Accepted for/Published in: JMIR Mental Health
Date Submitted: Dec 18, 2025
Date Accepted: Feb 26, 2026
The efficacy of a WHO guided self-help intervention for reducing psychological distress in Afghan refugees: A randomized controlled trial
ABSTRACT
Background:
Common mental health disorders are highly prevalent among refugees. Prior research has shown the effectiveness of scalable, task-shared, psychological interventions in improving refugee mental health and wellbeing. There is a lack of research on the effectiveness of individually supported, self-help interventions for refugees in low-resource, transit settings.
Objective:
The current study aimed to test the efficacy of an individually-supported self-help stress-management intervention developed by the World Health Organization - Doing What Matters in Times of Stress- 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 ≥ 20) were randomly allocated to the facilitator-guided individual DWM condition (N = 202) or a repeated assessment control (RAC) condition (N = 101). The primary outcome was psychological distress (K10) at the post-treatment assessment. Secondary outcomes were PTSD 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 than those in RAC (β = -0.563, SE = 0.124, p<.001, Cohen’s d = 0.56 at post-treatment, β = -0.447, SE = 0.140, p =.002, Cohen’s d= 0.45 at 1-month follow-up). Similarly, those participants in the DWM condition reported greater improvements in PTSD symptoms, wellbeing, 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 might offer an effective, feasible, and scalable approach to improving mental health for refugees. Clinical Trial: ACTRN12624000609550
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