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BackgroundYoung adults’ drinking habits often exceed low-risk drinking guidelines. As young adults show increased access, use, and interest in personalized content related to physical and mental well-being, mobile applications might be a suitable tool to reach this target group. This study investigates the effectiveness of “Boozebuster”, a self-guided mobile application incorporating various therapeutic principles to reduce young adults’ alcohol consumption to not exceeding low-risk drinking guideline levels, compared to an educational website condition.MethodYoung adults aged 18–30 wanting to reduce their alcohol consumption entered a two-arm, parallel-group RCT. There were no minimum drinking severity inclusion criteria. Primary outcomes included alcohol consumption quantity and frequency. Secondary outcomes included binge drinking frequency and alcohol-related problem severity. Baseline, 6-week postbaseline, and 3-month post-baseline assessments were analyzed using linear mixed model analyses. Sex, treatment adherence, experienced engagement and motivation to change alcohol use behavior were investigated as moderators. Sub-group analyses contained problem drinkers and binge drinkers.Results503 participants were randomized to the intervention or control condition. Results showed no intervention effects on primary or secondary outcomes compared to the control group. Both groups showed within-group reductions on all outcomes. Sub-group analyses in problem drinkers or binge drinkers showed similar results. Motivation to change drinking behavior and experienced engagement with the application significantly moderated the intervention effect regarding the quantity or frequency of alcohol consumption, respectively. Exploratory analyses showed that participants who indicated they wanted to change their drinking patterns during the initial PNF/MI module showed a significantly greater reduction in drinking quantity compared to those who indicated not wanting to change their drinking patterns.ConclusionThe intervention group did not show a greater reduction in alcohol-related outcomes compared to the control group, but both groups showed a similar decrease. Potential explanations include similar effectiveness of both condition due to using a minimal active control in participants predominantly in the action stage of motivation to change. Future research should further explore the effectiveness of using mobile application to reduce young adults’ drinking behavior to not exceed low-risk drinking guideline levels and identify factors that motivate participants to engage with such an intervention.

Additional file 1: Procedures for model identification. Fig. S1. Flowchart of sample identification. Table S1. Descriptive statistics of resilience indicators across the survey waves (N = 1052)*. Table S2. Frequency of each chronic medical condition in the whole sample. Table S3. Comparison between participants with and without chronic medical conditions at baseline*. Table S4. Descriptive statistics at the first wave of socio-demographic and clinical characteristics of participants with a chronic condition included vs excluded (because did not fill at least three waves of the survey). Table S5. Gender distribution of participants.

Background: Posttraumatic stress disorder (PTSD) is a serious mental disorder, which is associated with emotional and cognitive functioning problems. Psychological interventions, such as trauma-focused cognitive behavioural therapy (tf-CBT) and eye movement desensitization and reprocessing (EMDR) are effective in reducing PTSD symptoms. Despite evidence showing that PTSD is associated with neurocognitive deficits, there is no systematic overview available on neurocognitive outcomes following treatment for PTSD. The current systematic review examined whether psychological treatments for PTSD improve neurocognitive functioning outcomes related to memory, attention, information processing, and executive functioning. Method: A literature search in PubMed, PsycINFO, PTSDpubs, and Cochrane Library was performed up to March 7, 2022, in collaboration with a medical information specialist. Eligible PTSD treatment studies examining neurocognitive outcomes (memory, attention, information processing and executive function) in patients with a DSM-IV or ICD diagnosis of PTSD were included. Results: Of the 3023 titles and abstracts identified, 9 articles met inclusion criteria, of which 5 randomized controlled trials (RCTs) and 4 non-randomized studies. Treatments included were cognitive behavioural therapy (CBT), cognitive processing therapy (CPT), brief eclectic psychotherapy (BEP), eye movement desensitization and reprocessing (EMDR), virtual reality graded exposure therapy (VR-GET), and resilience-oriented treatment (ROT). Conclusions: This systematic review showed that psychological treatments for PTSD do not affect most neurocognitive functions, with exception of the memory outcomes. Future research, high-quality studies are needed to provide evidence of the effect of psychological treatment in improving neurocognitive functioning in PTSD. HIGHLIGHTS: This systematic review investigated the effects of psychological treatments on neurocognitive functioning in adults with PTSD. This review showed that most studies were very heterogeneous in design, method, and analysis. This review supports the evidence for psychological treatments for PTSD on improving memory outcomes.

