Investigating the potential of a novel internet-based cognitive behavioural intervention for Dari and Farsi speaking refugee youth: A feasibility study

Tomas Lindegaard, Elisabet Wasteson, Youstina Demetry, Gerhard Andersson, Derek Richards, Shervin Shahnavaz, Tomas Lindegaard, Elisabet Wasteson, Youstina Demetry, Gerhard Andersson, Derek Richards, Shervin Shahnavaz

Abstract

Objective: Over half of the world's forcibly displaced persons are under the age of 25, with many suffering from symptoms of psychological disorders. Many refugees from Afghanistan or Iran speak either Dari or Farsi, which are mutually intelligible dialects of the Persian language. Previous research on adult refugees and immigrants have shown that internet-based cognitive behavioural therapy (ICBT) can be a valuable complement to other forms of treatment. However, there is a lack of knowledge if ICBT is a feasible and acceptable treatment for adolescents and young adults with a refugee background.

Method: Fifteen Dari/Farsi-speaking adolescents and young adults between 15 and 26 years of age participated in a feasibility study of a novel individually tailored guided ICBT intervention targeting symptoms of common mental disorders such as anxiety and depression. Self-reported symptoms of anxiety and depression were assessed using the Hopkins Symptom Checklist-25 (HSCL-25) as the primary outcome measure. Four of the treatment participants and three additional non-treatment participants consented to be interviewed regarding the programme's acceptability. The interviews were analysed using Thematic Analysis.

Results: The intervention suffered from low adherence, with only 3 participants completing the post-treatment assessment and with participants completing 0.9 modules on average, which meant that the intended quantitative analysis of the pre to post change was not possible. The thematic analysis resulted in two overarching categories, barriers and facilitators, that each contained four themes and related subthemes. Overall, the intervention was deemed culturally relevant and easy to understand. The most salient barriers to participation across interviews concerned interference of symptoms such as concentration difficulties, low energy, and a lack of human contact and support.

Conclusion: The current version of the ICBT program demonstrated low feasibility and acceptability in the target population, which mainly seemed to be related to the delivery format. Future studies should investigate if a blended treatment format with regular phone/video calls with a therapist can increase adherence to the intervention.

Keywords: Acceptability; Adolescents; Culturally adapted psychotherapy; Feasibility; Internet-based treatment.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2022 The Authors. Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
Flow chart of participants throughout the current study.
Fig. 2
Fig. 2
Structure of the thematic analysis.

