Prevention of mental health problems among Ukrainian refugees

​Background

The war in Ukraine has created a devastating humanitarian crisis in Europe. Almost 7 million Ukrainians have fled the country, and near 30,000 displaced persons have sought refuge in Denmark. Given the realities that most of these displaced persons from Ukraine have faced, including exposure to war, having to leave their homes, leaving family members behind in an ongoing conflict and other migration-related stressors, we anticipate high rates of psychological distress in this population

Hence there is currently an urgent need to prevent the development of Posttraumatic stress disorder (PTSD) and other trauma-related psychiatric disorders in displaced persons arriving from Ukraine. MindSpring is a psychosocial group intervention for refugees and is currently the only intervention of its kind in Denmark. A version has been developed targeting the Ukrainian refugees specifically. It consists of six two-hour sessions and groups are facilitated by a Ukrainian trainer alongside a Danish trainer.  The purpose of MindSpring is to strengthen the refugees' ability to cope with psychosocial problems that are a direct or indirect result of past events and thereby aims to prevent the participants from developing psychiatric illnesses1. The intervention additionally provides an opportunity to identify individuals with severe psychopathology that require specialist treatment and to refer them to an appropriate facility quickly.  The feasibility and acceptability of the intervention has previously been investigated with a sample of Arabic-speaking refugees in a mixed method study with very positive feedback from participants as well as an improvement in life quality of over 20% over the course of the intervention2

Aim and objective

Our project overall aims are to improve mental health for Ukrainian refugees resettling in Denmark and to establish proof of concept for a programme to improve mental health among displaced persons arriving in European countries from Ukraine. The objective of the study is to evaluate the acceptability, feasibility and outcome of the psychosocial group-intervention MindSpring for Ukrainian refugees. 

Methods

The number of participants in the study will be 80-100 (eight-ten groups with ten participants each). The content of the intervention and its cross-cultural acceptability as well as overall satisfaction will be evaluated through translated and validated questionnaires and semi-structured interviews. Using a web-based survey, we assess self-reported health and psychosocial wellbeing in combination with screening for mental health problems at baseline and post-intervention. Questionnaires applied will be the WHO-5 wellbeing rating scale, the Refugee Health Screener-15 (RHS-15) and the MindSpring empowerment scale developed during a previous study (results yet unpublished). Furthermore, a previously developed semi-structured qualitative interview will be conducted 3-6 months post-intervention with a subsample of the participants to investigate the feasibility, cultural acceptability, and outcomes of the program in the participants' own words. Adding a qualitative dimension to the study has in previous studies proven to be important in order to nuance and provide a deeper understanding of the outcomes and has generated knowledge that is of high importance for further adaptation and upscaling of the program2. ​

The MindSpring intervention is carried out in collaboration with The Danish Refugee Council (DRC) – Center for Vulnerable Refugees who has been operating the MindSpring program over the past 10 years for other groups of refugees. DRC will take care of all practical aspects of running the MindSpring groups throughout the project, including training of trainers and recruitment of participants.

The inclusion criteria for the study are that participants are adult Ukrainian refugees (18 years and above) and that they have arrived to Denmark within the last three years. Refugees who fulfill these criteria will be able to take part in the MindSpring group program regardless of whether they choose to participate in the study. Study participants will have to sign a written informed consent before they are included.

Ethical considerations

The Helsinki declaration will be observed and special attention will be paid towards the vulnerability of the target group. The participants will receive information about the study in their mother tongue and will get the opportunity to ask questions to a native speaker of their language. Written informed consent will be obtained from all participants before they are included in the study. All relevant permissions from Danish authorities including the regional ethics committee will be obtained before initiating the study. 

MindSpring in practice also serves as a 'screening' of individuals with mental health problems and if identified, participants will be referred to relevant services.

Setting and research group

Charlotte Sonne (MD, PhD) will be the primary investigator of the project. Previously she has undertaken a PhD as well as a three-year postdoc at Competence Center for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, where she has been responsible for the design, conduction, and evaluation of several studies. CTP is a highly specialised treatment facility for trauma-affected refugees and other transcultural clients. The Centre differs from other similar facilities by its focus on clinical research, which is closely integrated with the treatment programs. The research group at CTP is internationally acknowledged for its high standard of research and for some of the largest existent trials in the field. 

Jessica Carlsson (Research associate professor, MD, PhD) is the head of CTP and head of research at Mental Health Centre Ballerup. She has carried out research on trauma and mental health in refugees for over 20 years. She has taken part in designing the current project and will assist with supervision of all major decisions concerning the study.

Erik Lykke Mortensen (Professor Emeritus) is an extremely experienced and skilled researcher and the author of more than 300 scientific publications. He has contributed to the design of the project and will primarily assist with statistical analyses throughout the project.

The MindSpring intervention is carried out in collaboration with The Danish Refugee Council (DRC) – Center for Vulnerable Refugees who has been operating the MindSpring program over the past 10 years for other groups of refugees and is currently assisting implementation of the programme in Poland, Estonia, Iceland, and Finland in collaboration with local authorities. ​

Dissemination of results

The project results will be widely disseminated in professional and public forums. Results will be disseminated to clinicians and researchers within will the field through national and international conference presentations as well as scientific papers.

References

  1. Danish Refugee Counsil. wwww.mindspring-grupper.dk. http://www.mindspring-grupper.dk/. Accessed February 24, 2015.
  2. Husby SR, Carlsson J, Mathilde Scotte Jensen A, Glahder Lindberg L, Sonne C. Prevention of trauma-related mental health problems among refugees: A mixed-methods evaluation of the MindSpring group programme in Denmark. J Community Psychol. 2020;48(3):1028-1039. doi:10.1002/jcop.22323​


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