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Pregnancy is a period in which women can experience or develop feelings of anxiety. Research shows that particularly high levels of pregnancy-related anxiety may have detrimental effects on childbirth and child development. One could assume that general anxiety, or a tendency to worry and ruminate, and pregnancy-related anxiety are (strongly) interrelated. Similarly, pregnancy-related anxiety and depression may be associated, as both may develop during pregnancy and reflect an internalizing pattern of symptoms. Yet, recent studies suggest that pregnancy-related anxiety denotes an emotional state that is more contextually based than general anxiety and is clearly linked to concerns about one’s current pregnancy and as such may reflect a distinct type of anxiety occurring in pregnancy only. This chapter starts with describing normal patterns of change in maternal psychological well-being during pregnancy, including the occurrence and pattern over time of pregnancy-related anxiety. Next, this chapter will provide an overview of studies that examined the interrelationship of pregnancy-related anxiety and general anxiety or depression, across pregnancy. Finally, it describes the predictive validity of pregnancy-related anxiety, when compared to more general measures of anxiety across pregnancy.

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Substance use disorders (SUDs) pose a major public health concern. In recent years, technological (i.e., e-health) interventions have emerged and are increasingly offered in a variety of settings, including substance use treatment. E-health interventions encompass a wide variety of advantages depending on the chosen delivery format. This chapter discusses existing interventions and the effectiveness of delivering them as an e-health intervention, with a focus on randomized controlled trials, for the treatment of alcohol, cannabis, opioid, psychostimulant, or poly-substance use, as well as in transdiagnostic interventions. Based on the literature, suggestions for future research and clinical implications are discussed.

Growing up in an urban area has been associated with an increased chance of mental health problems in adults, but less is known about this association in adolescents. We examined whether current urbanicity was associated with mental health problems directly and indirectly via biological stress system functioning. Participants (n = 323) were adolescents from the Dutch general population. Measures included home and laboratory assessments of autonomic nervous system and hypothalamic-pituitary-adrenal axis functioning, neighborhood-level urbanicity and socioeconomic status, and mother- and adolescent self-reported mental health problems. Structural equation models showed that urbanicity was not associated with mental health problems directly. Urbanicity was associated with acute autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity such that adolescents who lived in more urban areas showed blunted biological stress reactivity. Furthermore, there was some evidence for an indirect effect of urbanicity on mother-reported behavioral problems via acute autonomic nervous system reactivity. Urbanicity was not associated with overall autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity or basal hypothalamic-pituitary-adrenal axis functioning. Although we observed some evidence for associations between urbanicity, biological stress reactivity and mental health problems, most of the tested associations were not statistically significant. Measures of long-term biological stress system functioning may be more relevant to the study of broader environmental factors such as urbanicity., Funding Agencies:Netherlands Organization for Health Research and Development 3116.0002Behavioural Science Institute Fellowship (Radboud University)

Work-related stress is relatively common in modern society and is a major cause of sick-leave. Thus, effective stress reducing interventions are needed. This study examined the effects of mental training and mechanical massage, on employee's heart rate variability (HRV) and plasma cortisol at their workplaces. Moreover, it was investigated whether baseline systolic blood pressure (SBP) can explain differences in effectiveness of the intervention. Ninety-three participants from four workplaces were randomly assigned to one of the five programs: (I) Mechanical massage and mental training combined, II) Mechanical massage, III) Mental training, IV) Pause, or V) Control. HRV and plasma cortisol were measured at baseline and after 4 and 8 weeks. SBP was measured at baseline. On the reduction of cortisol levels, a small effect of the mechanical massage program was found, whereas no effect was found for the other programs. None of the programs showed any effect on HRV. Nonetheless, when the level of systolic blood pressure was taken into account, some small beneficial effects on HRV and cortisol of mental training and the mechanical massage were found. This exploratory pilot-study provides useful information for future studies that aim to reduce stress among employees. Stavning i artikeln: Jasmin Müller

