​1. Title: 

The MindSpring project: Prevention of trauma-related mental health problems among refugees 

2. Project period: 

February 2016 – July 2020 

3. Investigator: 

Charlotte Sonne, MD, PhD, postdoc fellow 

4. Supervisors and collaborative partners 

The project supervisors include Senior Consultant Jessica Carlsson, PhD (Competence Centre for Transcultural Psychiatry at Mental Health Centre Ballerup), Professor Erik Lykke Mortensen (University of Copenhagen) and Professor Derrick Silove (Director of Psychiatry Research & Teaching at the Mental Health Centre, Liverpool Hospital and professor at the University of New South Wales, Australia). 

The project is carried out in collaboration with the Danish Refugee Council’s Centre for Vulnerable Refugees 

5. Background 

Posttraumatic stress disorder (PTSD) is a serious psychiatric condition that in some individuals causes severe disabilities. In Denmark PTSD has been the most common reason for early retirement during the last seven years1 . It is estimated that PTSD affects approximately 30% of all refugees2 . Newly arrived refugees are in an especially vulnerable position as cultural differences often are experienced as additional stressors to pre-migration and migration traumas3 . There is therefore an urgent need to take steps early on to prevent the development of trauma-related psychiatric disorders as well as to identify individuals in need of immediate psychiatric treatment. The current knowledge about preventive interventions is however very limited. Although rehabilitation programmes for refugees were first established in countries of resettlement more than 30 years ago, the field has been slow to develop and apply evidenced-based interventions, a gap that it is now recognised and urgently in need of being addressed4–6 . Particularly when it comes to group interventions for trauma-affected refugees only few studies have been published7 . 

6. Aim/s 

The aim of the project is to prevent PTSD and other mental health problems among traumaaffected refugees by achieving a better understanding of the effects of early interventions. The objectives are to evaluate short- and long-term effects of the psychosocial group intervention MindSpring among refugees who have recently obtained asylum. 

The hypothesis is: 

• Participants of the MindSpring intervention show significantly greater improvement in psychiatric symptoms and level of functioning compared to matched controls. 

7. Methods 

The project includes two studies about the MindSpring intervention: 

1) The pilot study: Adjustment of the MindSpring intervention 

2) The matched control study: Determining effects of preventive interventions among newly arrived refugees

7.1 Number of participants (N) 

Study 1: 98 

Study 2: approx. 100 active participants and a similar number of matched controls 

7.2 Population: 

Newly arrived trauma-affected refugees (max. 5 years after visa granted) 

7.3 Description of data and data collection 

The MindSpring pilot study 

This pilot study will be carried out in order to customise the intervention to newly arrived refugees. Content of the intervention, cultural acceptability as well as overall satisfaction is evaluated with a satisfaction survey and focus groups. The WHO-5 rating is completed in the beginning of and after the intervention to provide a preliminary picture of change over the intervention course. Results will be used to adapt the intervention and research setup before the matched control group study. Success criteria: Min. 25% of participants and trainers respectively participate in focus groups. 

The MindSpring controlled study 

Built upon the results of the pilot study a matched control group study will be carried out. Active participants complete a brief sociodemographic questionnaire, an intervention specific questionnaire as well as the Refugee Health screener (RHS-13) and an extended version of the WHO-5. Ratings are completed before and after participating in the MindSpring group intervention. Controls are identified via language schools and will be rated with the same intervals. Success criteria: Minimum 80% of participants complete rating 1. 

7.4 Application/acceptance from the Danish Data Protection Agency, the National Committee on Health Research Ethics: 

All relevant permissions will be obtained before the project commence. 

7.5 Analysis 

Baseline differences in both the register study and the matched control study will be analysed with t-test/chi2-test. For the pilot study pre-post treatment changes will be analysed with paired t-test whereas follow up differences for the controlled study will be analysed with mixed method multiple regression. 

8. Expected results 

The project is expected to contribute with new important knowledge about the effect of early interventions on the mental health and wellbeing among refugees. In the long term the results can be used to prevent that individuals with refugee background develop chronic mental disorders and thus potentially cut down society’s expenses of treatment, flexible jobs and early retirement. 

9. Dissemination of results 

Two publications are planned based on the results from the project:

1) The MindSpring intervention – a pilot study of a psycho-social group intervention for refugees 

2) MindSpring – psychological and social effects of a group program for newly arrived refugees. 

10. References 

1. Bjoernager JA. Posttraumatisk stress sender flest på førtidspension - Politiken.dk. Politikken. http://politiken.dk/indland/ECE2322737/posttraumatisk-stress-sender-flest-paafoertidspension/. Published 2014. Accessed February 24, 2015. 

2. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537-49. doi:10.1001/jama.2009.1132. 

3. Betancourt TS, Abdi S, Ito BS, Lilienthal GM, Agalab N, Ellis H. We left one war and came to another: Resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families. Cultur Divers Ethnic Minor Psychol. 2015;21(1):114-25. doi:10.1037/a0037538. 

4. Carlsson JM, Mortensen EL, Kastrup M. A follow-up study of mental health and healthrelated quality of life in tortured refugees in multidisciplinary treatment. J Nerv Ment Dis. 2005;193(10):651-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16208160. Accessed April 15, 2014. 

5. Başoğlu M. Rehabilitation of traumatised refugees and survivors of torture. BMJ. 2006;333(7581):1230-1. doi:10.1136/bmj.39036.739236.43. 

6. Carlsson J, Sonne C, Silove D. From pioneers to scientists: challenges in establishing evidence-gathering models in torture and trauma mental health services for refugees. J Nerv Ment Dis. 2014;202(9):630-7. doi:10.1097/NMD.0000000000000175. 

7. McFarlane CA, Kaplan I. Evidence-based psychological interventions for adult survivors of torture and trauma: a 30-year review. Transcult Psychiatry. 2012;49(3-4):539-67. doi:10.1177/1363461512447608.