Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis

Introduction The World Health Organization’s (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees. Methods and analysis Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list. Ethics and dissemination Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals

Modulation nutritionnelle du métabolisme lipidique et de la mitochondrie (structure et fonction) : effet des lipides et des polyphénols

High fat and high sugar diets and lack of physical activity are believed to contribute to the increasing rates of obesity in wealthy societies. This trend is associated with a parallel increase in the prevalence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). Diets contains different types of lipids, and not only the quantity but also the quality of dietary lipids modulates lipid metabolism and are involved in these nutritional associated pathologies. Moreover, the quality of dietary lipids influences the biological membrane composition and thus their functions. So, membrane fluidity, cellular signalisation pathways, protein translocation into and across the membrane and many enzymatic activities, which are crucial for cell functions, are influenced by membrane lipid composition. However, some dietary nutrients as polyphenols may also modulate lipid metabolism and thus prevent against hepatic steatosis and/or IR. In that aim, this work was designed to determine, firstly, the preventive effect of polyphenols in rats fed a high fat high sucrose diet and, secondly, the impact of the quantity and the quality of dietary lipids, on triglycerides (TG) and membranes phospholipids (PL) content and/or fatty acid composition and on lipid metabolism in the whole tissue and particularly in mitochondria. Indeed, mitochondria are both a major site for fat metabolism and the main source of reactive oxygen species in hepatocytes and they are postulated to play a central role in the pathogenesis of NAFLD and IR. Our results showed clearly that polyphenols modulate differently lipid metabolism in tissues. In liver, polyphenols prevent lipid accumulation and hepatic steatosis by activating fatty acid oxidation. In skeletal muscle, polyphenols regulate membrane fatty acids composition and fatty acid and glucose transporters expression, thus preventing lipid accumulation and enhancing glucose transport. These modifications may prevent IR in skeletal muscle. In addition, dietary fatty acids quantity and quality influenced significantly fatty acids composition of membrane phospholipids from liver mitochondria, particularly cardiolipin; and thus altered mitochondria functions and liver lipid metabolism which could play a role in the NAFLD pathogenesis.Dans les pays industrialisés, une alimentation riche en lipides et en sucres et le manque d'exercice sont responsables d'une épidémie d'obésité, d'insulino-résistance (IR) et de stéatose hépatique non-alcoolique (NAFLD). L'alimentation apporte différents types de lipides, et non seulement la quantité mais également la qualité des lipides alimentaires module le métabolisme lipidique et joue un rôle important dans le développement de ces pathologies. La nature des acides gras (AG) ingérés peut également influencer la composition des membranes biologiques, et ainsi leurs fonctions comme la fluidité membranaire, la signalisation cellulaire, la translocation des protéines vers la membrane ou à travers la membrane, et des activités enzymatiques variées. Le fonctionnement de la cellule toute entière dépend donc de la composition membranaire en lipides. Par ailleurs, certains microconstituants alimentaires, tels les polyphénols, pourraient moduler le métabolisme lipidique, prévenant ainsi la NAFLD et l'IR.L'objectif de ce travail de thèse est d'explorer, en même temps, l'impact potentiellement protecteur des polyphénols lors d'une surcharge en graisses et en saccharose d'un côté et l'effet de différents profils lipidiques nutritionnels d'un autre sur la composition en acides gras et les taux des différents lipides complexes (triglycérides (TG) tissulaires et phospholipides (PL) membranaires) et sur le métabolisme lipidique en s'intéressant au tissu tout entier et à la mitochondrie en particulier ; puisque de plus en plus d'arguments expérimentaux et cliniques suggèrent qu'un déficit de la chaîne respiratoire mitochondriale joue un rôle physiopathologique important dans la NAFLD et l'IR. Ainsi, ce travail de thèse nous a permis de montrer qu'une supplémentation en polyphénols à dose nutritionnelle modulerait différemment le métabolisme lipidique au niveau des tissus, (1) en activant l'oxydation des AG et prévenant l'accumulation des TG intra-hépatiques et la stéatose au niveau du foie ; et (2) en modulant la composition membranaire en AG des cellules musculaires ainsi que l'expression de certains transporteurs prévenant ainsi l'accumulation cytosolique des lipides et améliorant le transport du glucose ce qui préviendrait une IR au niveau du muscle. De plus, nous avons pu montrer que la qualité et la quantité des AG apportés par l'alimentation affecteraient de façon significative la composition en acide gras de l'ensemble des PL membranaires de la mitochondrie du foie, particulièrement le cardiolipide; altérant ainsi la fonction de la mitochondrie et le métabolisme lipidique au niveau du foie, ce qui pourrait jouer un rôle dans le développement de la NAFLD

