andreas Hoell; Max Burger; Tilmann Bunse; Edgar Hoehne; Nassim Mehran; Franziska Kaiser; Eric Hahn; Paul Plener; Aline Übleis; Frank Padberg

doi:10.1016/j.jad.2022.11.050

Predicting treatment outcomes of the Empowerment group intervention for refugees with affective disorders: Findings from the MEHIRA project

J Affect Disord. 2023 Feb 15:323:241-250. doi: 10.1016/j.jad.2022.11.050. Epub 2022 Nov 23.

Authors

Michael Strupf¹, Maren Wiechers², Malek Bajbouj³, Kerem Böge³, Carine Karnouk³, Stephan Goerigk⁴, Inge Kamp-Becker⁵, Tobias Banaschewski⁶, Michael Rapp⁷, Alkomiet Hasan⁸, Peter Falkai², Andrea Jobst-Heel², Ute Habel⁹, Thomas Stamm¹⁰, Andreas Heinz¹¹, Andreas Hoell¹², Max Burger², Tilmann Bunse⁸, Edgar Hoehne⁶, Nassim Mehran¹¹, Franziska Kaiser⁹, Eric Hahn³, Paul Plener¹³, Aline Übleis², Frank Padberg²

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany. Electronic address: Michael.Strupf@med.uni-muenchen.de.
² Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.
³ Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.
⁴ Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany; Charlotte Fresenius Hochschule, University of Applied Sciences, Munich, Germany.
⁵ Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany.
⁶ Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁷ Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.
⁸ Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University Augsburg, BKH Augsburg, Augsburg, Germany.
⁹ Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany.
¹⁰ Brandenburg Medical School, Neuruppin, Germany.
¹¹ Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany.
¹² Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany.
¹³ Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.

PMID: 36427652
DOI: 10.1016/j.jad.2022.11.050

Abstract

Background: Research on outcome predictors in the field of transcultural treatment for refugees and asylum seekers (RAS) is scarce. We aimed to evaluate predictors of outcome of a group intervention (Empowerment) for RAS with affective disorders which was incorporated at level three of the stratified stepped-care model within the Mental Health in Refugees and Asylum Seekers (MEHIRA) project.

Methods: A predictor analysis was performed at level three of the MEHIRA project, where 149 refugees with moderate depressive symptoms were treated either with Empowerment or Treatment-as-usual (TAU). Outcome measures were depression severity as assessed by patient-rated Patient Health Questionnaire 9 (PHQ-9) and clinician-rated Montgomery Asberg Depression Rating Scale (MADRS). Regression models with change scores (T1-T0) of PHQ-9 and MADRS as dependent variables were fit. Predictor selection was a mixed-method approach combining testing of literature-based hypotheses and explorative hypothesis-generating analyses of multiple baseline variables.

Results: Intention-to-treat (ITT) analyses revealed significant linear relationships between change in PHQ-9 and baseline depression severity (β = -0.35, t = -3.27, p = .002) and perceived self-efficacy (β = -0.24, t = -2.26, p = .027) in the treatment (verum) condition. MADRS change scores were predicted by baseline depression severity (β = -0.71, t = -8.65, p < .001) in the treatment (verum) condition.

Limitations: Due to small cell numbers, single predictors could not be evaluated reliably.

Conclusions: Severity of depression and self-efficacy at baseline were predictors of symptom improvement at level three (Empowerment) of the MEHIRA project. Comorbidity and trauma indicators did not predict outcomes in the treatment (verum) condition, pointing towards broad applicability of the Empowerment intervention in refugee populations.

Keywords: Affective disorders; Asylum seekers; Group intervention; Predictor; Randomized controlled trial; Refugees.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Mental Health
Mood Disorders
Refugees* / psychology
Stress Disorders, Post-Traumatic* / psychology
Treatment Outcome