References

    1. Andersson G., Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry. 2014;13(1):4–11. doi: 10.1002/wps.20083.
    1. Ashworth M., Robinson S., Godfrey E., Shepherd M., Evans C., Seed P., Parmentier H., Tylee A. Measuring mental health outcomes in primary care: the psychometric properties of a new patient-generated outcome measure, ‘PSYCHLOPS’ ('psychological outcome profiles') Primary Care Mental Health. 2005;3:261–270.
    1. Ashworth M., Evans C., Clement S. Measuring psychological outcomes after cognitive behaviour therapy in primary care: a comparison between a new patient-generated measure “PSYCHLOPS” (Psychological Outcome Profiles) and “HADS” (Hospital Anxiety and Depression Scale) J. Ment. Health. 2009;18(2):169–177. doi: 10.1080/09638230701879144.
    1. Attkisson C.C., Greenfield T.K. Outcome Assessment in Clinical Practice. Williams & Wilkins; 1995. The client satisfaction questionnaire (CSQ) scales.
    1. Bastien C.H., Vallières A., Morin C.M. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307. doi: 10.1016/s1389-9457(00)00065-4.
    1. Bendelin N., Hesser H., Dahl J., Carlbring P., Nelson K.Z., Andersson G. Experiences of guided internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry. 2011;11(1):107. doi: 10.1186/1471-244X-11-107.
    1. Berg M., Malmquist A., Rozental A., Topooco N., Andersson G. Knowledge gain and usage of knowledge learned during internet-based CBT treatment for adolescent depression—a qualitative study. BMC Psychiatry. 2020;20(1):441. doi: 10.1186/s12888-020-02833-4.
    1. Berg M., Rozental A., de Brun Mangs J., Näsman M., Strömberg K., Viberg L., Wallner E., Åhman H., Silfvernagel K., Zetterqvist M., Topooco N., Capusan A., Andersson G. The role of learning support and chat-sessions in guided internet-based cognitive behavioral therapy for adolescents with anxiety: a factorial design study. Front. Psychiatry. 2020;11:503. doi: 10.3389/fpsyt.2020.00503.
    1. Bernal G., Jiménez-Chafey M.I., Domenech Rodríguez M.M. Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Prof. Psychol. Res. Pract. 2009;40(4):361–368. doi: 10.1037/a0016401.
    1. Betancourt T.S., Newnham E.A., Layne C.M., Kim S., Steinberg A.M., Ellis H., Birman D. Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States. J. Trauma. Stress. 2012;25(6):682–690. doi: 10.1002/jts.21749.
    1. Blevins C.A., Weathers F.W., Davis M.T., Witte T.K., Domino J.L. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J. Trauma. Stress. 2015;28(6):489–498. doi: 10.1002/jts.22059.
    1. Boß L., Lehr D., Reis D., Vis C., Riper H., Berking M., Ebert D.D. Reliability and validity of assessing user satisfaction with web-based health interventions. J. Med. Internet Res. 2016;18(8) doi: 10.2196/jmir.5952.
    1. Braun V., Clarke V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Bronstein I., Montgomery P. Psychological distress in refugee children: a systematic review. Clin. Child. Fam. Psychol. Rev. 2011;14(1):44–56. doi: 10.1007/s10567-010-0081-0.
    1. Bronstein I., Montgomery P., Dobrowolski S. PTSD in asylum-seeking male adolescents from Afghanistan. J. Trauma. Stress. 2012;25(5):551–557. doi: 10.1002/jts.21740.
    1. Christ C., Schouten M.J., Blankers M., van Schaik D.J., Beekman A.T., Wisman M.A., Stikkelbroek Y.A., Dekker J.J. Internet and computer-based cognitive behavioral therapy for anxiety and depression in adolescents and young adults: systematic review and meta-analysis. J. Med. Internet Res. 2020;22(9) doi: 10.2196/17831.
    1. Chu J., Leino A. Advancement in the maturing science of cultural adaptations of evidence-based interventions. J. Consult. Clin. Psychol. 2017;85(1):45–57. doi: 10.1037/ccp0000145.
    1. Djelantik A.A.A.M.J., de Heus A., Kuiper D., Kleber R.J., Boelen P.A., Smid G.E. Post-migration stressors and their association with symptom reduction and non-completion during treatment for traumatic grief in refugees. Front. Psychiatry. 2020;11 doi: 10.3389/fpsyt.2020.00407.
    1. Fazel M., Reed R.V., Panter-Brick C., Stein A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet. 2012;379(9812):266–282. doi: 10.1016/S0140-6736(11)60051-2.
