The mediational role of post traumatic symptoms in the association between potentially traumatic events and psychological distress, well-being and quality of life: re-analysis of two large prevention trials in asylum seekers and refugees

In recent years, global migrations have drawn increasing attention on migrant’s mental health who often are displaced from their native countries in mass due to famine, war, and natural disasters [1]. Regardless of the driving motives, migration is considered per se a vulnerability factor for the development mental health problems [2, 3], with migrants showing higher prevalence of mental disorders and psychological distress than natives [4, 5]. Governments and policy makers around the globe are therefore faced with the challenge of effectively addressing mental health of a large number of diverse people. In this frame, clinical trials on low-intensity, scalable psychological intervention have been run, showing some promising results both in the short- and in the long-term [5-7]. For example, the WHO has recently developed low-intensity psychosocial intervention strategies, such as Self-Help Plus (SH+). SH+ is a low-resources, group-based, self-help psychological intervention composed of five sessions of about 90 minutes, aiming at empowering participants to better manage their mental health and well-being using evidence-based techniques and strategies [2, 8]. Although effective in large trials, these scalable interventions necessarily apply a “one size fits all” approach. Individual factors however can vary greatly and can affect psychological conditions and treatment outcomes across settings and interventions [9-11]. One specific factor that can have a great impact on individuals’ mental health and treatment outcome is the exposure to potentially traumatic events (PTEs) [12-15]. PTEs disproportionately affect subpopulations of migrants such as refugees and asylum seekers adding on to the post-migration living challenges (e.g., socioeconomic instability, language barriers, and discrimination) [16-19]. Although a body of research exists on trauma focused treatments for migrants and refugees [20, 21], literature on the predictive role of PTEs in large-scale protocolled psychological interventions for mental health and the possible mediators of such effect is scant and somewhat inconsistent (e.g., [22, 23]). Findings from research on psychosis [24], substance abuse [25], eating disorders [13], depression [26], and anxiety [27], indicate that trauma itself does not necessarily lead to psychopathological outcomes, and that its effect on mental health and psychological treatments is mediated by post-traumatic symptoms. PTEs can in fact lead to symptoms such as emotional dysregulation, intrusive memories, isolation, and hyperarousal, regardless of a full-threshold Post-traumatic stress disorder diagnosis [28]. As PTEs are common in migrants, determining their effect and mediators on the treatment for mental distress could be of relevance for the field of global mental health.