Modulation nutritionnelle du métabolisme lipidique et de la mitochondrie (structure et fonction) : effet des lipides et des polyphénols

High fat and high sugar diets and lack of physical activity are believed to contribute to the increasing rates of obesity in wealthy societies. This trend is associated with a parallel increase in the prevalence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). Diets contains different types of lipids, and not only the quantity but also the quality of dietary lipids modulates lipid metabolism and are involved in these nutritional associated pathologies. Moreover, the quality of dietary lipids influences the biological membrane composition and thus their functions. So, membrane fluidity, cellular signalisation pathways, protein translocation into and across the membrane and many enzymatic activities, which are crucial for cell functions, are influenced by membrane lipid composition. However, some dietary nutrients as polyphenols may also modulate lipid metabolism and thus prevent against hepatic steatosis and/or IR. In that aim, this work was designed to determine, firstly, the preventive effect of polyphenols in rats fed a high fat high sucrose diet and, secondly, the impact of the quantity and the quality of dietary lipids, on triglycerides (TG) and membranes phospholipids (PL) content and/or fatty acid composition and on lipid metabolism in the whole tissue and particularly in mitochondria. Indeed, mitochondria are both a major site for fat metabolism and the main source of reactive oxygen species in hepatocytes and they are postulated to play a central role in the pathogenesis of NAFLD and IR. Our results showed clearly that polyphenols modulate differently lipid metabolism in tissues. In liver, polyphenols prevent lipid accumulation and hepatic steatosis by activating fatty acid oxidation. In skeletal muscle, polyphenols regulate membrane fatty acids composition and fatty acid and glucose transporters expression, thus preventing lipid accumulation and enhancing glucose transport. These modifications may prevent IR in skeletal muscle. In addition, dietary fatty acids quantity and quality influenced significantly fatty acids composition of membrane phospholipids from liver mitochondria, particularly cardiolipin; and thus altered mitochondria functions and liver lipid metabolism which could play a role in the NAFLD pathogenesis.Dans les pays industrialisés, une alimentation riche en lipides et en sucres et le manque d'exercice sont responsables d'une épidémie d'obésité, d'insulino-résistance (IR) et de stéatose hépatique non-alcoolique (NAFLD). L'alimentation apporte différents types de lipides, et non seulement la quantité mais également la qualité des lipides alimentaires module le métabolisme lipidique et joue un rôle important dans le développement de ces pathologies. La nature des acides gras (AG) ingérés peut également influencer la composition des membranes biologiques, et ainsi leurs fonctions comme la fluidité membranaire, la signalisation cellulaire, la translocation des protéines vers la membrane ou à travers la membrane, et des activités enzymatiques variées. Le fonctionnement de la cellule toute entière dépend donc de la composition membranaire en lipides. Par ailleurs, certains microconstituants alimentaires, tels les polyphénols, pourraient moduler le métabolisme lipidique, prévenant ainsi la NAFLD et l'IR.L'objectif de ce travail de thèse est d'explorer, en même temps, l'impact potentiellement protecteur des polyphénols lors d'une surcharge en graisses et en saccharose d'un côté et l'effet de différents profils lipidiques nutritionnels d'un autre sur la composition en acides gras et les taux des différents lipides complexes (triglycérides (TG) tissulaires et phospholipides (PL) membranaires) et sur le métabolisme lipidique en s'intéressant au tissu tout entier et à la mitochondrie en particulier ; puisque de plus en plus d'arguments expérimentaux et cliniques suggèrent qu'un déficit de la chaîne respiratoire mitochondriale joue un rôle physiopathologique important dans la NAFLD et l'IR. Ainsi, ce travail de thèse nous a permis de montrer qu'une supplémentation en polyphénols à dose nutritionnelle modulerait différemment le métabolisme lipidique au niveau des tissus, (1) en activant l'oxydation des AG et prévenant l'accumulation des TG intra-hépatiques et la stéatose au niveau du foie ; et (2) en modulant la composition membranaire en AG des cellules musculaires ainsi que l'expression de certains transporteurs prévenant ainsi l'accumulation cytosolique des lipides et améliorant le transport du glucose ce qui préviendrait une IR au niveau du muscle. De plus, nous avons pu montrer que la qualité et la quantité des AG apportés par l'alimentation affecteraient de façon significative la composition en acide gras de l'ensemble des PL membranaires de la mitochondrie du foie, particulièrement le cardiolipide; altérant ainsi la fonction de la mitochondrie et le métabolisme lipidique au niveau du foie, ce qui pourrait jouer un rôle dans le développement de la NAFLD

