A Randomized Trial Testing Group Mental Health Supports for Afghan Refugees in Malaysia

Background and Purpose: Worldwide, over 65 million people are currently displaced, representing an unprecedented crisis of individuals seeking asylum. Malaysia hosts approximately 250,000 displaced persons, who face a number of stressors while living in a transitory situation where they are unable to receive permanent asylum. Prior research has found high levels of mental distress among refugee communities, though treatments responding to such distress are limited. This study addresses this gap by assessing a group support intervention implemented with female refugees from Afghanistan living in Kuala Lumpur, Malaysia.

Method: An 8-week group intervention was implemented with 39 participants. The intervention was developed based on an assessment of mental health needs and participant preferences regarding group implementation and content. Drawing from approaches with refugees elsewhere, the intervention incorporated cognitive behavioral, stretching, and meditative techniques to address trauma, physical symptoms, and anger. Twenty-nine participants were randomly assigned to treatment conditions, resulting in 20 participants in two separate initial intervention groups and 9 in a wait list control group. An additional 10 participants were not randomly assigned and, therefore, were treated as an additional group and analyzed separately. A three-group piecewise growth curve model was specified in Mplus using Bayesian analysis. Dependent variables included mental distress measured by the RHS-15, anxiety and depression measured by the HSC-25, post-traumatic stress measured by the HTQ, resilience measured by the Brief Resilience Scale, and social support measured by the MOS Social Support Survey. Control variables included age, marital status, time living in Malaysia, food insecurity, and whether the participant had children.

Results: The slopes of the treatment groups baseline scores, post-treatment scores, and 3-month post-treatment scores were compared. From baseline to post-treatment, the intervention treatment group had significant declines in mental distress (b= -16.90, p<.001), anxiety (b= -.80, p<.001), depression (b= -.59, p<.001), and post-traumatic stress (b= -.24, p<.05); conversely, resilience scores increased (b= .27, p<.05). Similar trends were observed in the non-randomized group. Three months post-treatment, gains were maintained, indicated by the non-significant slopes from post-treatment to 3 months post-treatment (p>.05). Subsequent to the wait-list group receiving treatment, they too showed significant negative slopes in mental distress (b= -20.88, p<.001), anxiety (b= -1.10, p<.001), depression (b= -.79, p<.001), and post-traumatic stress scores (b= -.82, p<.001), but did not show an increase in resilience scores (p>.05). Social support scores did not significantly change in any group over any time period.

Conclusions and Implications: Results indicate that the group intervention led to a decrease in mental health symptoms among female refugees from Afghanistan living in Malaysia. The study underscores the positive impact that group interventions may have among refugee populations, and suggests further research is needed to examine the potential for group supports to enhance wellbeing among various refugee communities in Malaysia and elsewhere.