Objective: Due to the wide impact of the COVID-19 pandemic on mental health, the need for scalable interventions that can effectively reduce psychological distress has been recognized. Expressive writing (EW) can be beneficial for different conditions, including depression, suicidal ideation, and coping with trauma. Therefore, we aim to assess the applicability and effectiveness of an online format of EW in the reduction of psychological distress in context of the COVID-19 pandemic. Methods: In this parallel-group, randomized controlled trial, participants (n = 120) were randomly allocated to (1) the intervention group-who completed five EW sessions over the 2 week period-or (2) the control group-who received treatment as usual (TAU). Participants were assessed for primary and secondary outcome measures at baseline, post-treatment, and follow-up-1-month after the treatment. The primary outcome was severity of psychological distress assessed at post-treatment, operationalized as Depression Anxiety Stress Scale (DASS) summary score. Secondary outcomes were severity of depression, anxiety, and stress (DASS subscale scores), well-being (WHO-5), subjective perception of quality of life (SQOL), and subjective evaluation of difficulties coping with pandemic, which were also assessed at post-treatment. Per protocol, analysis was conducted with available cases only. Results: A less favorable outcome was found in the intervention group on psychological distress, and symptoms of stress, after controlling for baseline scores. Increased stress was recorded in the treatment group, with no effect in the control group. There was no significant difference between the groups on depression, anxiety, well-being, and subjective quality of life. No group effect for any of the outcomes measures was recorded at follow-up. Additional analysis revealed moderation effects of age and gender with older and male participants scoring higher on distress measures. Conclusion: Engaging in EW during the pandemic was found to elevate stress; thus, when applied in the context of the COVID-19 pandemic, it may be harmful. Hence, EW or similar self-guided interventions should not be applied without prior evidence on their effects in the context of a pandemic and similar stressful and unpredictable circumstances. Clinical Trial Registration: This study is approved by the Institutional Ethics Committee (Protocol number #2020-20), and a trial has been registered at ISRCTN registry https://www.isrctn.com/ISRCTN17898730.

There are 26 million people recognised as refugees worldwide. Many of them spent a prolonged period of time in transit – time after they leave their country of origin and before they reach the rece... There is a high prevalence of traumatic experiences refugees face during transit and pushback, a high prevalence of mental health problems, and impaired psychological well-being in refugees.Traumat... Antecedentes: Hay 26 millones de personas reconocidas como refugiados alrededor del mundo. Muchos de ellos pasaron un período de tiempo prolongado en tránsito: el tiempo después de que salen de su ... 背景：全世界有 2600 万人被确认为难民。 他们中的许多人在过境中度过了很长一段时间——从他们离开原籍国到到达接收国之前的这段时间。 过境为难民带来了众多保护和心理健康风险。目的：本研究旨在评估难民在过境期间所面临的应激和创伤经历，特别关注驳回经历——没有评估其获得国际保护的权利便拒绝外国国民进入该领土并强行返回原籍国或邻国，以及这些经历对难民心理健康和福祉的影响。方法：目前居住在塞尔维亚...

Exposure to the traumatic experiences of others can lead to secondary traumatization (STS), a condition comprising trauma-related symptoms. There is a lack of evidence on efficient ways to mitigate STS among professionals working with refugees, who are secondarily exposed to traumatic content. This study examines the latent structure of coping mechanisms and explores the predictive power of coping strategies for STS in a sample of professionals working with refugees. A total of 288 participants (age: M = 34.01, SD = 10.03; 57.3% female) working with refugees completed the COPE Inventory and Secondary Traumatic Stress Scale. Factor analysis of the COPE Inventory showed that coping mechanisms are grouped around four interrelated factors—Problem-focused, Socially supported emotion-focused, Avoidant, and Passive coping—which accounted for 46.7% of the variance. The regression model showed that Avoidant coping positively predicts negative alterations in cognition, mood, and reactivity (NACMR) and intrusions, and Passive coping was positively associated with NACMR and avoidance. Problem-focused coping was related to lower NACMR and avoidance, while Socially supported emotion-focused coping was not associated with any of the STS symptoms. In total, coping factors accounted for 10.8%, 6.3%, and 4.3% of the variance of NACMR, intrusions, and avoidance, respectively. The study provides a foundation for programs to mitigate STS among professionals working with refugees.

