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STRENGTHS Project: Scaling Up Psychological Interventions with Syrian Refugees

The STRENGTHS project ran from 2017 to 2022. The project focused on translating, adapting, testing, and implementing scalable mental health interventions for Syrian refugees.

One of the major challenges in refugee-hosting countries is providing mental health care to vulnerable populations. To address this gap, the STRENGTHS project trained Syrian refugees to deliver the WHO’s Problem Management Plus (PM+) intervention, which targets common mental health disorders. PM+ does not focus on specific conditions but addresses a range of symptoms. WHO published the manual after the intervention was found to be effective in studies in Pakistan and Kenya.

STRENGTHS translated, adapted, and tested PM+, including both its individual and group delivery formats, Early Adolescent Skills for Emotions (EASE) for young adolescents and their caregivers, and Step-by-Step, an internet-delivered intervention, for Syrian refugees. The project went beyond assessing whether these interventions worked. It also sought to understand how they could be effectively implemented in diverse contexts and whether they were cost-effective.

The project was conducted across eight countries in Europe and the Middle East and North Africa. While not all refugees develop serious mental health issues, research shows that a significant proportion experience mental health challenges.

Scalable psychological interventions, such as PM+, may offer an effective solution. Below is a list of publications produced by the STRENGTHS consortium.

VU TEAM MEMBERS

KNOP Department

Clinical, Neuro- & Developmental Psychology

Clinical Psychology Section

Scaling up psychological interventions with Syrian refugees

This video provides an introduction to the project. Please note that the project has finished and that there are no vacancies.

List of publications

2025

Coşkun-Toker, A., İlkkurşun, Z., Fuhr, D., Roberts, B., Cuijpers, P., Sijbrandij, M., & Acarturk, C. (2025). A qualitative process evaluation of group problem management plus for distressed Syrian refugees in Türkiye. Cambridge Prisms: Global Mental Health, 12, e87. https://doi.org/10.1017/gmh.2025.10035

Sijbrandij, M., de Graaff, A. M., Cadorin, C., Twisk, J. W., Elsawy, M., Ramia, J. A., ... & STRENGTHS Consortium. World Health Organization's Scalable Psychological Interventions for Syrian Refugees: An Individual Participant Data Meta-Analysis of Problem Management Plus and Step-by-Step. http://dx.doi.org/10.2139/ssrn.5191106

2024

Abi Hana, R., Abi Ramia, J., Burchert, S., Carswell, K., Cuijpers, P., Heim, E., ... & Smit, F. (2024). Cost-Effectiveness of Digital Mental Health Versus Usual Care During Humanitarian Crises in Lebanon: Pragmatic Randomized Trial. JMIR Mental Health, 11(1), e55544. https://doi.org/10.2196/55544

Ali, R., Brown, F. L., Stevenson, K., Jordans, M., Taha, K., Amine, M. E., … & STRENGTHS Consortium. (2024). Implementing a Non-Specialist Delivered Psychological Intervention for Young Adolescents in a Protracted Refugee Setting: a Qualitative Process Evaluation in Lebanon. The Journal of Behavioral Health Services & Research, 51(3), 377-394. https://doi.org/10.1007/s11414-023-09870-3

Burchert, S., Alkneme, M. S., Alsaod, A., Cuijpers, P., Heim, E., Hessling, J., … & STRENGTHS Consortium. (2024). Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial. PLoS medicine, 21(9), e1004460. https://doi.org/10.1371/journal.pmed.1004460

de Graaff, A. M., Cuijpers, P., Boschloo, L., Elsawy, M., Hunaidy, S., Seedat, S., … & Sijbrandij, M. (2024). The associations of hair cortisol and DHEA with posttraumatic stress disorder symptoms in refugees. Comprehensive Psychiatry, 129, 152438. https://doi.org/10.1016/j.comppsych.2023.152438

de Graaff, A. M., Cuijpers, P., Elsawy, M., Hunaidy, S., Kieft, B., Gorgis, N., ... & Sijbrandij, M. (2024). The effectiveness of Problem Management Plus at 1-year follow-up for Syrian refugees in a high-income setting. Epidemiology and Psychiatric Sciences, 33, e50. https://doi.org/10.1017/S2045796024000519

