A Randomized Clinical Trial Testing a Screening, Brief Intervention, & Referral to Treatment Intervention for Mental Health Among Refugees in Malaysia

Background and purpose: Refugees and asylum seekers often experience elevated levels of mental and emotional distress due to the social and economic challenges surrounding forced migration experiences. In transitory countries of first migration where most refugees reside, opportunities, legal rights, and service access are limited. In response to high levels of emotional distress observed among refugees in Malaysia, we developed and tested a brief mental health intervention. Screening, brief intervention, and referral to treatment (SBIRT) tools have shown promise in serving those affected by substance use and intimate partner violence. The purpose of this study was to examine whether a SBIRT tool would impact emotional distress among refugees residing in Malaysia.  

Methods: The brief intervention tool involved education about mental wellbeing in contexts of forced migration, screening of emotional distress, skill building, goal setting, and referrals to services. A randomized design was used where half of participants were assigned to the initial intervention group, the remainder were assigned to a wait-list control group, which received the intervention at the 30-day follow up period. Participants were recruited through community service agencies, online networking platforms, and word-of-mouth. We examined the intervention effect using a general linear model with the 30-day score on the Refugee Health Screening-15 (RHS-15) as the dependent variable. Study arm was examined as the independent variable while we controlled for RHS-15 score at baseline, gender, ethnicity, employment, spouse, and an interaction between arm and ethnicity. The model was run with MPLUS with Bayesian estimation. In total 85 people participated in the study, including 41 Rohingya and 44 Afghan refugees. Two thirds of the sample were female and on average, participants had been in Malaysia for 4 years.

Results: Participation in the intervention led to a decrease in emotional distress scores at 30 days when compared to the waitlist control group (b=-0.62, 95% CI=-.80, -.42, p<.001). Baseline score, gender, nationality, employment, and the interaction between nationality and study arm were also associated with distress scores at 30 days, suggesting distress was higher among those with higher baseline scores, women, and Rohingya participants. Intervention effects were stronger for participants from Afghanistan.  

Conclusions and implications: Findings suggest the SBIRT model has promise for building awareness and coping strategies surrounding mental wellbeing. Additional research is needed to examine how the intervention can be tailored to specific community needs. Practitioners can use such tools to help build capacity as well as to identify those in need of more intensive supports. Beyond providing such limited assistance, attention is needed to supportive migration policies that will enable permanent and secure resettlement solutions for forced migrants.