Addressing mental health problems among persons without stable housing in the context of the COVID-19 pandemic: study protocol for a randomised trial. RESPOND - France

BACKGROUND

The COVID-19 pandemic has had an impact on population-wide mental health and well-being. Although people experiencing socioeconomic disadvantage may be especially vulnerable, they experience barriers in accessing mental health care. To overcome these barriers, the World Health Organization (WHO) designed two scalable psychosocial interventions, namely the web-based Doing What Matters in Times of Stress (DWM) and the face-to-face Problem Management Plus (PM+), to help people manage stressful situations. Our study aims to test the effectiveness of a stepped-care program using DWM and PM + among individuals experiencing unstable housing in France - a majority of whom are migrant or have sought asylum.

METHODS

This is a randomised controlled trial to evaluate the effectiveness and cost effectiveness of a stepped-care program using DWM and PM + among persons with psychological distress and experiencing unstable housing, in comparison to enhanced care as usual (eCAU). Participants (N = 210) will be randomised to two parallel groups: eCAU or eCAU plus the stepped-care program. The main study outcomes are symptoms of depression and anxiety measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS).

DISCUSSION

This randomised controlled trial will contribute to a better understanding of effective community-based scalable strategies that can help address the mental health needs of persons experiencing socioeconomic disadvantage, whose needs are high yet who frequently have limited access to mental health care services.

TRIAL REGISTRATION

this randomised trial has been registered at ClinicalTrials.gov under the number NCT05033210.

Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial

Introduction

Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems.

Methods and analysis

We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness.

Discussion

This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health.

Clinical trial registration

ClinicalTrials.gov, identifier: NCT04993534.

Immediate transmucosal implant placement in fresh maxillary and mandibular molar extraction sockets: description of technique and preliminary results

AIM

The study was designed to evaluate the clinical treatment outcome of placing transmucosal implants into extraction. The purpose of the present clinical study was to test whether peri-implant bone defects can successfully be filled by applying both the bone and the bioresorbable materials for the guided tissue regeneration.

METHODS

Twelve patients who required extraction of a single molar were treated with immediate placement of an ITI implant (Dental Implant System). Guided bone regeneration (GBR) technique was always applied simultaneously using deproteinized bovine bone mineral. Implants and bone were covered with a resorbable collagen membrane. Clinical measurements were taken at 6 sites around each implant. Radiological and clinical parameters were measured at the time of implant placement and at follow-up after 1, 3, 6, 12 and 24 months. Prosthetic rehabilitation was performed 3 months after surgery using a porcelain fused to metal crown.

RESULTS

Soft tissue healing, at all sites, was free of complications, independently on the width of bone defect. Radiographs showed strength contact between peri-implant bone and the fixture without any defect between bone and implant. Clinical examination showed absolute implant stability complying with Albrekts-son's requirements.

CONCLUSIONS

The use of GBR with resorbable membrane to cover Bio-oss, in association with immediate implant insertion at posterior sites when there is a wide bone defect, also allows early defect filling and good stability, already in the first month, with the possibility of prosthetic loading after only 3 months.