Schoenberger, S. F., Schönenberg, K., Fuhr, D. C., Nesterko, Y., Glaesmer, H., Sondorp, E., … & Roberts, B. (2024). Mental healthcare access among resettled Syrian refugees in Leipzig, Germany. Cambridge Prisms: Global Mental Health, 11, e25. https://doi.org/10.1017/gmh.2024.16

Woodward, A., Fuhr, D., Barry, A.S, Balabanova, D., Sondorp, E., Dieleman, M.A., Pratley, P., Schoenberger, S., McKee, M., B., Sijbrandij, M., Cuijpers, P., Roberts, B. (2024). Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East. Open Research Europe, 3, 14. https://doi.org/10.12688/openreseurope.15293.2

2023

Brown, F. L., Taha, K., Steen, F., Kane, J., Gillman, A., Aoun, M., … & Jordans, M. J. (2023). Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon. BMC psychiatry23(1), 1-18. https://doi.org/10.1186/s12888-023-04571-9

de Graaff, A. M., Cuijpers, P., Twisk, J. W. R., Kieft, B., Hunaidy, S., Elsawy, M., … & Sijbrandij, M. on behalf of the STRENGTHS consortium. (2023). Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus. BMJ Mental Health, 26, 1-10. http://dx.doi.org/10.1136/bmjment-2022-300637

Spaaij, J., Fuhr, D. C., Akhtar, A., Casanova, L., Klein, T., Schick, M., … & Morina, N. (2023). Scaling-up problem management plus for refugees in Switzerland-a qualitative study. BMC Health Services Research23(1), 488. https://doi.org/10.1186/s12913-023-09491-8

Woodward, A., Burchert, S., Barry, A. S., Broerse, J. E., Sondorp, E., Bold, A., … & Dieleman, M. A. (2023). Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden. SSM-Mental Health, 100231. https://doi.org/10.1016/j.ssmmh.2023.100231

Woodward, A., Sondorp, E., Barry, A.S, Dieleman, M.A., Fuhr, D., Broerse, J.E.W, Akhtar, A. Awwad, M., Bawaneh, A., Bryant, R., Sijbrandij, M., Cuijpers, P., Roberts, B. (2023). Scaling up task-sharing psychological interventions for refugees in Jordan: a qualitative study on the potential barriers and facilitators, Health Policy and Planning, czad003. https://doi.org/10.1093/heapol/czad003

2022

Acarturk, C., Uygun, E., Ilkkursun, Z., Yurtbakan, T., Kurt, G., Adam-Troian, J., … & Fuhr, D. C.(2022). Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial. BMC psychiatry, 22(1), 1-11. https://doi.org/10.1186/s12888-021-03645-w

Akhtar, A., Koyiet, P., Rahman, A., Schafer, A., Hamdani, S. U., Cuijpers, P., Sijbrandij, M., & Bryant, R. A. (2022). Residual posttraumatic stress disorder symptoms after provision of brief behavioral intervention in low- and middle-income countries: An individual-patient data meta-analysis. Depress Anxiety, 39(1), 71-82. https://doi.org/10.1002/da.23221

Bryant, R., Bawaneh, A., Awwad, M., Al-Hayek, H., Giardinelli, L., Whitney, C., . . . Akhtar, A. (2022). Twelve-month follow-up of a randomised clinical trial of a brief group psychological intervention for common mental disorders in Syrian refugees in Jordan. Epidemiology and Psychiatric Sciences, 31, E81. https://doi.org/10.1016/j.ssmmh.2022.100171

Bryant, R. A., Bawaneh, A., Awwad, M., Al-Hayek, H., Giardinelli, L., Whitney, C., … & STRENGTHS Consortium. (2022). Effectiveness of a brief group behavioral intervention for common mental disorders in Syrian refugees in Jordan: A randomized controlled trial. Plos Medicine19(3), e1003949. https://doi.org/10.1371/journal.pmed.1003949

de Graaff, A. M., Cuijpers, P., Acarturk, C., Akhtar, A., Alkneme, M. S., Aoun, M., … & Sijbrandij, M. (2022). Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis. BMJ Open12(4), e058101. https://doi.org/10.1136/bmjopen-2021-058101

