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Community-based Sociotherapy Adapted for Refugees (COSTAR)

Treating depressive symptomatology in Congolese refugees in Uganda and Rwanda: adapting and evaluating community-based sociotherapy.

Refugee mental health and wellbeing

Refugees face a wide range of daily stressors (e.g. lack of access to basic resources, lack of safety and security, risk of family violence) that impact mental health. In addition, refugees are at increased risk of experiencing historical traumatic events as a consequence of persecution, conflict, or forced displacement. As such, refugees experience elevated rates of mental health difficulties including depression and post-traumatic stress disorder.
Guidelines exist for delivering psychosocial support in emergency situations, but contention remains about which approaches are most effective, and whether these interventions can be delivered at sufficient scale. An absence of highly-skilled professionals means that the 'task-sharing' of roles to lay people is required. Community-based approaches offer promise for treating common mental disorders, are socially acceptable, and can decrease pressure on primary healthcare.

The African continent is home to the largest number of refugees who have been displaced from their home countries. It is vitally important that we find culturally sensitive, community-based and scalable ways of supporting their mental health and wellbeing. Conflict in the Democratic Republic of Congo has led to large numbers of Congolese refugees being displaced into neighbouring Rwanda and Uganda.

The community-based sociotherapy intervention

Community-based sociotherapy (CBS) is an approach that was developed to support conflict transformation and community healing in post-Genocide Rwanda. The intervention is delivered to groups of 10-15 people who live in close proximity to each other. CBS is delivered in 15 weekly group sessions of 3 hours duration. Group members are facilitated to focus on phases of safety, trust, care, respect, new life orientations and memory. The social space of the group is governed by principles including democracy, equality and confidentiality, aiming for participants to regain their capacity to relate and connect to others so that they can experience again the vitality of humanity and feel mentally healthy

About the project

The ‘Community Based Sociotherapy Adapted for Refugees (COSTAR)’ project is being funded by the Economic and Social Research Council (ESRC) and the Arts and Humanities Research Council (AHRC) as part of the Global Challenges Research Fund (GCRF) ‘New social and cultural insights into mental, neurological and substance use disorders in developing countries’ funding call. The project aims to culturally and linguistically adapt CBS for use with Congolese refugees, and evaluate its efficacy and cost-effectiveness for addressing the elevated levels of mental health difficulties experienced by populations that have been subject to conflict and displacement. If the intervention is shown to be effective, the research team will work with the United Nations High Commissioner for Refugees (UNHCR: a partner organization in the project) to disseminate the approach into diverse humanitarian settings.

Project objectives

The study will use an interdisciplinary approach to:

  1. Adapt CBS and assessment measures for use with Congolese refugees in Rwanda and Uganda
  2. Investigate the efficacy and cost-effectiveness of adapted CBS (aCBS) for reducing depressive symptomatology in Congolese refugees, and determine whether changes in levels of social capital and daily stressors are important for influencing depressive symptomatology
  3. Develop implementation guidance for adapting and disseminating aCBS for refugees across diverse settings in conjunction with the UNHCR.

The approach

The project commenced on the 1st October 2018 and will run for 30 months. The work will be undertaken in two phases - Phase 1 will be conducted over the first 6 months of the project and will utilise qualitative research methods and fieldwork data to tailor assessment measures and the CBS intervention to the local contexts. Phase 2, the cluster randomised controlled trial methodology to evaluate the efficacy and cost-effectiveness of CBS for Congolese refugees in Nakivale refugee camp in Uganda and Gihembe refugee camp in Rwanda.

The research consortium

The research consortium conducting the research involves academic partners (University of Liverpool, Makerere University and University of Rwanda), non-governmental organizations (Community Based Sociotherapy Rwanda and Humanitarian Initiative Just Relief Aid) and the United Nations High Commissioner for Refugees.