The Effect of Two Different Interventions on Chronic Pain and Mental Health Symptoms among Syrian Refugees

The main aim of this PhD project is to assess the effect of two different interventions among adult Syrian refugees suffering from pain and/or post-traumatic symptoms: (i) Physiotherapy Activity and Awareness Intervention (PAAI) in reducing pain disorders and mental health symptoms (if present), and (ii) a self-help group intervention using Teaching Recovery Techniques (TRT) to improve mental health and reduce pain (if present). The interventions were adapted for our participants in cooperation with the municipality of Bergen, municipality of Fjell, the Centre for Crisis Psychology, and the users. Both treatments were tested using a randomized controlled trial (RCT) design implemented from August 2018 to December 2019. In addition, a qualitative assessment was performed through an embedded process evaluation and through personal interviews with participants after the completion of the interventions. The first paper in this thesis is the study protocol for both interventions and it describes in detail the methodology used. The second paper presents, primarily, the effect of PAAI in reducing pain disorders and secondarily in improving general mental health among 101 Syrian refugees. Although PAAI had no effect on reducing either pain symptoms or improving mental health among refugees by intention-to-treat (ITT), this paper also includes the qualitative experiences among participants, including self-perceived benefits of the intervention and challenges/barriers to attending the intervention. The third paper presents the effect of a self-help group using TRT to improve mental health and secondarily reduce the pain disorder among 76 adult Syrian refugees reporting mental health symptoms. Our study found that the self-help group intervention statistically improved general mental health among adults’ refugees in ITT analysis measured by the 12-item General Health Questionnaire (GHQ-12). However, there was no effect of TRT on either mental health when measured by the 22-item Impact of Event Scale-Revised (IES-R 22) or on pain levels measured by the Brief Pain Inventory (BPI). Our research contributes to the evidence base needed to develop focused and effective healthcare services for refugees and indicates that the tested interventions might have some positive effects but are generally not as effective as expected on the primary outcomes. Thus, further research on how to improve health among refugees is needed