Abstract:
BACKGROUND:Syrian refugees residing in Germany often develop posttraumatic stress as a result of the Syrian civil war, their escape, and postmigration stressors. At the same time, there is a lack of adequate treatment options. The smartphone-based app Sanadak was developed to provide cognitive behavioral therapy-based self-help in the Arabic language for Syrian refugees with posttraumatic stress. OBJECTIVE:The aim of this study was to evaluate the effectiveness and cost-effectiveness of the app. METHODS:In a randomized controlled trial, eligible individuals were randomly allocated to the intervention group (IG; app use) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects linear regression models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis. Cost-effectiveness was evaluated based on adjusted mean total costs, quality-adjusted life years (QALYs), and cost-effectiveness acceptability curves using the net benefit approach. RESULTS:Of 170 screened individuals (aged 18 to 65 years), 133 were eligible and randomized to the IG (n=65) and CG (n=68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between the IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff -0.90, 95% CI -0.24 to 0.47; P=.52) and after 4 months (Diff -0.39, 95% CI -3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma: after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS-stereotype agreement: d=0.86, 95% CI 0.46 to 1.25; stereotype application: d=0.60, 95% CI 0.22 to 0.99) and after 4 months (d=0.52, 95% CI 0.12 to 0.92; d=0.50, 95% CI 0.10 to 0.90), the IG showed significantly lower values in self-stigma than the CG. ITT showed no significant group differences in total costs and QALYs. The probability of cost-effectiveness was 81% for a willingness-to-pay of €0 per additional QALY but decreased with increasing willingness-to-pay. CONCLUSIONS:Sanadak was not more effective in reducing mild to moderate posttraumatic stress in Syrian refugees than the control condition nor was it likely to be cost-effective. Therefore, Sanadak is not suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach. TRIAL REGISTRATION:German Clinical Trials Register DRKS00013782; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013782. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.1186/s12888-019-2110-y.
journal_name
JMIR Mhealth Uhealthjournal_title
JMIR mHealth and uHealthauthors
Röhr S,Jung FU,Pabst A,Grochtdreis T,Dams J,Nagl M,Renner A,Hoffmann R,König HH,Kersting A,Riedel-Heller SGdoi
10.2196/24807subject
Has Abstractpub_date
2021-01-13 00:00:00pages
e24807issue
1issn
2291-5222pii
v9i1e24807journal_volume
9pub_type
杂志文章abstract:BACKGROUND:Posttraumatic stress disorder (PTSD) is a prevalent mental health issue among veterans. Access to PTSD treatment is influenced by geographic (ie, travel distance to facilities), temporal (ie, time delay between services), financial (ie, eligibility and cost of services), and cultural (ie, social stigma) barr...
journal_title:JMIR mHealth and uHealth
pub_type: 杂志文章
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更新日期:2017-10-26 00:00:00
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journal_title:JMIR mHealth and uHealth
pub_type: 杂志文章
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journal_title:JMIR mHealth and uHealth
pub_type: 杂志文章,评审
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journal_title:JMIR mHealth and uHealth
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journal_title:JMIR mHealth and uHealth
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journal_title:JMIR mHealth and uHealth
pub_type: 杂志文章,评审
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abstract::[This corrects the article DOI: 10.2196/mhealth.7275.]. ...
journal_title:JMIR mHealth and uHealth
pub_type: 已发布勘误
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