Efficacy of a World Health Organization-Guided Self-Help Intervention for Reducing Psychological Distress in Afghan Refugees: Randomized Controlled Trial

Clinical Snapshot

Key Findings

• P Value: P<0.001 at posttreatment, P=0.002 at follow-up

• Effect Size: Cohen's d = 0.56 at posttreatment, 0.45 at 1-month follow-up

• Primary Outcome: K10 psychological distress score reduction

• Nnt Or Sensitivity: Moderate effect size suggests approximately 3-4 patients need treatment for one additional positive outcome

• Confidence Interval: Not specified in abstract

Clinical Application

High feasibility given WHO endorsement, individual delivery format, and demonstrated effectiveness in resource-limited settings Highly relevant for Australian refugee mental health services, aligns with RACGP refugee health guidelines, potentially PBS-eligible as psychological intervention Refugees and asylum seekers with moderate to high psychological distress in Australian community and detention settings

Abstract

BACKGROUND: Common mental health disorders are highly prevalent among refugees. There is an urgent need to address the mental health burden in this population. OBJECTIVE: This study tested the efficacy of an individually supported self-help stress-management intervention developed by the World Health Organization-Doing What Matters in Times of Stress (DWM)-in reducing psychological distress and improving functioning among refugees in Indonesia, a major transit country in the Asia-Pacific region. METHODS: A single-blind randomized controlled trial with 303 Farsi-speaking refugees was conducted between June 2024 and June 2025. Participants with moderate to high psychological distress (Kessler Psychological Distress Scale [K10] score≥20) were randomly allocated to the facilitator-guided individual DWM condition (n=202) or a repeated assessment control condition (n=101). The primary outcome was psychological distress (K10 score) at the posttreatment assessment. Secondary outcomes were posttraumatic stress disorder symptoms, functional impairment, social functioning, and personally identified problems. RESULTS: Intent-to-treat analysis indicated that participants in the DWM condition showed greater reductions in K10 scores than those in the repeated assessment control condition (posttreatment: β=-.563, SE=0.124; P<.001; Cohen d=0.56; 1-month follow-up: β=-.447, SE=0.140; P=.002; Cohen d=0.45). Similarly, those participants in the DWM condition reported greater improvements in posttraumatic stress disorder symptoms, well-being, social functioning, functional impairment, and personally identified psychological problems. No serious adverse events were reported. CONCLUSIONS: The findings provide the first evidence for the effectiveness of DWM in reducing psychological distress and improving overall functioning among urban refugees living in a transit setting. Individually supported self-help interventions such as DWM mayoffer an effective, feasible, and scalable approach to improving mental health for refugees.

References

1. 1.Nickerson, A., Kurt, G., Specker, P., Camilleri, A., Susanty, D., Argadianti, R., Keegan, D., Nandyatama, R., Yuanita, A., Hermawan, A. P. R., Bryant, R. A., O'Donnell, M., Rafei, M., Bayani, R., & Liddell, B. J. (2026). Efficacy of a World Health Organization-Guided Self-Help Intervention for Reducing Psychological Distress in Afghan Refugees: Randomized Controlled Trial. JMIR Mental Health, 13(1), e89928. https://doi.org/10.2196/89928