Treating sleep disturbances in refugees and asylum seekers: results from a randomized controlled pilot trial evaluating the STARS group intervention.
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| Title: | Treating sleep disturbances in refugees and asylum seekers: results from a randomized controlled pilot trial evaluating the STARS group intervention. |
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| Alternate Title: | Tratamiento de las alteraciones del sueño en refugiados y solicitantes de asilo: Resultados de un ensayo piloto controlado aleatorizado que evalúa la intervención grupal STARS. |
| Authors: | Dumser, Britta (AUTHOR), Müller, Celina L. (AUTHOR), Ehring, Thomas (AUTHOR), Werner, Gabriela G. (AUTHOR), Koch, Theresa (AUTHOR) |
| Source: | European Journal of Psychotraumatology. Dec2025, Vol. 16 Issue 1, p1-14. 14p. |
| Subjects: | Insomnia, Refugees, Sleep interruptions, Post-traumatic stress disorder, Cultural adaptation, Psychotherapy, Randomized controlled trials, Political refugees |
| Abstract (English): | Background: Sleep disturbances are highly prevalent in traumatized refugees and often persist despite treatment, and adapted scalable interventions are needed. The group intervention 'Sleep Training adapted for Refugees' (STARS) is a culturally- and context-sensitive approach based on evidence-based treatments for sleep disturbances (e.g. CBT-I, IRT). This study evaluated the feasibility, acceptability, and effectiveness of STARS. Method: A randomized-controlled trial (STARS vs. waitlist) with 47 young male Afghan refugees was conducted in a routine clinical setting (DRKS-ID: DRKS00024419) with pre-, post- and 3-month follow-up assessments. The primary outcome was insomnia severity (Insomnia Severity Index); secondary outcomes included PTSD, anxiety and depression symptoms, nightmares, coping with nightmares, fear of sleep, selected sleep diary measures, and quality of life. The data were analysed using mixed models. Results: Adherence to STARS was high (dropout = 17.4%, average attended sessions = 77 %) as was client satisfaction (MCSQ-4 = 12.74, SDCSQ-4 = 2.08). A medium to large significant effect of time was observed for insomnia severity (d = 0.96) and most secondary measures (except nightmares and fear of sleep). However, there was no significant interaction with condition at post-treatment for the primary outcome (d = 0.29) and most secondary outcomes; the only exceptions were increased coping with nightmares, decreased daytime sleep, and time in bed. Conclusions: STARS appears feasible for treating sleep disturbances in traumatized refugees in a routine clinical setting, showing moderate to large within-group effects. However, it was not superior to the waitlist, likely due to unexpected improvements in the waitlist group. Adjustments to STARS may enhance its efficacy. Further research is needed to determine how STARS can be a scalable add-on treatment for sleep disturbances in traumatized refugees and asylum seekers. Trial registration: German Clinical Trials Register identifier: DRKS00024419.. HIGHLIGHTS: A context- and culture-sensitive group sleep intervention for traumatized refugees and asylum-seekers was feasible in a routine clinical setting. Client satisfaction and acceptance were high, indicating successful adaptation of evidence-based sleep interventions. Insomnia severity and most secondary outcomes were significantly reduced post-treatment and at follow-up, yet no superiority to waitlist was found. Further research is needed to refine STARS and explore scalable, effective treatments for sleep disturbances in this population. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | Antecedentes: Las alteraciones del sueño son altamente prevalentes en los refugiados traumatizados y a menudo persisten a pesar del tratamiento, por lo que se necesitan intervenciones adaptadas y escalables. La intervención grupal 'Entrenamiento del Sueño Adaptado para Refugiados' (STARS, por sus siglas en inglés) es un enfoque cultural y contextualmente sensible sustentado en tratamientos basados en evidencia para las alteraciones del sueño (por ejemplo, CBT-I, IRT). Este estudio evaluó la viabilidad, aceptabilidad y efectividad de STARS. Método: Se realizó un ensayo clínico controlado aleatorizado (STARS vs. lista de espera) con 47 jóvenes refugiados afganos en un entorno clínico rutinario (DRKS-ID: DRKS00024419) con evaluaciones antes, después y a los 3 meses de seguimiento. El resultado primario fue la gravedad del insomnio (Índice de Severidad del Insomnio); los resultados secundarios incluyeron síntomas de TEPT, ansiedad y depresión, pesadillas, afrontamiento de las pesadillas, miedo a dormir, medidas seleccionadas del diario de sueño y calidad de vida. Los datos fueron analizados utilizando modelos mixtos. Resultados: La adherencia a STARS fue alta (deserción = 17.4%, sesiones asistidas promedio = 77 %) al igual que la satisfacción de los clientes (MCSQ-4 = 12.74, SDCSQ-4 = 2.08). Se observó un efecto significativo de mediano a grande del tiempo para la gravedad del insomnio (d = 0.96) y la mayoría de las medidas secundarias (excepto pesadillas y miedo a dormir). Sin embargo, no hubo interacción significativa con la condición después del tratamiento para el resultado primario (d = 0.29) ni para la mayoría de los resultados secundarios; las únicas excepciones fueron un mayor afrontamiento de las pesadillas, disminución del sueño diurno y tiempo en la cama. Conclusiones: STARS parece ser viable para tratar las alteraciones del sueño en refugiados traumatizados en un entorno clínico rutinario, mostrando efectos moderados a grandes dentro del grupo. Sin embargo, no fue superior a la lista de espera, probablemente debido a mejoras inesperadas en el grupo de lista de espera. Es posible que ajustes en STARS mejoren su eficacia. Se necesita más investigación para determinar cómo STARS puede ser un tratamiento complementario escalable para las alteraciones del sueño en refugiados traumatizados y solicitantes de asilo. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Background: Sleep disturbances are highly prevalent in traumatized refugees and often persist despite treatment, and adapted scalable interventions are needed. The group intervention 'Sleep Training adapted for Refugees' (STARS) is a culturally- and context-sensitive approach based on evidence-based treatments for sleep disturbances (e.g. CBT-I, IRT). This study evaluated the feasibility, acceptability, and effectiveness of STARS. Method: A randomized-controlled trial (STARS vs. waitlist) with 47 young male Afghan refugees was conducted in a routine clinical setting (DRKS-ID: DRKS00024419) with pre-, post- and 3-month follow-up assessments. The primary outcome was insomnia severity (Insomnia Severity Index); secondary outcomes included PTSD, anxiety and depression symptoms, nightmares, coping with nightmares, fear of sleep, selected sleep diary measures, and quality of life. The data were analysed using mixed models. Results: Adherence to STARS was high (dropout = 17.4%, average attended sessions = 77 %) as was client satisfaction (MCSQ-4 = 12.74, SDCSQ-4 = 2.08). A medium to large significant effect of time was observed for insomnia severity (d = 0.96) and most secondary measures (except nightmares and fear of sleep). However, there was no significant interaction with condition at post-treatment for the primary outcome (d = 0.29) and most secondary outcomes; the only exceptions were increased coping with nightmares, decreased daytime sleep, and time in bed. Conclusions: STARS appears feasible for treating sleep disturbances in traumatized refugees in a routine clinical setting, showing moderate to large within-group effects. However, it was not superior to the waitlist, likely due to unexpected improvements in the waitlist group. Adjustments to STARS may enhance its efficacy. Further research is needed to determine how STARS can be a scalable add-on treatment for sleep disturbances in traumatized refugees and asylum seekers. Trial registration: German Clinical Trials Register identifier: DRKS00024419.. HIGHLIGHTS: A context- and culture-sensitive group sleep intervention for traumatized refugees and asylum-seekers was feasible in a routine clinical setting. Client satisfaction and acceptance were high, indicating successful adaptation of evidence-based sleep interventions. Insomnia severity and most secondary outcomes were significantly reduced post-treatment and at follow-up, yet no superiority to waitlist was found. Further research is needed to refine STARS and explore scalable, effective treatments for sleep disturbances in this population. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 20008066 |
| DOI: | 10.1080/20008066.2025.2455248 |