Introduction and Aims. The aims of this study were to examine the roles of parental permissiveness toward alcohol use and affiliation with alcohol-using peers in alcohol use in youths from various ethnic backgrounds, and whether the role of peers was moderated by parental permissiveness. In addition, differences in these associations between native Dutch and non-Western immigrant youths were examined. Design and Methods. Cross-sectional data of 578 youths with Surinamese, Moroccan, Turkish, Antillean and Asian backgrounds and 81 native Dutch were used, all aged 15–24. Alcohol use, affiliation with alcohol-using peers and parental permissiveness were measured using self-report questionnaires. Regression models controlled for age, religiousness, education level and parental alcohol use. Because of very low levels of alcohol use, data from Turkish and Moroccan immigrants were aggregated, and logistic regression analyses were performed. Results. Parental permissiveness and affiliation with alcohol-using peers were positively related to level of alcohol use in youths with Surinamese, Antillean and Asian backgrounds and played an equally strong role in native Dutch youths with one exception. In Surinamese youths, parental permissiveness was more strongly related to alcohol use than in native Dutch youths. In youths with a Turkish/Moroccan background, parental permissiveness and affiliation with alcohol-using peers were strongly associated with any (versus no) alcohol use. Only parental permissiveness was, equally strong, associated with any alcohol use in native Dutch youths. Discussion and Conclusions. Irrespective of ethnic background and differences in level of alcohol use, parental permissiveness and affiliation with alcohol-using peers are related to youth alcohol use. [Creemers HE, Spanakis P, Delforterie MJ, Huizink AC. Alcohol use of immigrant youths in The Netherlands: The roles of parents and peers across different ethnic backgrounds.

Aims: To determine (1) the prospective associations of conduct problems during early adolescence with tobacco, alcohol and cannabis use in young adulthood and (2) to what extent these associations are due to overlapping genetic versus environmental influences. Design: A prospective twin study using biometric twin modelling. Setting: Finland. Participants: A total of 1847 Finnish twins (943 males and 904 females) were interviewed in early adolescence, 73% of whom (n = 1353, 640 males and 713 females) were retained in young adulthood. Measurements: Symptom counts of conduct disorder (CD) criteria were obtained from a semi-structured clinical interview in early adolescence [age 14-15 years, mean = 14.2, standard deviation (SD) = 0.15]. Frequency of alcohol, tobacco and cannabis use was obtained from a semi-structured clinical interview in young adulthood (age 19.9-26.6 years, mean = 22.4, SD = 0.7). Findings: We found modest to moderate phenotypical correlations (r = 0.16-0.35) between early adolescent CD symptoms and substance use in young adulthood. In males, the phenotypical correlations of CD symptoms with all three substance use variables are explained largely by overlapping genetic influences. In females, overlapping shared environmental influences predominantly explain the phenotypical correlation between CD symptoms and tobacco and cannabis use. Conclusions: Conduct disorder symptoms in early adolescence appear to moderately predict substance use in early adulthood. In males, genetic influences seem to be most important in explaining the relationship between conduct disorder symptoms and substance use whereas in females, shared environmental influences seem to be most important.

Background and Objectives: The second to fourth (2D:4D) digit ratio is a sexually dimorphic trait which has been studied to examine the association between fetal hormones and a variety of behaviors. Lower 2D:4D ratios, suggestive of exposure to higher levels of prenatal testosterone, have been associated with male-linked disorders, while higher 2D:4D ratios, suggestive of exposure to weaker prenatal androgen action, have been associated with female-linked disorders. Past research has concentrated on the 2D:4D ratio, whereas the relationship between other ratios, such as the 3D:5D ratio, and psychopathology has not much been studied before. Therefore, the aim of this study was to assess the correlation between the 2D:4D and 3D:5D ratio, and internalizing as well as externalizing symptoms, in a large non-clinical sample (143 boys, 150 girls) of white Caucasian children aged 7 to 13 years. Methods: Externalizing and internalizing symptoms were assessed with the Child Behavior Checklist (CBCL). Results: The 3D:5D ratio in boys and in girls was positively associated with scores on Externalizing Problems. Further, in girls only, the 3D:5D ratio was positively correlated to scores on Internalizing Problems. Conclusions: The 3D:5D ratio can be considered a correlate of externalizing and internalizing problems in children from the general population.

