Peer-delivered problem-solving program reduces stress and anxiety in resettled Bhutanese refugees

Researchers randomly assigned 116 families (232 individuals, all aged 18+) to either Problem Management Plus for Immigrants (PMP-I)—five sessions delivered by trained community members in family settings—or a control group that received a talk program and community support pamphlet. The PMP-I program included psychoeducation, problem-solving skills, behavioral activation, social support building, and mind-body exercises. All participants had PHQ-9 depression scores of 14 or lower at baseline, meaning the study enrolled people without diagnosed depression. At 6 weeks and 3 months after intervention, the PMP-I group showed significantly greater reductions in stress (Cohen Perceived Stress Scale-10), anxiety, and depressive symptoms compared to controls. Secondary outcomes also favored PMP-I: participants reported larger improvements in coping skills, self-efficacy, family conflict resolution, family satisfaction, and social networking, with large effect sizes (Cohen's d > 0.8). One notable limitation was that hair cortisol concentrations—an objective biological marker of stress—did not differ significantly between groups at 3 months, suggesting the benefits may be primarily self-reported. All 232 participants completed the study, indicating high feasibility and acceptability.

The study enrolled only adults scoring ≤14 on depression screening, so this was a prevention trial—not treatment for those with diagnosed depression or anxiety disorders. Secondary findings revealed that coping self-efficacy (confidence in one's ability to handle problems) improved markedly in the intervention group, with effect sizes exceeding 0.8—as large as benefits from some pharmacological treatments. Interestingly, while self-reported stress and mood improved substantially, objective hair cortisol (a biomarker of chronic stress) did not shift, a discrepancy that may reflect either measurement timing issues or genuine gaps between subjective well-being and underlying physiology. The program's family-centered delivery was deliberate: Bhutanese culture emphasizes collective decision-making, and involving families may have amplified social support effects beyond individual counseling. The research team adjusted for age, duration of residence, marital status, and chronic disease history, strengthening causal inference. Researchers note this is a pilot; the small sample, single refugee population, and lack of long-term follow-up (beyond 3 months) limit generalizability.