A WHO mh-GAP intervention with lay mental health workers in a protection of civilians site: a randomized controlled trial in Malakal, South Sudan

Objective Mental disorders are a challenge among Internally Displaced People (IDPs). Training lay mental health workers (LMHWs) might offer an effective solution. Method The study was conducted in a camp for IDPs in Malakal, South Sudan. LMHWs were trained based on WHO Mental Health Gap Action Programme (mh-GAP) guidelines to provide psychosocial interventions. Participants (n = 988) were randomised to either the intervention arm, receiving help from the trained lay mental health workers (LMHWs), or a waitlist control arm. A structured clinical interview, the Composite International Diagnostic Interview (CIDI), as well as the Brief Disability Questionnaire (BDQ), Impact Event Scale (IES) and the Alcohol Use Disorders Identification Test (AUDIT) were used for baseline and follow-up assessment. Results A statistically significant intervention effect on PTSD severity was established (Cohen’s d = −0.20, 95% CI = (−0.23, −0.17), p < 0.001). Additionally, significant effects on the prevalence of several CIDI diagnoses, including anxiety and depression (OR = 0.46, 95% CI = (0.33, 0.63) and OR = 0.62, 95% CI = (0.45, 0.84), respectively) were found. Disability and alcohol abuse were also reduced (Cohen’s d = −0.30, 95% CI = (−0.38, −0.21) and d = −0.08, 95% CI = (−0.13, −0.02), respectively). The positive impact of treatment was found to be lower in the control group. Discussion The lessons learned could potentially be used future programs.