A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: a randomized controlled trial

Figures & data

Figure 1. Consort flow-diagram.

Note. ¹SOP = Standard operating procedure; Participants who violated the SOP mostly did not keep apointments repeatedly after they started the treatment. Some also dropped out because of the SARS-CoV2 pandemic related social measures that hindered them from coming to the outpatient unit for too long.

Table 1. Baseline clinical comparisons between groups.

Primary outcomes	aPM+ /TAU Baseline Statistic M (SD)	TAU Baseline Statistic M (SD)	p-value
GHQ total	6.45 (1.19)	6.38 (2.42)	.590 (ns)
GHQ somatic	1.69 (0.46)	1.63 (0.60)	.664 (ns)
GHQ anxiety/insomnia	1.89 (0.43)	1.77 (0.75)	.762 (ns)
GHQ social dysfunction	1.57 (0.49)	1.50 (0.56)	.641 (ns)
GHQ depression	1.31 (0.63)	1.49 (0.94)	.770 (ns)
Secondary outcomes
PMLDC frequency	2.95 (0.57)	2.84 (0.53)	.429 (ns)
PMLDC distress	5.40 (1.52)	5.42 (1.41)	.977 (ns)
ITQ PTSD	13.67 (4.22)	14.8 (4.44)	.558 (ns)
ITQ DSO	12.38 (5.05)	12.80 (6.32)	.705 (ns)
WHOQOL physical	2.54 (0.62)	2.80 (0.73)	.181 (ns)
WHOQOL psychological	3.14 (0.63)	3.08 (0.83)	.887 (ns)
WHOQOL social	2.83 (0.83)	2.88 (0.70)	.672 (ns)
WHOQOL environment	2.50 (0.48)	2.50 (0.56)	.946 (ns)
PSYCHLOPS	4.61 (0.51)	4.59 (0.57)	.968 (ns)
IPL-12 integration	2.41 (0.59)	2.49 (0.57)	.666 (ns)

Note. GHQ, General Health Questionnaire 28-item version; PMLDC, Post-Migration Living Difficulties Checklist; ITQ, International Trauma Questionnaire; WHOQOL, WHO Quality of Life Questionnaire; PSYCHLOPS, Psychological Outcome Profiles; IPL-12, Immigrant Integration Index 12-item version; aPM+, adapted Problem Management Plus; TAU, Treatment As Usual.

Table 2. Sample Characteristics.

	Total Sample (n = 51)	aPM+/ TAU (n = 26)	TAU (n = 25)	Test-statistic	p-value
Biological Sex (female) n (%)	25 (49.0)	10 (38.5)	15 (60.0)	χ²(1) = 1.58^c	.208 (ns)
Age M (SD)	34.3 (13.6)	29.9 (10.7)	38.8 (14.9)	t(43.5) = 2.42	.019
Marital Status n (%)				χ²(4) = 2.78	.593^d (ns)
Single	20 (39.2)	13 (50.0)	7 (28.0)
Married	25 (49.0)	10 (38.5)	15 (60.0)
In relationship	2 (3.9)	1 (3.8)	1 (4.0)
Divorced	2 (3.9)	1 (3.8)	1 (4.0)
Widowed	2 (3.9)	1 (3.8)	1 (4.0)
Education n (%)^a				χ²(5) = 6.37	.305^d (ns)
No formal education	15 (30.0)	8 (30.8)	7 (29.2)
Elementary school (6 years)	11 (22.0)	6 (23.1)	5 (20.8)
Secondary school (9 years)	9 (18.0)	7 (26.9)	2 (8.3)
High school (12 years)	8 (16.0)	3 (11.5)	5 (20.8)
Vocational school	3 (6.0)	0 (0.0)	3 (12.5)
University/College	4 (8.0)	2 (7.7)	2 (8.3)
Asylum status				χ²(1) = 0.02	.891 (ns)
Secure asylum status^b	26 (51.0)	14 (53.8)	12 (48.0)
Insecure asylum status	25 (49.0)	12 (46.2)	13 (52.0)
Traumatic Experiences M (SD)^a
Total count M (SD)	12.7 (5.4)	11.6 (5.7)	13.8 (4.9)	t(46.9) = 1.46	.151 (ns)
Being in danger during the flight n (%)	43 (86.0)	23 (88.5)	20 (83.3)
Being a civilian in a war zone n (%)	35 (70.0)	17 (65.4)	18 (75.0)
Being close to death n (%)	32 (64.0)	16 (61.5)	16 (66.7)
Living in a refugee camp n (%)	30 (60.0)	17 (65.4)	13 (54.2)
Murder of a family member or friend n (%)	30 (60.0)	13 (50.0)	17 (70.8)
Being in a combat situation n (%)	30 (60.0)	11 (42.3)	19 (79.2)

Note. ^a Based on n = 50, no data for one participant from the TAU group. ^b Secure asylum status is defined as having a long-term perspective in Austria, i.e. unconditional permit of residence for more than a year and free access to the labour market. ^cχ²-test with Yates continuity correction. ^d p-value based on Fisher’s exact test.

Table 3. Baseline vs. post-intervention within group comparisons and summary statistics for primary and secondary outcomes.

