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Affective DisordersMEHIRANCT03109028

Mental Health in Refugees and Asylum Seekers

A study testing Peer-to-Peer-Groupintervention, Smartphone-based-Intervention and Gendersensitive-Groupintervention in people with Affective Disorders, run by Charite University, Berlin, Germany at 1 site in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The objective of this study is to investigate a stepped and collaborative care model (SCCM) for adolescent and adult refugees suffering from depression living in Germany. Read more about this study

Who is it for?
Ages 14 to 65 years
Conditions the study is for
Affective Disorders
What is being tested?
Peer-to-Peer-Groupintervention, Smartphone-based-Intervention and Gendersensitive-Groupintervention
Could I receive a placebo?
No, everyone receives an active treatment
How many people
584 participants
Where
1 siteGermany
Study dates
1 Mar 2018to 1 Mar 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 14 to 65 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Obtained a statutory health insurance
  • Approved residence status as a refugee, asylum seeker or asylee
  • Mother tongue in Arabic or Farsi/Urdu or speaks English or German fluently
  • Age between 16-65 years
  • Participants shows relevant depressive symptoms measured by the PHQ-9 or PHQ-A

Who cannot join

  • An existing schizophrenia or degenerative disorder
  • Missing informed consent
  • Possible suicidality
  • Uncertain residence status

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • Central Institute of Mental Health

    Mannheim

Other trials in Germany

About this study

Official title: Stepped Care Model Supporting Mental Health in Refugees and Asylum Seekers

The objective of this study is to investigate a stepped and collaborative care model (SCCM) for adolescent and adult refugees suffering from depression living in Germany.

Read the detailed description

A prospective, cluster-randomized intervention study, conducted in seven German cities and comprising a total of 476 patients, should compare effectiveness and efficiency of this SCCM as compared to a 'Treatment as Usual' (TAU) condition. The fundamental principle of the examined care model is to provide patients with mild and moderate depression with accessible and affordable treatments, which are located outside the usual psychiatric-psychotherapeutic institutions (e.g. peer-to-peer-approaches or smartphone based interventions).

The acquired insights from the stepped care model, as well as concerning the individual low barrier interventions for adolescents and adults, can be used immediately for benefitting the provision of care of refugees but also for improving care of other communities with lacking access to health care systems. The generated disease figures from the nationwide screening process can be utilized directly to manage the provision of mental health fostering offers for refugees by federal institutions and social health insurance companies.

In both treatment arms (SCCM and TAU) and independent of intervention form participants will be assessed at four time periods after the initial screening process: Baseline (T1), after week 12 (T1), after week 24 (T2), after week 48 (T3).

Following clinical measurement tools will be used at all time periods:

  • Refugee Health Screener (RHS-15)
  • Patient Health Questionnaire (PHQ-9)
  • Patient Health Questionnaire-Adapted (PHQ-A) *
  • Montgomery-Åsberg Depression Scale (MÅDRS)
  • Mannheimer Modul Ressourcenverbrauch (MRV)
  • Brief Resilience Scale (BRS)
  • General Self-Efficacy Scale (GSE)
  • World Health Organization Quality of Life (WHOQOL-BREF)
  • Child \& Adolescent Trauma Screening (CATS)*

Following clinical measurement tools will be used at Baseline (T1):

  • Demographics / Migration Questionnaires
  • M.I.N.I. International Neuropsychiatric Interview
  • M.I.N.I. KID International Neuropsychiatric Interview*
  • Harvard Trauma Questionnaire (HTQ)

Following clinical measurement tools will be used at Baseline (T0) and after Post-Intervention (T1):

  • Cultural Differences Subscale
  • Credibility / Expectancy Questionnaire

Following clinical measurement tools will be used at Baseline (T0), after Post-Intervention (T1) and Follow-Up 1 (T3):

  • Strengths and Difficulties Questionnaire (SDQ)

*Adolescents only

Being tested
Peer-to-Peer-Groupintervention, Smartphone-based-Intervention, Gendersensitive-Groupintervention, Empowerment-Groupintervention, Adolescent-Groupintervention
Medical subject headings
Mood Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Peer-to-Peer-GroupinterventionBehavioural

    Target group: Adult participants with mild to moderate depressive symptoms who prefer therapists with the same cultural background.