The number of refugees and asylum seekers in Serbia is significantly increasing. Many have experienced traumatic events and suffer from posttraumatic stress disorder and depression. In order to provide them with adequate assistance, caregivers need adjusted assessment tools. The main goal of this research was the adaptation of the Harvard Trauma Questionnaire for working with refugees and asylum seekers in Serbia. A total of 16 focus groups were interviewed in two phases in order to create an adequate list of traumatic events for this population. The adapted list was subsequently administered to 226 persons seeking asylum in Serbia, along with the remaining parts of HTQ, HSCL-25 and BDI-II. Results show that the adapted list of traumatic events, as well as a shorter version, has good validity and other metric properties. The adaptation of the first assessment tool for working with refugees and asylum seekers in Serbia has significant practical implications.

Background: Previous studies have demonstrated that traumatic experiences from countries of origin (so-called pre-migratory factors), as well as stressors in countries of destination (so-called post-migratory factors), are related to the extent of mental health difficulties and psychological well-being of refugees. However, numerous risks that this population is exposed to during transit have so far been neglected. Objective: The aim of this research was to construct and validate a questionnaire for assessing stressful and traumatic experiences in transit as well as its short form, which would at the same time provide information on one’s stressful experiences as well as existing risks that refugees are exposed to on their journey. Method: The study was realized in three phases – item construction, item revision and instrument validation. In the validation phase, a total of 226 refugees completed the Stressful Experiences in Transit Questionnaire (SET-Q), along with Harvard Trauma Questionnaire (HTQ) Parts I and IV, Hopkins Symptom Checklist-25 (HSCL-25) and Beck Depression Inventory – II (BDI-II). Results: Refugees were exposed to an average of 13 stressful events during transit. SET-Q total score was positively correlated with HTQ Part IV Post-Traumatic Stress Disorder (PTSD) and Self-Perception of Functioning scales (SPFS) while the number of stressful experiences with the local population was positively related to BDI-II depression symptoms. Moreover, SET-Q scores were significant predictors of PTSD and SPFS even after traumatic experiences in the country of origin, assessed by HTQ Part I, were taken into account. A short form of the questionnaire (SET-SF) has also been developed. Conclusions: SET-Q is a valid instrument for measuring the scope of stressful experiences refugees have been exposed to during transit, targeted for this population specifically. Furthermore, SET-SF has the potential to assess the same extent of stressful experiences with a significantly reduced number of items. • We developed the Stressful Experiences in Transit Questionnaire (SET-Q) and its short form (SET-SF).• Refugees are exposed to multiple risks during transit.• SET-Q and SET-SF have an incremental prediction of symptomatology measures.

Most interventions for mental health and psychosocial support (MHPSS) have been developed in contexts and with populations that differ significantly from the realities of migration. There is an urgent need for MHPSS in transit; however, transit-specific aspects of MHPSS provision are often neglected due to the inherent challenges transit poses to traditional conceptualizations of practice. The Delphi method, which consisted of three iterative rounds of surveys, was applied with the goal of identifying challenges to and adaptations of MHPSS in the transit context. Twenty-six MHPSS providers working with refugees in 10 European transit countries participated; 69% of participants completed all three survey rounds. There was consensus that a flexible model of MHPSS, which can balance low intensity interventions and specialized care, is needed. Agreement was high for practice-related and sociopolitical factors impacting MHPSS in transit; however, the mandate of MHPSS providers working in the transit context achieved the lowest consensus and is yet to be defined. There is a need to rethink MHPSS in the refugee transit context. Providing MHPSS to refugees on the move has specificities, most of which are related to the instability and uncertainty of the context. Future directions for improving mental health protection for refugees, asylum seekers, and migrants in transit are highlighted.