Item does not contain fulltext Aims The aim of the present study was to determine the mediating role of affiliation with cannabis-using peers in the pathways from various dimensions of temperament to life-time cannabis use, and to determine if these associations also contributed to the development of regular cannabis use. Methods Objectives were studied using data from 1300 participants of the Tracking Adolescents' Individual Lives Survey (TRAILS), a large, general population study of Dutch adolescents. We used parent-reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high-intensity pleasure, shyness, fearfulness, frustration and effortful control at age 10-12 years. By means of self-reports, life-time and regular cannabis use were determined at age 15-18 years, and proportion of substance-using peers was determined at ages 12-15 and 15-18 years. Models were adjusted for age, sex, intelligence and parental cannabis use. Results High-intensity pleasure [odds ratio (OR) = 1.09, 95% confidence interval (CI) = 1.05-1.13] and effortful control (OR = 0.92, 95% CI = 0.89-0.96) affected the risk for life-time cannabis use through their influence on affiliation with cannabis-using peers. Shyness affected this risk independently from peer cannabis use. Only the pathway from effortful control was associated additionally with the development of regular cannabis use (OR = 0.93, 95% CI = 0.89-0.98). Conclusions Peer cannabis use and, to a lesser extent, certain temperamental characteristics affect an adolescent's risk of cannabis use, and should be considered in prevention programmes. We recommend future research to focus upon factors that potentially modify the association between temperament, affiliation with cannabis-using peers and cannabis use.

Contains fulltext : 157470.pdf (Publisher’s version ) (Closed access) The current study examined mean level and change in extraversion and neuroticism across adolescence in relation to physiological stress reactivity to social evaluation. Adolescents (n = 327) from the Dutch general population reported on personality measures at five annual assessments. At age 17 years, adolescents participated in a psychosocial stress procedure characterized by social evaluation during which cortisol, heart rate, pre-ejection period (PEP) and heart rate variability were assessed. Dual latent growth curve models were fitted in which the intercepts (mean level) and slopes (change) of personality across adolescence predicted the intercepts (baseline) and slopes (reactivity) of the physiological stress measures. Most comparisons revealed no relation between personality and stress reactivity. Adolescents with higher mean level scores on extraversion did show lower cortisol reactivity. Adolescents with higher mean level neuroticism scores showed higher PEP reactivity. Our findings lend partial support for a relation between personality and physiological stress reactivity. 13 p.

AimsTo examine whether early onset of tobacco or alcohol use, and continued use of tobacco or alcohol in early adolescence, are related to a higher likelihood of developing a cannabis use disorder during adolescence. Design and settingData were used from four consecutive assessment waves of the TRacking Adolescents' Individual Lives Survey (TRAILS), a general Dutch population study. TRAILS is an ongoing longitudinal study that will follow the same group of adolescents from the ages of 10 to 24 years. ParticipantsThe sample consisted of 1108 (58% female) adolescents (mean ages at the four assessment waves are 11.09, 13.56, 16.27 and 19.05 years, respectively) MeasurementsCannabis use disorders were assessed using the Composite International Diagnostic Interview 3.0 (CIDI). Adolescent tobacco and alcohol use were assessed using self-report questionnaires. FindingsEarly-onset tobacco use [odds ratio (OR)=1.82, confidence interval (CI)=1.05-3.14, P0.05), was associated with a higher likelihood of developing a cannabis use disorder. Similarly, adolescents who reported continued use of tobacco (OR=2.47, CI=1.02-5.98, P0.05), were more likely to develop a cannabis use disorder. ConclusionsEarly-onset and continued tobacco use appear to predict the development of a cannabis use disorder in adolescence, whereas early onset and continued alcohol use do not.

AimsTo examine whether early onset of tobacco or alcohol use, and continued use of tobacco or alcohol in early adolescence, are related to a higher likelihood of developing a cannabis use disorder during adolescence. Design and settingData were used from four consecutive assessment waves of the TRacking Adolescents' Individual Lives Survey (TRAILS), a general Dutch population study. TRAILS is an ongoing longitudinal study that will follow the same group of adolescents from the ages of 10 to 24 years. ParticipantsThe sample consisted of 1108 (58% female) adolescents (mean ages at the four assessment waves are 11.09, 13.56, 16.27 and 19.05 years, respectively) MeasurementsCannabis use disorders were assessed using the Composite International Diagnostic Interview 3.0 (CIDI). Adolescent tobacco and alcohol use were assessed using self-report questionnaires. FindingsEarly-onset tobacco use [odds ratio (OR)=1.82, confidence interval (CI)=1.05-3.14, P0.05), was associated with a higher likelihood of developing a cannabis use disorder. Similarly, adolescents who reported continued use of tobacco (OR=2.47, CI=1.02-5.98, P0.05), were more likely to develop a cannabis use disorder. ConclusionsEarly-onset and continued tobacco use appear to predict the development of a cannabis use disorder in adolescence, whereas early onset and continued alcohol use do not.