    Therapists: Recruitment of psychosocial counselors within refugee community who have sufficient German or English language knowledge. Counselors will be trained for a time period of two months.

    Content: Vulnerability and resilience factors; Self-efficacy strategies; Causes and consequences of stress; Possibilities on accelerating the integration process; Strategies preventing violence and radicalization Form of therapy: Group-based intervention for a time period of three months; Two times per week with each session enduring 90 minutes; Group size between 8-10 participants; Headed by two psychosocial counselors.

  • Smartphone-based-InterventionBehavioural

    Target group: Participants with moderate depressive symptoms who prefer an internet-based intervention.

    Content: Five modules with 20 exercises elaborating on psycho-education, treatment options, self-management and diagnostics.

    Form of therapy: Participants receive regular emails and sms to encourage steady participation via the internet-based smartphone-application. Weekly questionnaires ascertain the degree of participants symptomatology.

  • Gendersensitive-GroupinterventionBehavioural

    Target group: Vulnerable group of adult women while taking cultural characteristics into account Therapists: Recruitment of psychosocial counselors (similar to Peer-to-Peer-Intervention); Training and supervision of gender-specific aspects.

    Content: Focus on psycho-education which consider women specific topics such as gender-differences in symptoms and prevalence in psychic stress related and trauma disorders; physical, psychic and psychosocial consequences of traumatic and violent experiences; gender-specific risk and safety factors; stress and emotional self-regulation Form of therapy: Group-based intervention for a time period of three months; Two times per week with each session enduring 90 minutes; Group size between 8-10 participants; Headed by two female psychosocial counselors.

  • Empowerment-GroupinterventionBehavioural

    Target group: Gender-sensitive group with mild to moderate depressive symptoms. Therapists: Psychologists and doctors in psychotherapeutic advanced training; The therapist-training lasts for three months with continued supervision during the intervention.

    Content: Low-threshold intervention based on the treatment of depression; psycho-education about psychic burdens, trauma, stress and grief as well as vulnerability and resilience factors; Problem solving and self-actualization strategies.

    Form of therapy: Group-based intervention for a time period of two months; Two times per week with each session enduring 90 minutes; Group size between 8-10 participants;

  • Adolescent-GroupinterventionBehavioural

    Target group: Adolescent participants with moderate depressive symptoms. Therapists: Two child and adolescent psychiatrists with translators or two native speaking child and adolescent psychotherapists.

    Content: Elements which are based on the START-Manual13 teaching emotion recognition and emotion regulation; Foundations are based on Dialetical behavior therapy; Specific focus lies on the use of mindfulness; Additionally the social network of the participants will receive psycho-education; Professional helpers in facilities will acquire E-learning elements of the SHELTER-program (Safety and Help for Early Adverse Life events and Traumatic Experiences in minor refugees)

  • Treatment as UsusalOther

    Participants will receive the currently conducted routine and standard psychiatric health care. This involves ambulatory and stationary treatment by board certificated psychiatrists and psychotherapists.

Study groups in NCT03109028
Study groupRoleWhat they receive
Treatment as UsualActive comparatorRegular standard psychiatric health care including all feasible interventions including medication, psychotherapy and social work.
Receives: Other: Treatment as Ususal
Stepped and Collaborative Care ModellExperimentalA stepped and collaborative treatment model with varying stepped psychotherapeutic interventions for adult and adolescent refugees.
Receives: Behavioral: Peer-to-Peer-Groupintervention; Behavioral: Smartphone-based-Intervention; Behavioral: Gendersensitive-Groupintervention; Behavioral: Empowerment-Groupintervention; Behavioral: Adolescent-Groupintervention

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Depression severity measured by the Patient Health Questionnaire - 9 (PHQ-9)

    Significant reduction in depression severity as measured by the Patient Health Questionnaire - 9 (PHQ-9) from baseline to post intervention in the experimental condition (SCCM) compared to the active control condition (TAU)

    Measured: Baseline,12, 24 and 48 weeks after randomization

Secondary outcomes (2)
  1. Response and remission rates measured by the Mannheimer Modul Ressourcenverbrauch (MRV)

    Exploreing the superiority of broader effectiveness parameters, such as response and remission rates measured by the MRV between the SCCM and TAU condition.

