A new digital mental health intervention, Step-by-Step, developed by the World Health Organization (WHO) with the National Mental Health Programme (NMHP) at the Ministry of Public Health Lebanon and other partners, was effective in reducing depression among Syrian refugees in Lebanon, according to a study published in PLOS Medicine.
The study, a randomized controlled trial, supported by Elrha’s Research for Health in Humanitarian Crises (R2HC), was conducted among Syrians suffering from depression and impaired functioning in Lebanon. It found that people who received the digital intervention with remote guidance from trained non-specialist helpers were significantly less depressed and had significantly better functioning after the intervention compared with those who received enhanced usual care in the control group. People who received Step-by-Step also showed improvements in symptoms of anxiety, post-traumatic stress, well-being and personal problems, with all improvements maintained at 3‑month follow-up. This study supports results from a parallel trial of Step-by-Step with Lebanese and other populations living in Lebanon, which showed similar positive results … Step-by-Step is a 5‑session WHO digital intervention designed to treat depression through an internet-connected device, with weekly support (e.g. a 15 minute call or message) from trained non-specialist helpers. It provides psychoeducation and training in behavioural activation (e.g. doing more pleasant activities) through an illustrated narrative, with additional therapeutic techniques such as stress management, a gratitude exercise, positive self-talk, strengthening social support, and relapse prevention.
Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial (PLOS Medicine). From the Abstract:
- Background: Most displaced people with mental disorders in low- and middle-income countries do not receive effective care, and their access to care has deteriorated during the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health interventions are scalable when digital access is adequate, and they can be safely delivered during the COVID-19 pandemic. We examined whether a new WHO-guided digital mental health intervention, Step-by-Step, in which participants were supported by a nonspecialist helper, was effective in reducing depression among displaced people in Lebanon.
- Methods and findings: We conducted a single-blind, 2‑arm pragmatic randomized clinical trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among displaced Syrians suffering from depression and impaired functioning in Lebanon. Primary outcomes were depression (Patient Health Questionnaire, PHQ‑9) and impaired functioning (WHO Disability Assessment Schedule-12, WHODAS) at posttreatment. Secondary outcomes included subjective well-being, anxiety, post-traumatic stress, and self-described problems … Significant effects on all outcomes were maintained at 3 months follow-up. During the trial, one serious adverse event occurred, unrelated to the intervention. The main limitation of the current trial is the high dropout rate.
- Conclusions: In this study, we found that a guided, digital intervention was effective in reducing depression in displaced people in Lebanon. The guided WHO Step-by-Step intervention we examined should be made available to communities of displaced people that have digital access.
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