Evidence map›Paper›PMID 31981556›Full record

Trial reportThe Lancet. Global health2020

Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial.

Wietse A Tol, Marx R Leku, Daniel P Lakin, Kenneth Carswell, Jura Augustinavicius, Alex Adaku, Teresa M Au, Felicity L Brown, Richard A Bryant, Claudia Garcia-Moreno and 4 more

4 registry-linked trialsOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Lancet. Global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 124 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
124citing papers in PubMed, 13 pooled it
35.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05033210 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Prevention of Mental Health Problems Among Persons Without Personal Housing in the Context of the COVID-19 Epidemic: a Randomized Controlled Trial

TypeinterventionalSponsorANRS, Emerging Infectious DiseasesRan2022 to 2023Enrolled210ConditionsPsychological Distress, Quality of Life, Psychosocial InterventionArmsPsychological First Aid (PFA), Care as Usual (CAU), Doing What Matters in Times of Stress (DWM), Problem Management Plus (PM+)
NCT06425523 naactive not recruitingnot on this mapstarted 2024, after this paper: background citation

Strengthening Resilience to Climate Change by Improving Mental Health: Evidence from a Randomized Intervention in Southwestern Uganda

TypeinterventionalSponsorUppsala UniversityRan2024 to 2026Enrolled904ConditionsPsychological Distress, Malnutrition, Child, Dietary Deficiency, Mental HealthArmsHome Gardening Intervention (HGI), Self-Help Plus (SH+), Enhanced Usual Care (EUC)
NCT07062341 naactive not recruitingnot on this mapstarted 2025, after this paper: background citation

Building Resilience in the Aftermath of Displacement: The Intergenerational Effects of a Randomized Mental Health Intervention for Refugee Families

TypeinterventionalSponsorUppsala UniversityRan2025 to 2027Enrolled725ConditionsMental Health, Psychological Distress, Child Wellbeing, Child Mental HealthArmsSelf-Help Plus (SH+), Enhanced Usual Care (EUC)
NCT07447921 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Combining Mental Health and Violence Prevention Interventions to Enhance Child Wellbeing Under Adversity - Study Protocol for a Three-arm, Cluster-randomized, Superiority Trial With Primary Caregivers in Nyarugusu Refugee Camp, Tanzania (WEMA Trial)

TypeinterventionalSponsorUppsala UniversityRan2026 to 2027Enrolled1,296ConditionsMental Health, Socio-emotional Well-being, Functioning, Psychosocial, Parenting BehaviorArmsSelf Help Plus, Interaction Competencies with Children - for Parents
3 · Its place in the literature

Who cites it

124 citing papers in PubMed, 13 syntheses or guidelines pooled it, 236 citations in OpenAlex.

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64 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 6 countries.

Wietse A TolDepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA. Electronic address: wtol@jhu.edu.
Marx R LekuArua, Uganda.
Daniel P LakinDepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Kenneth CarswellDepartment of Mental Health and Substance Abuse, WHO, Geneva, Switzerland.
Jura AugustinaviciusDepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Alex AdakuArua, Uganda; Department of Psychiatry, Arua Regional Referral Hospital, Arua, Uganda.
Teresa M AuDepartment of Mental Health and Substance Abuse, WHO, Geneva, Switzerland.
Felicity L BrownWarChild Holland, Amsterdam, Netherlands.
Richard A BryantSchool of Psychology, University of New South Wales, Sydney, NSW, Australia.
Claudia Garcia-MorenoDepartment of Reproductive Health & Research, WHO, Geneva, Switzerland.
Rashelle J MusciDepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Peter VentevogelPublic Health Section, UN High Commissioner for Refugees, Geneva, Switzerland.
Ross G WhiteInstitute of Population Health, University of Liverpool, Liverpool, UK.
Mark van OmmerenDepartment of Mental Health and Substance Abuse, WHO, Geneva, Switzerland.
Johns Hopkins University · USAddiction Switzerland · CHArua Regional Referral Hospital · UGOffice of the United Nations High Commissioner for Refugees · CHUniversity of Liverpool · GBUNSW Sydney · AUWar Child · NLWorld Health Organization · CH

Funding

Global Mental Health Training ProgramT32MH103210 · NIMH · JOHNS HOPKINS UNIVERSITY · PI Judith Karen Bass, Sarah Sutherlin-McIvor Murray · 2015 to 2026
$4.0M
NIMH NIH HHS T32 MH103210World Health Organization 001
6 · The paper itself

Abstract

backgroundInnovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help intervention (Self-Help Plus) to reduce psychological distress in female refugees.

methodsWe did a cluster randomised trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cutoff ≥5 on the Kessler 6). The intervention comprised access to usual care and five 2-h audio-recorded stress-management workshops (20-30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomly assigned to either intervention (Self-Help Plus or enhanced usual care) on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20-30 eligible participants were identified per site. The primary outcome was individual psychological distress, assessed using the Kessler 6 symptom checklist 1 week before, 1 week after, and 3 months after intervention, in the intention-to-treat population. All outcomes were measured at the individual (rather than cluster) level. Secondary outcomes included personally identified problems, post-traumatic stress, depression symptoms, feelings of anger, social interactions with other ethnic groups, functional impairment, and subjective wellbeing. Assessors were masked to allocation. This trial was prospectively registered at ISRCTN, number 50148022.

findingsOf 694 eligible participants (331 Self-Help Plus, 363 enhanced usual care), 613 (88%) completed all assessments. Compared with controls, we found stronger improvements for Self-Help Plus on psychological distress 3 months post intervention (β -1·20, 95% CI -2·33 to -0·08; p=0·04; d -0·26). We also found larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range -0·30 to -0·36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. With regard to safety considerations, the independent data safety management board responded to six adverse events, and none were evaluated to be concerns in response to the intervention.

interpretationSelf-Help Plus is an innovative, facilitator-guided, group-based self-help intervention that can be rapidly deployed to large numbers of participants, and resulted in meaningful reductions in psychological distress at 3 months among South Sudanese female refugees.

fundingResearch for Health in Humanitarian Crises (R2HC) Programme.

Indexed as

AdultCluster AnalysisDepressionFemaleHumansPsychotherapyRefugeesSelf CareStress, PsychologicalUgandaYoung Adult

Identifiers

PMID31981556
PMCPMC9899129
OpenAlexW3001930487

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.