    Measured: Baseline, 12, 24 and 48 weeks after randomization

  2. Traumatic events measured by the Child and Adoleszent Trauma Screening (CATS)

    Significant reduction in emotional stress experienced by traumatic experiences as measured by the Child and Adoleszent Trauma Screening (CATS) in adolescents refugees from baseline to post intervention in the experimental condition (SCCM) compared to the active control condition (TAU)

    Measured: Baseline, 12, 24 and 48 weeks after randomization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Apr 2017
  2. Study start1 Mar 2018
  3. Primary completion31 Dec 2019
  4. Study completion1 Mar 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
584 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03109028
Sponsor's protocol ID
01VSF16061
Acronym
MEHIRA
Status last verified
Feb 2022
First submitted
6 Apr 2017
Last updated
18 Feb 2022
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Kemna S, Bringmann M, Karnouk C, Hoell A, Tschorn M, Kamp-Becker I, Padberg F, Ubleis A, Hasan A, Falkai P, Salize HJ, Meyer-Lindenberg A, Banaschewski T, Schneider F, Habel U, Plener P, Hahn E, Wiechers M, Strupf M, Jobst A, Millenet S, Hoehne E, Sukale T, Schuster M, Dinauer R, Mehran N, Kaiser F, Lieb K, Heinz A, Rapp M, Bajbouj M, Boge K. Characterizing of dropouts in the mental health of refugees and asylum seekers (MEHIRA) study examining the effects of a stepped and collaborative care model - a multicentered rater-blinded randomized controlled trial. Psychol Med. 2024 Dec;54(16):4868-4877. doi: 10.1017/S0033291724003179. Epub 2025 Jan 8.

    PubMed 39773258
  • Strupf M, Hoell A, Bajbouj M, Boge K, Wiechers M, Karnouk C, Kamp-Becker I, Banaschewski T, Meyer-Lindenberg A, Rapp M, Hasan A, Falkai P, Habel U, Heinz A, Plener P, Kaiser F, Weigold S, Mehran N, Ubleis A, Padberg F. Shared sorrow, shared costs: cost-effectiveness analysis of the Empowerment group therapy approach to treat affective disorders in refugee populations. BJPsych Open. 2023 Jun 22;9(4):e113. doi: 10.1192/bjo.2023.504.

    PubMed 37345544
  • Boge K, Karnouk C, Hoell A, Tschorn M, Kamp-Becker I, Padberg F, Ubleis A, Hasan A, Falkai P, Salize HJ, Meyer-Lindenberg A, Banaschewski T, Schneider F, Habel U, Plener P, Hahn E, Wiechers M, Strupf M, Jobst A, Millenet S, Hoehne E, Sukale T, Dinauer R, Schuster M, Mehran N, Kaiser F, Brocheler S, Lieb K, Heinz A, Rapp M, Bajbouj M. Effectiveness and cost-effectiveness for the treatment of depressive symptoms in refugees and asylum seekers: A multi-centred randomized controlled trial. Lancet Reg Health Eur. 2022 Jun 6;19:100413. doi: 10.1016/j.lanepe.2022.100413. eCollection 2022 Aug.

    PubMed 35694653

Questions about this trial

What is this clinical trial studying?

A study testing Peer-to-Peer-Groupintervention, Smartphone-based-Intervention and Gendersensitive-Groupintervention in people with Affective Disorders, run by Charite University, Berlin, Germany at 1 site in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Feb 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Depression severity measured by the Patient Health Questionnaire - 9 (PHQ-9) (time frame: Baseline,12, 24 and 48 weeks after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03109028, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Feb 2022.

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