Spaaij, J., Kiselev, N., Berger, C., Bryant, R. A., Cuijpers, P., De Graaff, A. M., … & Morina, N. (2022). Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial. European Journal of Psychotraumatology, 13(1), 2002027. https://doi.org/10.1080/20008198.2021.2002027

Woodward, A., de Graaff, A. M., Dieleman, M. A., Roberts, B., Fuhr, D. C., Broerse, J. E., … & Sondorp, E. (2022). Scalability of a task-sharing psychological intervention for refugees: A qualitative study in the Netherlands. SSM-Mental Health, 100171. https://doi.org/10.1016/j.ssmmh.2022.100171

2021

Drescher, A., Kiselev, N., Akhtar, A., Acarturk, C., Bryant, R. A., Ilkkursun, Z., … & Morina, N. (2021). Problems after flight: understanding and comparing Syrians’ perspectives in the Middle East and Europe. BMC Public Health, 21(1), 1-12. https://doi.org/10.1186/s12889-021-10498-1

Akhtar, A., Bawaneh, A., Awwad, M., Al-Hayek, H., Sijbrandij, M., Cuijpers, P., & Bryant, R. A. (2021). A longitudinal study of mental health before and during the COVID-19 pandemic in Syrian refugees. European Journal of Psychotraumatology12(1), 1991651. https://doi.org/10.1080/20008198.2021.1991651

Akhtar, A., Engels, M. H., Bawaneh, A., Bird, M., Bryant, R., Cuijpers, P., … & STRENGTHS Consortium. (2021). Cultural Adaptation of a Low-Intensity Group Psychological Intervention for Syrian Refugees. Intervention, 19(1), 48-57. DOI: https://doi.org/10.4103/INTV.INTV_38_20

Akhtar, A., Cuijpers, P., Morina, N., Sijbrandij, M., & Bryant, R. (2021). Exploratory and confirmatory factor analysis of the 12-item Arabic World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a screening tool for Syrian refugees. BJPsych Open7(6), e190. https://doi.org/doi:10.1192/bjo.2021.1017

Akhtar, A., Giardinelli, L., Bawaneh, A., Awwad, M., Al-Hayek, H., Whitney, C., … & Bryant, R. (2021). Feasibility trial of a scalable transdiagnostic group psychological intervention for Syrians residing in a refugee camp. European Journal of Psychotraumatology, 12(1), 1932295. https://doi.org/10.1080/20008198.2021.1932295

de Graaff, A. M., Cuijpers, P., Leeflang, M., Sferra, I., Uppendahl, J. R., de Vries, R., & Sijbrandij, M. (2021). A systematic review and meta-analysis of diagnostic test accuracy studies of self-report screening instruments for common mental disorders in Arabic-speaking adults. Global Mental Health, 8, 1-18. https://doi.org/10.1017/gmh.2021.39

Woodward, A., Dieleman, M. A., Sondorp, E., Roberts, B., Fuhr, D. C., Ventevogel, P., … & Broerse, J. E. (2021). A System Innovation Perspective on the Potential for Scaling Up New Psychological Interventions for Refugees. Intervention, 19(1), 23-26. https://doi.org/10.4103/INTV.INTV_29_20

2020

Acarturk, C., McGrath, M., Roberts, B., Ilkkursun, Z., Cuijpers, P., Sijbrandij, M., … & Fuhr, D. C. (2020). Prevalence and predictors of common mental disorders among Syrian refugees in Istanbul, Turkey: a cross-sectional study. Social Psychiatry and Psychiatric Epidemiology, 56, 475-484. https://doi.org/10.1007/s00127-020-01941-6

Akhtar, A., Giardinelli, L., Bawaneh, A., Awwad, M., Naser, H., Whitney, C., … & Bryant, R. A. (2020). Group problem management plus (gPM+) in the treatment of common mental disorders in Syrian refugees in a Jordanian camp: study protocol for a randomized controlled trial. BMC Public Health, 20(1), 1-8. https://doi.org/10.1186/s12889-020-08463-5

