Feasibility and acceptability of a culturally adapted digital intervention to reduce suicidal ideation for Syrian asylum seekers and refugees in the United Kingdom: A mixed methods study (Preprint)

Abstract

War in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life changing events including the loss of family members, property, and livelihood. Their experiences have given rise to high rates of anxiety, depression, and post-traumatic stress disorder. Their exposure to stressors continue in the pursuit of refuge and mental health support in the UK leading some to develop suicidal ideation. To address the treatment gap and reduce the burden of help seeking, a digital intervention to reduce suicidal ideation developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the UK. The study revealed the importance of understanding lived experience and teleological explanations in (i) their case examples of suicidal ideation, (ii) coping-strategies, and (iii) cultural adaptation of the intervention. First, participants attributed a wish for death to the post-migration phase and a suicidal ideation crisis to torture during the pre- and peri-migration phase. However, importantly they provided teleological explanations for suicide and suicide attempt to weak faith, mental illness, a loss of soul and character, and a lack of access to mental health treatment. Second, participants coped with their experiences by attributing them to a ibtilā' (a test) and hoping for God's help while reading the Quran, praying, exercising, and engaging in hobbies and volunteering. Third, rather than preferring a directive approach that involves reducing the length of the intervention, they prefered to maintain supportive exercises with teleological explanations, reminders, encouragement, and goal setting. This study will now assess the feasibility and acceptability of the culturally adapted intervention by delivering it to Syrian asylum seekers and refugees in the UK with suicidal ideation.

The first phase of the study will include recruiting participants and delivering the digital intervention: 1. To assess the feasibility of meeting recruitment goals and recruitment rates. 2. To assess the feasibility of outcome measures. The second phase of the study will include one-to-one semi-structured interventions: 1. To assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates as well as barriers and facilitators to engagement. 2. To assess the acceptability of the culturally adapted intervention in terms of its cultural relevance and appropriateness, and whether participants were satisfied with their experience.

This is a single-group, non-controlled, mixed methods feasibility and acceptability study of a culturally adapted digital intervention to reduce suicidal ideation for Syrian asylum seekers and refugees in the United Kingdom.The 6-session self-help culturally adapted intervention to reduce suicidal ideation will be delivered to participants via Qualtrics over 6 weeks. The feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures will be tracked using individual participant tracking forms which will be added to a joint database and analysed quantitatively. The suitability and acceptability of the intervention will be assed using one-to-one semi-structured post-intervention interviews with 12 participants and analysed thematically.

Recruitment will begin in February 2024 and run until 30 participants have been recruited to the study or until the end of July 2024. The study, including the write-up period, is expected to end in December 2024.

Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. Cultural adaptations of digital interventions developed for general populations could potentially increase access to treatment and reduce the burden of help seeking for this population. In a previous study, the digital intervention to reduce suicidal ideation was culturally adapted in collaboration with Syrian asylum seekers and refugees in the UK using experience-based co-design, an action research method for collaboratively improving health care services and interventions. The main adaptations to the intervention included Arabic translation, case examples of SI, coping-strategies, and teleological explanations, reminders, encouragement, and early goal setting. This study will now assess the feasibility and acceptability of the culturally adapted digital intervention as well as culturally appropriate recruitment strategies. Like the previous study, identifying and understanding the experiences associated with the intervention could facilitate a future RCT and local implementation.

(In the process of obtaining the study ID from ISRCTN)