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The Capital Region of Denmark - a part of Copenhagen University Hospital

Predictors of psychotherapy outcome in trauma-affected refugees: secondary analysis of a randomized controlled trial

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Background
Studies on psychotherapy for trauma-affected refugees have shown therapy outcome to be quite varied among patients, with some patients benefitting more from therapy than others. In pragmatic RCTs at the Competence Centre for Transcultural Psychiatry (CTP), where representative clinical populations of trauma-affected refugees are studied, psychotherapy tends to show only small effects. However, little is known about specific patient factors that predict psychotherapy outcome in this population. Increased awareness of such factors can help clinicians identify patients who are not likely to benefit from standardized treatment, and help them take additional measures to tailor treatment to the individual patient. The objective of this study is to examine whether motivation for therapy, locus of control, cognitive functioning, and levels of personality functioning assessed prior to psychotherapy can predict psychotherapy outcomes of PTSD, depression, anxiety, and disability in trauma-affected refugees.

Aim
The aim of the study is to identify patient factors that predict psychotherapy outcome in trauma-affected refugees.

Methods
The study is a secondary analysis of a pragmatic randomized controlled trial at CTP: “Treatment of sleep disturbances in trauma-affected refugees: a randomised controlled trial” .

Number of participants (N): 219 participants

Population
Trauma-affected refugees with a diagnosis of posttraumatic stress disorder, who were referred for treatment at CTP, and agreed to participate in the RCT.

Description of data and data collection
To identify predictors of psychotherapy outcome we will examine four patient factors assessed by the psychologists at onset of psychotherapy. These factors are:
•Cognitive functioning measured on the WHO Disability Assessment Schedule (WHODAS 2.0).
•Locus of control measured on the Locus of Control (LoC) scale adjusted to the patient population.
•Motivation for therapy measured on the Client Motivation for Therapy Scale (CMTS) adjusted to the patient population.
•Personality-related functioning measured on the Levels of Personality Functioning Scale (LPFS).
The primary outcome in the study are PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures are the Hamilton anxiety and depression scales (HAM-D and HAM-A), and the Sheehan Disability Scale (SDS).

Analysis
Structural equation modelling will be used to investigate the association between the predictors and psychotherapy outcome. The model will adjust for sociodemographic information, treatment condition, and the use of interpreter-mediated therapy. Data will be analyzed under the intention to treat paradigm using ML to estimate missing values. Further exploratory analyses of missing value patterns on the predictors will be conducted.

Expected results
The study is expected to add new knowledge on patient factors that predict psychotherapy outcome in trauma-affected refugees. Identifying those who will benefit from psychotherapy and those who will not can help clinicians tailor treatment to their patients’ needs and make treatment more effective.

StatusCurrent
Period01/02/202030/06/2020

ID: 59565719