Brown, F. L., Aoun, M., Taha, K., Steen, F., Hansen, P., Bird, M., … & Jordans, M. J. (2020). The cultural and contextual adaptation process of an intervention to reduce psychological distress in young adolescents living in Lebanon. Frontiers in Psychiatry, 11, 212. https://doi.org/10.3389/fpsyt.2020.00212

de Graaff, A. M., Cuijpers, P., Acarturk, C., Bryant, R., Burchert, S., Fuhr, D. C., … & Sijbrandij, M. (2020). Effectiveness of a peer-refugee delivered psychological intervention to reduce psychological distress among adult Syrian refugees in the Netherlands: study protocol. European Journal of Psychotraumatology, 11(1), 1694347. https://doi.org/10.1080/20008198.2019.1694347

de Graaff, A. M., Cuijpers, P., McDaid, D., Park, A., Woodward, A., Bryant, R. A., … & Sijbrandij, M. (2020). Peer-provided Problem Management Plus (PM+) for adult Syrian refugees: a pilot randomised controlled trial on effectiveness and cost-effectiveness. Epidemiology and Psychiatric Sciences, 29, E162. https://doi.org/10.1017/S2045796020000724

Drescher, A., Kiselev, N., Akhtar, A., Acarturk, C., Bryant, R., Ilkkursun, Z., … & Morina, N. (2020). Problems After Flight: Understanding and Comparing Syrians’ Perspectives in the Middle East and Europe. BMC Public Health21(1), 1-12. https://doi.org/10.1186/s12889-021-10498-1

Fuhr, D. C., Acarturk, C., McGrath, M., Ilkkursun, Z., Sondorp, E., Sijbrandij, M., … & Roberts, B. (2020). Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey. Epidemiology and Psychiatric Sciences, 29, E70. https://doi.org/10.1017/S2045796019000660

Fuhr, D. C., Acarturk, C., Sijbrandij, M., Brown, F. L., Jordans, M. J., Woodward, A., … & Roberts, B. (2020). Planning the scale up of brief psychological interventions using theory of change. BMC Health Services Research, 20, 801. https://doi.org/10.1186/s12913-020-05677-6

Fuhr, D. C., Acarturk, C., Uygun, E., McGrath, M., Ilkkursun, Z., Kaykha, S., … & Roberts, B. (2020). Pathways towards scaling up problem management plus in Turkey: a theory of change workshop. Conflict and Health, 14(1), 1-9. https://doi.org/10.1186/s13031-020-00278-w

Fuhr, D. C., Roberts, B., Woodward, A., Sondorp, E., Sijbrandij, M., De Graaff, A., & Balabanova, D. (2020). Health System Responsiveness to the Mental Health Needs of Forcibly Displaced Persons. In Health Policy and Systems Responses to Forced Migration (pp. 213-234). Springer International Publishing AG. https://doi.org/10.1007/978-3-030-33812-1_12

Kiselev, N., Morina, N., Schick, M., Watzke, B., Schnyder, U., & Pfaltz, M. C. (2020). Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist’s view. BMC psychiatry, 20, 378. https://doi.org/10.1186/s12888-020-02783-x

Kiselev, N., Pfaltz, M., Haas, F., Schick, M., Kappen, M., Sijbrandij, M., … & Morina, N. (2020). Structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. European Journal of Psychotraumatology, 11(1), 1717825. https://doi.org/10.1080/20008198.2020.1717825

Kiselev, N., Pfaltz, M., Schick, M., Bird, M., Pernille, H., Sijbrandij, M., … & Morina, N. (2020). Problems faced by Syrian refugees and asylum seekers in Switzerland. Swiss Medical Weekly, 150:w20381. https://doi.org/10.4414/smw.2020.20381

Morina, N., Drescher, A., Akhtar, A., Spaaij, J., & Kiselev, N. (2020). Understanding and comparison of self-reported problems of Syrian refugees in three countries. European Journal of Public Health, 30(Supplement_5), ckaa165-624. https://doi.org/10.1093/eurpub/ckaa165.624

Uygun, E., Ilkkursun, Z., Sijbrandij, M., Aker, A. T., Bryant, R., Cuijpers, P., … & Acarturk, C. (2020). Protocol for a randomized controlled trial: peer-to-peer Group Problem Management Plus (PM+) for adult Syrian refugees in Turkey. Trials, 21(1), 1-9. https://doi.org/10.1186/s13063-020-4166-x