	Group	Descriptive statistics M (SD)		Analysis
		Baseline	Post-intervention	p-value	Effect size (Cohen’s dz)
Primary outcomes
GHQ total	aPM+ /TAU	6.45 (1.19)	4.83 (1.81)	<.001	1.04
	TAU	6.38 (2.42)	6.58 (2.61)	.469 (ns)	0.15
GHQ somatic	aPM+ /TAU	1.69 (0.46)	1.31 (0.64)	.003	0.64
	TAU	1.63 (0.60)	1.70 (0.77)	.511 (ns)	0.14
GHQ anxiety/insomnia	aPM+ /TAU	1.89 (0.43)	1.37 (0.66)	.002	0.75
	TAU	1.77 (0.75)	1.86 (0.81)	.413 (ns)	0.17
GHQ social dysfunction	aPM+ /TAU	1.57 (0.49)	1.30 (0.53)	.014	0.52
	TAU	1.50 (0.56)	1.62 (0.65)	.099 (ns)	0.34
GHQ depression	aPM+ /TAU	1.31 (0.63)	0.84 (0.56)	<.001	0.99
	TAU	1.49 (0.94)	1.41 (0.81)	.614 (ns)^a	0.13
Secondary outcomes
PMLDC frequency	aPM+ /TAU	2.95 (0.57)	2.51 (0.71)	.001	0.99
	TAU	2.84 (0.53)	2.85 (0.71)	.940 (ns)	0.02
PMLDC distress	aPM+ /TAU	5.40 (1.52)	4.39 (1.70)	.001	0.98
	TAU	5.42 (1.41)	5.53 (1.93)	.707 (ns)	0.08
ITQ PTSD	aPM+ /TAU	13.67 (4.22)	10.96 (5.50)	.005	0.61
	TAU	14.8 (4.44)	13.96 (5.98)	.422 (ns)	0.16
ITQ DSO	aPM+ /TAU	12.38 (5.05)	10.21 (5.32)	.011	0.54
	TAU	12.80 (6.32)	12.40 (6.74)	.697 (ns)	0.08
WHOQOL physical	aPM+ /TAU	2.54 (0.62)	2.30 (0.70)	.019	0.50
	TAU	2.80 (0.73)	2.89 (0.78)	.321 (ns)	0.20
WHOQOL psychological	aPM+ /TAU	3.14 (0.63)	2.76 (0.67)	.004	0.64
	TAU	3.08 (0.83)	3.15 (0.89)	.460 (ns)	0.15
WHOQOL social	aPM+ /TAU	2.83 (0.83)	2.54 (0.81)	.011	0.55
	TAU	2.88 (0.70)	2.88 (0.84)	1.000 (ns)	0
WHOQOL environment	aPM+ /TAU	2.50 (0.48)	2.35 (0.49)	.107 (ns)	0.33
	TAU	2.50 (0.56)	2.42 (0.62)	.434 (ns)	0.15
PSYCHLOPS	aPM+ /TAU	4.61 (0.51)	3.94 (0.74)	.002	0.74
	TAU	4.59 (0.57)	4.33 (0.54)	.095 (ns)	0.35
IPL-12 integration	aPM+ /TAU	2.41 (0.59)	2.45 (0.55)	.688 (ns)	0.08
	TAU	2.49 (0.57)	2.49 (0.52)	.970 (ns)	0.001

Note. ^a Nonparametric test because normality assumption was violated.

GHQ, General Health Questionnaire 28-item version; PMLDC, Post-Migration Living Difficulties Checklist; ITQ, International Trauma Questionnaire; WHOQOL, WHO Quality of Life Questionnaire; PSYCHLOPS, Psychological Outcome Profiles; IPL-12, Immigrant Integration Index 12-item version; aPM+, adapted Problem Management Plus; TAU, Treatment As Usual.

Table 4. Post-intervention between group comparisons and summary statistics for primary and secondary outcomes.

	Timepoint	Descriptive statistics M (SD)		Analysis
		aPM+/TAU	TAU	p-value	Effect size (Cohen’s d)
Primary outcomes
GHQ total	Post-intervention	4.83 (1.81)	6.58 (2.61)	.006	0.78
GHQ somatic	Post-intervention	1.31 (0.64)	1.70 (0.77)	.086 (ns)	0.55
GHQ anxiety/insomnia	Post-intervention	1.37 (0.66)	1.86 (0.81)	.025	0.66
GHQ social dysfunction	Post-intervention	1.30 (0.53)	1.62 (0.65)	.024	0.54
GHQ depression	Post-intervention	0.84 (0.56)	1.41 (0.81)	.003	0.81
Secondary outcomes
PMLDC frequency	Post-intervention	2.51 (0.71)	2.85 (0.71)	.123 (ns)	0.48
PMLDC distress	Post-intervention	4.39 (1.70)	5.53 (1.93)	.045	0.62
ITQ PTSD	Post-intervention	10.96 (5.50)	13.96 (5.98)	.036	0.52
ITQ DSO	Post-intervention	10.21 (5.32)	12.40 (6.74)	.082 (ns)	0.36
WHOQOL physical	Post-intervention	2.30 (0.70)	2.89 (0.78)	.017	0.79
WHOQOL psychological	Post-intervention	2.76 (0.67)	3.15 (0.89)	.064 (ns)	0.49
WHOQOL social	Post-intervention	2.54 (0.81)	2.88 (0.84)	.195 (ns)	0.41
WHOQOL environment	Post-intervention	2.35 (0.49)	2.42 (0.62)	.300 (ns)	0.13
PSYCHLOPS	Post-intervention	3.94 (0.74)	4.33 (0.54)	.069 (ns)	0.60
IPL-12 integration	Post-intervention	2.45 (0.55)	2.49 (0.52)	.431 (ns)	0.07

Note. GHQ, General Health Questionnaire 28-item version; PMLDC, Post-Migration Living Difficulties Checklist; ITQ, International Trauma Questionnaire; WHOQOL, WHO Quality of Life Questionnaire; PSYCHLOPS, Psychological Outcome Profiles; IPL-12, Immigrant Integration Index 12-item version; aPM+, adapted Problem Management Plus; TAU, Treatment As Usual.