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Abstract
There is a growing number of refugees and displaced persons worldwide, with many suffering the psychological consequences of traumatic and stressful events occurring both in their country of origin, during the migratory journey and after arriving in a new country. Despite this, there is limited evidence on how to best help refugees and migrants with the mental health problems that they sometimes experience. Internet-based interventions show promise in the treatment of many common mental disorders and can be adapted into different languages to meet the needs of diverse groups.
The overarching aim of the present thesis was to investigate the usefulness of internet-based cognitive behavioural therapy (ICBT) for migrants and refugees in Sweden suffering from depression and anxiety.
Study I describes the stages of development of a self-help material for common mental health problems in Arabic, which included 9 modules on common problems such as anxiety, depression and insomnia. It was found that the material overall was acceptable, based on a number of pilot users as well as two focus groups. The cultural adaptation of the program consisted of minor changes in the case materials to make it recognizable for users of different cultural origins.
The material from Study I was then further developed for Study II into a more comprehensive treatment program which was evaluated using a randomized controlled trial design. A total of 59 participants were randomized to either guided ICBT or a waitlist control condition. Overall, the guided ICBT lead to moderate to large significant reductions in symptoms of depression, insomnia, and stress, as well as moderate, non-significant, improvements in quality of life and anxiety. However, the study had relatively low adherence and high attrition rate, possibly indicating a need for further adaptation.
In Study III, we conducted interviews and did a qualitative analysis of the participants’ experience of the treatment program from Study II to get a more comprehensive understanding of the way internet-based treatment is perceived among this group. Ten individuals were interviewed with the resulting analysis revealing five overarching themes describing the importance of the contact with the therapist, positive learning experiences from the treatment, difficulties encountered with the treatment format, changing attitudes towards mental health treatment, and difficulties navigating the Swedish healthcare system.
Finally, Study IV describes the development and pilot testing of an intervention aimed at Dari and Farsi-speaking youth in Sweden. Fifteen participants were included in the study with only three completing the post-treatment evaluation. Interviews were also conducted with four of the participants of the study as well as three non-participants to better understand barriers and facilitating factors for engagement with the treatment. Overall, the study revealed low feasibility of the intervention in its current form, with the most salient barriers to participation being interference of mental health symptoms such as low concentration making it difficult to read the texts and a need for more support and contact with a therapist or support person.
In conclusion, the thesis shows that ICBT can be effective in reducing symptoms of common mental health problems such as depression, insomnia and stress among migrants and refugees in Sweden, and that relatively minor adaptations can be sufficient to make the treatment material relevant and recognizable for participants. However, in the case of refugee youth from Afghanistan, it was found that the structure of the delivery format constituted a major barrier. Future studies should investigate if a blended treatment format with regular phone/video calls with a therapist can increase acceptance of the intervention.
