title: Predicting post-traumatic stress disorder treatment response in refugees: Multilevel analysis.
abstract: OBJECTIVE
  Given the recent peak in refugee numbers and refugees' high odds of developing post-traumatic stress disorder (PTSD), finding ways to alleviate PTSD in refugees is of vital importance. However, there are major differences in PTSD treatment response between refugees, the determinants of which are largely unknown. This study aimed at improving PTSD treatment for adult refugees by identifying PTSD treatment response predictors.
  
  
  METHODS
  A prospective longitudinal multilevel modelling design was used to predict PTSD severity scores over time. We analysed data from a randomized controlled trial with pre-, post-, and follow-up measurements of the safety and efficacy of eye movement desensitization and reprocessing and stabilization in asylum seekers and refugees suffering from PTSD.
  
  
  METHODS
  Lack of refugee status, comorbid depression, demographic, trauma-related and treatment-related variables were analysed as potential predictors of PTSD treatment outcome. Treatment outcome data from 72 participants were used.
  
  
  RESULTS
  The presence (B = 6.5, p = .03) and severity (B = 6.3, p < .01) of a pre-treatment depressive disorder predicted poor treatment response and explained 39% of the variance between individuals.
  
  
  CONCLUSIONS
  Refugee patients who suffer from PTSD and severe comorbid depression benefit less from treatment aimed at alleviating PTSD. Results highlight the need for treatment adaptations for PTSD and comorbid severe depression in traumatized refugees, including testing whether initial targeting of severe depressive symptoms increases PTSD treatment effectiveness.
  
  
  CONCLUSIONS
  There are differences in post-traumatic stress disorder (PTSD) treatment response between traumatized refugees. Comorbid depressive disorder and depression severity predict poor PTSD response. Refugees with PTSD and severe depression may not benefit from PTSD treatment. Targeting comorbid severe depression before PTSD treatment is warranted. This study did not correct for multiple hypothesis testing. Comorbid depression may differentially impact alternative PTSD treatments.
authors.affiliation: Department of Clinical Psychology, Utrecht University, The Netherlands.|Arq Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: Joris F G
authors.identifier: http://orcid.org/0000-0003-3742-8636
authors.initials: JF
authors.lastname: Haagen
authors.affiliation: Foundation Centrum '45, Oegstgeest, The Netherlands.
authors.forename: F Jackie June
authors.initials: FJ
authors.lastname: Ter Heide
authors.affiliation: Department of Clinical Psychology, Utrecht University, The Netherlands.|Foundation Centrum '45, Oegstgeest, The Netherlands.
authors.forename: Trudy M
authors.initials: TM
authors.lastname: Mooren
authors.affiliation: Department of Clinical Psychology, Utrecht University, The Netherlands.|Foundation Centrum '45, Oegstgeest, The Netherlands.
authors.forename: Jeroen W
authors.initials: JW
authors.lastname: Knipscheer
authors.affiliation: Department of Clinical Psychology, Utrecht University, The Netherlands.|Arq Psychotrauma Expert Group, Diemen, The Netherlands.|Foundation Centrum '45, Oegstgeest, The Netherlands.
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Kleber
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012036:Refugees / Q000523:psychology*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology*; D016896:Treatment Outcome
keywords: depression; effectiveness; eye movement desensitization and reprocessing; stabilization; therapy