Building Resilience at Scale: DWM and PM+ for Public Mental Health in Vulnerable Groups

Background

Rising exposure to social, economic, and environmental stressors is placing increasing strain on population mental health, with disproportionate effects on vulnerable groups, including migrants, refugees, and healthcare workers. Addressing this burden requires scalable public mental health strategies that not only reduce symptoms but also strengthen resilience, the capacity to maintain mental health despite adversity. Doing What Matters (DWM) and Problem Management Plus (PM+), developed by the World Health Organization, are low-intensity, task-shifting interventions designed for scalability. While prior analyses show reductions in psychological distress, this study examines their function as resilience-promoting public mental health interventions.

Methods

We conducted an individual participant data meta-analysis of 5 randomised controlled trials of a stepped-care programme combining DWM and PM+, with 7-week follow-up as the primary endpoint. Participants are healthcare workers in 2 trials, and migrant or refugees in 3 trials. Resilience was operationalised as stressor reactivity, defined by modelling mental health as a function of stressor exposure across timepoints. Individual resilience was captured as the residual deviation from expected stress responses. Intervention effects were estimated using linear mixed effects models.

Results

The sample included N = 1060 participants across five trials in the Netherlands, Italy, Spain, and France. The intervention effectively reduced stressor reactivity compared to eCAU (preliminary result: Cohen’s d=-0.30, 95%CI [-0.59,-0.02]).

Conclusions

Findings indicate that DWM and PM+ enhance resilience, supporting their role as scalable public mental health interventions. These results support the scale-up of low-cost, widely implementable interventions to reduce mental health inequalities, particularly in high-risk populations such as migrants and refugees or refugees exposed to ongoing stressors.

Key messages

• DWM and PM+ strengthen resilience, reducing the mental health impact of adversity in vulnerable populations through scalable, low-intensity interventions.

• These findings support scaling up cost-effective interventions like DWM and PM+ to improve population mental health and reduce inequalities in high-risk groups.