AIMS: To examine the direction of the longitudinal association between vulnerability for psychosis and cannabis use throughout adolescence. DESIGN: Cross-lagged path analysis was used to identify the temporal order of vulnerability for psychosis and cannabis use, while controlling for gender, family psychopathology, alcohol use and tobacco use. SETTING: A large prospective population study of Dutch adolescents [the TRacking Adolescents' Individual Lives Survey (TRAILS) study]. PARTICIPANTS: A total of 2120 adolescents with assessments at (mean) age 13.6, age 16.3 and age 19.1. MEASUREMENTS: Vulnerability for psychosis at the three assessment points was represented by latent factors derived from scores on three scales of the Youth Self-Report and the Adult Self-Report, i.e. thought problems, social problems and attention problems. Participants self-reported on cannabis use during the past year at all three waves. FINDINGS: Significant associations (r = 0.12-0.23) were observed between psychosis vulnerability and cannabis use at all assessments. Also, cannabis use at age 16 predicted psychosis vulnerability at age 19 (Z = 2.6, P < 0.05). Furthermore, psychosis vulnerability at ages 13 (Z = 2.0, P < 0.05) and 16 (Z = 3.0, P < 0.05) predicted cannabis use at, respectively, ages 16 and 19. CONCLUSIONS: Cannabis use predicts psychosis vulnerability in adolescents and vice versa, which suggests that there is a bidirectional causal association between the two.

Several studies reported a negative association between ADHD symptoms and academic achievement. We investigated the etiology of the association between Attention Problems (AP, one of the core symptoms in ADHD) in early childhood and four academic skills across childhood in a genetically informative design.Academic skills (mathematics, spelling, reading and comprehension) were measured with standardized tests performed at school in grade 2, 4, and 6. AP were measured with mother ratings of the Devereux Child Behavior Rating Scale at age 5 and the Child Behavior Checklist at age 7. Subjects were 767 Dutch twins from 445 families.AP were negatively associated with most academic skills in each grade, and this association was stable over time. Correlations of AP with mathematics and comprehension were around -0.20, and with spelling around -0.15. Correlations with reading were not significant. A significant genetic correlation (-0.40) between AP and mathematics across time indicated that shared genes play a role for these measures. The genetic correlations of AP with spelling and comprehension (both -0.28, p= 0.09) were non-significant.More complex academic skills, requiring higher cognitive processes, like mathematics and comprehension, are especially negatively associated with attention problems. The association between AP and mathematics is partly due to shared genes, while the association with comprehension, and spelling was driven by unique environmental factors.

Backgrounds: individuals with chronic medical conditions are considered highly exposed to COVID-19 pandemic stress, but emerging evidence is demonstrating that resilience is common even among them. We aimed at identifying sustained resilient outcomes and their predictors in chronically ill people during the first year of the pandemic. Methods: this international 4-wave 1-year longitudinal online survey included items on socio-demographic characteristics, economic and living situation, lifestyle and habits, pandemic-related issues, and history of mental disorders. Adherence to and approval of imposed restrictions, trust in governments and in scientific community during the pandemic were also investigated. The following tools were administered: the Patient Health Questionnaire, the Generalized Anxiety Disorder scale, the PTSD Checklist DSM-5, the Oslo Social Support Scale, the Padua Inventory, and the Portrait Values Questionnaire. Results: one thousand fifty-two individuals reporting a chronic condition out of 8011 total participants from 13 countries were included in the study, and 965 had data available for the final model. The estimated probability of being "sustained-resilient" was 34%. Older male individuals, participants employed before and during the pandemic or with perceived social support were more likely to belong to the sustained-resilience group. Loneliness, a previous mental disorder, high hedonism, fear of COVID-19 contamination, concern for the health of loved ones, and non-approving pandemic restrictions were predictors of not-resilient outcomes in our sample. Conclusions: we found similarities and differences from established predictors of resilience and identified some new ones specific to pandemics. Further investigation is warranted and could inform the design of resilience-building interventions in people with chronic diseases., NA