    1. Gormez V., Kılıç H.N., Orengul A.C., Demir M.N., Demirlikan Ş., Demirbaş S., Babacan B., Kınık K., Semerci B. Psychopathology and associated risk factors among forcibly displaced Syrian children and adolescents. J. Immigr. Minor. Health. 2018;20(3):529–535. doi: 10.1007/s10903-017-0680-7.
    1. Gubi E., Sjöqvist H., Viksten-Assel K., Bäärnhielm S., Dalman C., Hollander A.-C. Mental health service use among migrant and Swedish-born children and youth: a register-based cohort study of 472,129 individuals in Stockholm. Soc. Psychiatry Psychiatr. Epidemiol. 2021 doi: 10.1007/s00127-021-02145-2.
    1. Hall G.C.N., Ibaraki A.Y., Huang E.R., Marti C.N., Stice E. A meta-analysis of cultural adaptations of psychological interventions. Behav. Ther. 2016;47(6):993–1014. doi: 10.1016/j.beth.2016.09.005.
    1. Heim E., Kohrt B.A. Cultural adaptation of scalable psychological interventions. Clin. Psychol. Eur. 2019;1(4):1–22. doi: 10.32872/cpe.v1i4.37679.
    1. Helms J.E. An examination of the evidence in culturally adapted evidence-based or empirically supported interventions. Transcult. Psychiatry. 2015;52(2):174–197. doi: 10.1177/1363461514563642.
    1. Huey S.J., Polo A.J. Evidence-based psychosocial treatments for ethnic minority youth. J. Clin. Child Adolesc. Psychol. 2008;37(1):262–301. doi: 10.1080/15374410701820174.
    1. Huey S.J., Tilley J.L., Jones E.O., Smith C.A. The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annu. Rev. Clin. Psychol. 2014;10:305–338. doi: 10.1146/annurev-clinpsy-032813-153729.
    1. Ibrahim H., Ertl V., Catani C., Ismail A.A., Neuner F. The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC Psychiatry. 2018;18(1):259.
    1. James A.C., James G., Cowdrey F.A., Soler A., Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. The. Cochrane Database Syst. Rev. 2013;6 doi: 10.1002/14651858.CD004690.pub3.
    1. Lenhard F., Vigerland S., Engberg H., Hallberg A., Thermaenius H., Serlachius E. “On my own, but not alone”—adolescents’ experiences of internet-delivered cognitive behavior therapy for obsessive-compulsive disorder. PLoS ONE. 2016;11(10) doi: 10.1371/journal.pone.0164311.
    1. Lindegaard T., Seaton F., Halaj A., Berg M., Kashoush F., Barchini R., Ludvigsson M., Sarkohi A., Andersson G. Internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a pilot randomized controlled trial. Cogn. Behav. Ther. 2020:1–20. doi: 10.1080/16506073.2020.1771414.
    1. Lindegaard T., Kashoush F., Holm S., Halaj A., Berg M., Andersson G. Experiences of internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a qualitative study. BMC Psychiatry. 2021;21 doi: 10.1186/s12888-021-03297-w.
    1. Lonner W.J. Issues in testing and assessment in cross-cultural counseling. Couns. Psychol. 1985;13(4):599–614. doi: 10.1177/0011000085134004.
    1. Mittendorfer-Rutz E., Hagström A., Hollander A.-C. High suicide rates among unaccompanied Minors/Youth seeking asylum in Sweden. Crisis. 2020;41(4):314–317. doi: 10.1027/0227-5910/a000636.
    1. Mollica R.F., Wyshak G., de Marneffe D., Khuon F., Lavelle J. Indochinese versions of the Hopkins symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am. J. Psychiatry. 1987;144(4):497–500. doi: 10.1176/ajp.144.4.497.
    1. Nettelbladt P., Hansson L., Stefansson C., Borgquist L. Test characteristics of the Hopkins symptom check List-25 ( HSCL-25) in Sweden, using the present state examination ( PSE-9) as a caseness criterion. Soc. Psychiatry Psychiatr. Epidemiol. 1993;28:130–133.
    1. Nocon A., Eberle-Sejari R., Unterhitzenberger J., Rosner R. The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis. Eur. J. Psychotraumatol. 2017;8(sup2) doi: 10.1080/20008198.2017.1388709.
    1. Oud M., de Winter L., Vermeulen-Smit E., Bodden D., Nauta M., Stone L., van den Heuvel M., Taher R.A., de Graaf I., Kendall T., Engels R., Stikkelbroek Y. Effectiveness of CBT for children and adolescents with depression: a systematic review and meta-regression analysis. Eur. Psychiatry. 2019;57:33–45. doi: 10.1016/j.eurpsy.2018.12.008.
