A Group Mental Health Randomized Controlled Trial for Female Refugees in Malaysia

Forcibly displaced persons confront multiple stressors while awaiting permanent asylum or resettlement and often experience high levels of emotional distress. This study assessed an 8-week somatic-focused culturally adapted cognitive-behavioral therapy (CBT) group intervention with 39 female refugees from Afghanistan living in Kuala Lumpur, Malaysia. Twenty-nine participants were randomly assigned to treatment conditions, resulting in 20 participants in two separate treatment groups and 9 in a waitlist control group. An additional 10 participants were not randomly assigned and therefore were treated as an additional treatment group and analyzed separately. A three-group piecewise linear growth model was specified in Mplus using Bayesian estimation. Dependent variables included emotional distress, anxiety, depression, posttraumatic stress, and social support. From baseline to posttreatment assessments, initial intervention participants experienced significant declines in emotional distress (b = −16.90, p < .001), anxiety (b = −.80, p < .001), depression (b = −.59, p < .001), and posttraumatic stress (b = −.24, p < .05). Gains were maintained three months posttreatment, with similar trends observed among nonrandomized participants. Subsequent to receiving treatment, the waitlist control participants also showed significant declines in emotional distress (b = −20.88, p < .001), anxiety (b = −1.10, p < .001), depression (b = −.79, p < .001), and posttraumatic stress scores (b = −.82, p < .001). Comparing the treatment groups to the waitlist control group revealed large effect sizes: Cohen's d was 2.14 for emotional distress, 2.31 for anxiety, 2.42 for depression, and 2.07 for posttraumatic stress. Relevant public health findings include low drop out, group format, and facilitation by a trained community member. Public Policy Relevance Statement A somatic focused culturally adapted cognitive-behavioral group intervention led to reductions in symptoms of emotional distress, depression, anxiety, and PTSD among female Afghan refugees residing in Malaysia. Findings suggest mental health supports should be provided in countries of first asylum and additional funding is needed to ensure services are available to a larger number of forced migrants. Individual and community supports are needed as are long-term solutions for forced migrants.