Wen, K., McGrath, M., Acarturk, C., Ilkkursun, Z., Fuhr, D. C., Sondorp, E., … & Roberts, B. (2020). Post-traumatic growth and its predictors among Syrian refugees in Istanbul: a mental health population survey. Journal of Migration and Health, 1, 100010. https://doi.org/10.1016/j.jmh.2020.100010

2019

Brown, F. L., Steen, F., Taha, K., Aoun, M., Bryant, R. A. , Jordans, M. J. D., Malik, A., van Ommeren, M., Abualhaija, A., Aqel, I. S., Ghatasheh, M., Habashneh, R., Sijbrandij, M., El Chammay, R., Watts, S., Akhtar, A.; STRENGTHS-consortium (2019). Early Adolescent Skills for Emotions (EASE) intervention for the treatment of psychological distress in adolescents: study protocol for randomised controlled trials in Lebanon and Jordan. Trials, 2;20(1):545. https://doi.org/10.1186/s13063-019-3654-3

Burchert, S., Alkneme, M. S., Bird, M., Carswell, K., Cuijpers, P., Hansen, P., … & Knaevelsrud, C. (2019). Usercentered app adaptation of a low-intensity e-mental health intervention for Syrian refugees. Frontiers in Psychiatry, 9, 663. https://doi.org/10.3389/fpsyt.2018.00663

Dawson, K. S., Watts, S., Carswell, K., Harper Shehadeh, M., Jordans, M. J. D., Bryant, R., Miller, K. E., Malik, A., Brown, F. L., Servili, C., van Ommeren, M. (2019). Improving access to effective psychological interventions for young adolescents: Early Adolescent Skills for Emotions (EASE). World Psychiatry, 18, 105-107. https://doi.org/10.1002/wps.20594

Fuhr, D. C., Acarturk, C., McGrath, M., Ilkkursun, Z., Sondorp, E., Sijbrandij, M., Ventevogel, P., Cuijpers, P., McKee, M., & Roberts, B. (2019). Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey. Epidemiology and Psychiatric Sciences, 29:e70. https://doi.org/10.1017/S2045796019000660.

Kiselev, N., Morina, N., Schick, M., Watzke, B., Schnyder, U., & Pfaltz, M. (2019). Current Situation and Admission Barriers in Outpatient Mental Health Care for Refugees and Asylum Seekers in Switzerland: The Therapists’ View, European Journal of Psychotraumatology (Vol. 10). https://doi.org/https://doi.org/10.1186/s12888-020-02783-x

2017

Sijbrandij, M., Acarturk, C., Bird, M., Bryant, R. A., Burchert, S., Carswell, K., ... & Cuijpers, P. (2017). Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries. European Journal of Psychotraumatology, 8(sup2), 1388102. https://doi.org/10.1080/20008198.2017.1388102

List of reports

Below is an Excel tool which provides models for each of the iPM+, gPM+, and SbS and EASE interventions in each of their different country contexts. It is based on preliminary results from STRENGTHS.

A welcome page provides some brief background on the tool. Two options are then possible: clicking on a link to download a brief version of a manual with instructions on how to use the tool or alternatively clicking on the link to ‘proceed to the interventions menu’. Most of the cells of the tool are protected, but interventions examined, countries of implementation, and many specific parameters can be varied for each of the four models in the tool.

Please note that the tool is still being developed and will be updated as more data becomes available. At this stage, it is not to be used for informing policy decisions.

Please click on the following link to access the document: STRENGTHS modelling tool.

These documents reflect only the authors’ views and the European Commission is not responsible for any use of the information they contain.

Funding

Funding

This project has received funding from the European Union’s Horizon 2020 Research and Innovation programme Societal Challenges under Grant Agreement No 733337.

STRENGTHS project partner logos

Partners

Related content

For general queries:

strengths.fgb@vu.nl

Faculty of Behavioural and Human Movement Sciences (FGB)
Department of Clinical, Neuro- & Developmental Psychology
Van der Boechorststraat 7
1081 BT Amsterdam

Contact

  • Marit Sijbrandij, PhD
  • Full Professor, Clinical Psychology
  • Faculty of Behavioural and Movement Sciences
  • e.m.sijbrandij@vu.nl
Marit Sijbrandij, PhD

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