    1. Păsărelu C.R., Andersson G., Bergman Nordgren L., Dobrean A. Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials. Cogn. Behav. Ther. 2017;46(1):1–28. doi: 10.1080/16506073.2016.1231219.
    1. Patel S., Akhtar A., Malins S., Wright N., Rowley E., Young E., Sampson S., Morriss R. The acceptability and usability of digital health interventions for adults with depression, anxiety, and somatoform disorders: qualitative systematic review and meta-synthesis. J. Med. Internet Res. 2020;22(7) doi: 10.2196/16228.
    1. Peltonen K., Kangslampi S. Treating children and adolescents with multiple traumas: a randomized clinical trial of narrative exposure therapy. European Journal of Psychotraumatology. 2019;17(10):1558708. doi: 10.1080/20008198.2018.1558708.
    1. Pina A.A., Polo A.J., Huey S.J. Evidence-based psychosocial interventions for ethnic minority youth: the 10-year update. J. Clin. Child Adolesc. Psychol. 2019;48(2):179–202. doi: 10.1080/15374416.2019.1567350.
    1. Pohlkamp L., Kreicbergs U., Prigerson H.G., Sveen J. Psychometric properties of the Prolonged Grief Disorder-13 (PG-13) in bereaved Swedish parents. Psychiatry Res. 2018;267:560–565. doi: 10.1016/j.psychres.2018.06.004.
    1. Resnicow K., Soler R., Braithwaite R.L., Ahluwalia J.S., Butler J. Cultural sensitivity in substance use prevention. J. Commun. Psychol. 2000;28(3):271–290. doi: 10.1002/(SICI)1520-6629(200005)28:3<271::AID-JCOP4>;2-I.
    1. Richards D., Dowling M., O’Brien E., Viganò N., Timulak L. Significant events in an internet-delivered (Space from Depression) intervention for depression. Couns. Psychother. Res. 2018;18(1):35–48. doi: 10.1002/capr.12142.
    1. Salamanca-Sanabria A., Richards D., Timulak L. Adapting an internet-delivered intervention for depression for a Colombian college student population: an illustration of an integrative empirical approach. Internet Interv. 2019;15:76–86. doi: 10.1016/j.invent.2018.11.005.
    1. Satinsky E., Fuhr D.C., Woodward A., Sondorp E., Roberts B. Mental health care utilisation and access among refugees and asylum seekers in Europe: a systematic review. Health Policy (Amsterdam, Netherlands) 2019;123(9):851–863. doi: 10.1016/j.healthpol.2019.02.007.
    1. Sekhon M., Cartwright M., Francis J.J. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv. Res. 2017;17(1):88. doi: 10.1186/s12913-017-2031-8.
    1. Shear K., M Complicated grief treatment: the theory, practice and outcomes. Bereave Care. 2010;29(3):10–14. doi: 10.1080/02682621.2010.522373.
    1. Song S.J. Protecting the global mental health of forcibly displaced children from the COVID-19 pandemic. Pediatrics. 2021;147(4) doi: 10.1542/peds.2020-025346.
    1. Spanhel K., Balci S., Feldhahn F., Bengel J., Baumeister H., Sander L.B. Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digital Med. 2021;4(1):128. doi: 10.1038/s41746-021-00498-1.
    1. Statistics Sweden Asylsökande i Sverige. Statistiska Centralbyrån. 2021.
    1. Swedish National Board of Health and Welfare Unga som fått uppehållstillstånd enligt den nya gymnasielagen – lägesbild i maj 2019. 2019.
    1. Topooco N., Berg M., Johansson S., Liljethörn L., Radvogin E., Vlaescu G., Nordgren L.B., Zetterqvist M., Andersson G. Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression: randomised controlled trial. BJPsych Open. 2018;4(4):199–207. doi: 10.1192/bjo.2018.18.
    1. UNHCR UNHCR Global Trends—Forced displacement in 2020. UNHCR Flagship Reports. 2021.
    1. United Nations Frequently asked questions | United Nations for youth. 2022.
    1. Unterhitzenberger J., Wintersohl S., Lang M., König J., Rosner R. Providing manualized individual trauma-focused CBT to unaccompanied refugee minors with uncertain residence status: a pilot study. Child and Adolescent Psychiatry and Mental Health. 2019;13(1) doi: 10.1186/s13034-019-0282-3.
    1. Yildiz A. Rethinking adult literacy in the context of oral culture. J. Fac. Educ.Sci. 2008;41(1):51–67.

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