Background: syrian refugees face multiple hardships and adversities which put them at risk for the development of mental health problems. However, access to adequate mental health care in host countries is limited. The WHO has developed Problem Management Plus (PM+), a brief, scalable psychological intervention, delivered by non-specialist helpers, that addresses common mental disorders in people affected by adversity. This study is part of the STRENGTHS project, that aims to evaluate peer-refugee delivered psychological interventions for Syrian refugees in Europe and the Middle East. Objective: to evaluate the effectiveness and cost-effectiveness of the peer-refugee delivered PM+ intervention among Syrian refugees with elevated levels of psychological distress in the Netherlands. Methods: PM+ will be tested in a randomized controlled trial (RCT) among Arabic-speaking Syrian refugees in the Netherlands aged 18 years and above with self-reported psychological distress (Kessler Psychological Distress Scale; K10 >15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 >16). Participants (N = 380) will be randomized into care as usual with PM+ (CAU/PM+, n = 190) or CAU only (CAU, n = 190). Baseline, 1-week post-intervention, and 3-month and 12-month follow-up assessments will be conducted. Primary outcomes are symptoms of depression and anxiety. Secondary outcomes are functional impairment, posttraumatic stress disorder symptoms, self-identified problems, anger, health and productivity costs, and hair cortisol concentrations. A process evaluation will be carried out to evaluate treatment dose, protocol fidelity and stakeholder views on barriers and facilitators to implementing PM+. Results and Conclusions: PM+ has proved effectiveness in other populations and settings. After positive evaluation, the adapted manual and training materials for individual PM+ will be made available through the WHO to encourage further replication and scaling up. Trial registration: Trial registration Dutch Trial Registry, NL7552, registered prospectively on March 1, 2019. Medical Ethics Review Committee VU Medical Center Protocol ID 2017.320, 7 September 2017. / Antecedentes: los refugiados sirios atraviesan muchas dificultades y adversidades, las cuales los ponen en riesgo para el desarrollo de problemas de salud mental. Sin embargo, el acceso a servicios de salud mental en los países que albergan a refugiados es limitado. La Organización Mundial de la Salud (OMS) ha desarrollado la intervención de Gestión de Problemas Plus (PM+, por sus siglas en inglés), una intervención psicológica breve, en etapas, realizada por facilitadores no especialistas, y que está dirigido al abordaje de los trastornos mentales más comunes en personas afectadas por la adversidad. Este estudio es parte de un proyecto más grande llamado STRENGTHS, cuyo objetivo es evaluar las intervenciones psicológicas brindadas por un refugiado a otro adaptadas para refugiados sirios en Europa y Medio Oriente. Objetivo: evaluar la efectividad y costo-efectividad de la adaptación de la intervención PM+ brindada por un refugiado a otro, en refugiados sirios con niveles elevados de malestar psicologico en los Países Bajos. Métodos: la adaptación de la intervención PM+ será evaluada en un ensayo clínico aleatorizado en refugiados sirios de habla árabe en los Países Bajos, en mayores de 18 años, con malestar psicológico auto-reportado (mediante la Escala de Kessler para Malestar Psicológico, K10>15) y deterioro en el funcionamiento diario (Registro de Evaluación de Discapacidad de la OMS; WHODAS 2.0 >16). Los participantes (N=380) serán distribuidos aleatoriamente en un grupo de tratamiento usual con PM+ (TU/PM+, n=190) y en uno de solo tratamiento usual (TU, n=190). Se tomarán evaluaciones de base, luego de la primera semana de la intervención, luego de los tres meses, y luego de los 12 meses. Estas evaluaciones serán asistidas por una aplicación de auto-entrevista con soporte de audio para tablet. Los resultados primarios son los síntomas de depresión y ansiedad. Los resultados primarios son los síntomas de depresión y ansiedad. Los resultados secundarios son el deterioro funcional, síntomas de estrés traumático, problemas auto-identificados, ira, costos en salud y productividad, y concentraciones de cortisol en el cabello. Se realizará un proceso de evaluación para valorar las opiniones de los interesados respecto a las barreras y facilitadores para implementar la intervención PM+, así como la dosis del tratamiento y la adherencia al protocolo.Discusión: la intervención PM+ ha mostrado efectividad en otras poblaciones y escenarios. Luego de obtener una evaluación positiva de la PM+ en refugiados sirios, se harán disponibles manuales y material de entrenamiento para PM+ individual a través de la OMS, de manera que se incentive la posterior replicación de la intervención y se aumente progresivamente su aplicación., European Union (European Union); H2020; Societal Challenge