Nutritional modulation of lipid metabolism and mitochondria (structure and function) : impact of dietary lipids and polyphenols

Dans les pays industrialisés, une alimentation riche en lipides et en sucres et le manque d'exercice sont responsables d'une épidémie d'obésité, d'insulino-résistance (IR) et de stéatose hépatique non-alcoolique (NAFLD). L'alimentation apporte différents types de lipides, et non seulement la quantité mais également la qualité des lipides alimentaires module le métabolisme lipidique et joue un rôle important dans le développement de ces pathologies. La nature des acides gras (AG) ingérés peut également influencer la composition des membranes biologiques, et ainsi leurs fonctions comme la fluidité membranaire, la signalisation cellulaire, la translocation des protéines vers la membrane ou à travers la membrane, et des activités enzymatiques variées. Le fonctionnement de la cellule toute entière dépend donc de la composition membranaire en lipides. Par ailleurs, certains microconstituants alimentaires, tels les polyphénols, pourraient moduler le métabolisme lipidique, prévenant ainsi la NAFLD et l'IR.L'objectif de ce travail de thèse est d'explorer, en même temps, l'impact potentiellement protecteur des polyphénols lors d'une surcharge en graisses et en saccharose d'un côté et l'effet de différents profils lipidiques nutritionnels d'un autre sur la composition en acides gras et les taux des différents lipides complexes (triglycérides (TG) tissulaires et phospholipides (PL) membranaires) et sur le métabolisme lipidique en s'intéressant au tissu tout entier et à la mitochondrie en particulier ; puisque de plus en plus d'arguments expérimentaux et cliniques suggèrent qu'un déficit de la chaîne respiratoire mitochondriale joue un rôle physiopathologique important dans la NAFLD et l'IR. Ainsi, ce travail de thèse nous a permis de montrer qu'une supplémentation en polyphénols à dose nutritionnelle modulerait différemment le métabolisme lipidique au niveau des tissus, (1) en activant l'oxydation des AG et prévenant l'accumulation des TG intra-hépatiques et la stéatose au niveau du foie ; et (2) en modulant la composition membranaire en AG des cellules musculaires ainsi que l'expression de certains transporteurs prévenant ainsi l'accumulation cytosolique des lipides et améliorant le transport du glucose ce qui préviendrait une IR au niveau du muscle. De plus, nous avons pu montrer que la qualité et la quantité des AG apportés par l'alimentation affecteraient de façon significative la composition en acide gras de l'ensemble des PL membranaires de la mitochondrie du foie, particulièrement le cardiolipide; altérant ainsi la fonction de la mitochondrie et le métabolisme lipidique au niveau du foie, ce qui pourrait jouer un rôle dans le développement de la NAFLD.High fat and high sugar diets and lack of physical activity are believed to contribute to the increasing rates of obesity in wealthy societies. This trend is associated with a parallel increase in the prevalence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). Diets contains different types of lipids, and not only the quantity but also the quality of dietary lipids modulates lipid metabolism and are involved in these nutritional associated pathologies. Moreover, the quality of dietary lipids influences the biological membrane composition and thus their functions. So, membrane fluidity, cellular signalisation pathways, protein translocation into and across the membrane and many enzymatic activities, which are crucial for cell functions, are influenced by membrane lipid composition. However, some dietary nutrients as polyphenols may also modulate lipid metabolism and thus prevent against hepatic steatosis and/or IR. In that aim, this work was designed to determine, firstly, the preventive effect of polyphenols in rats fed a high fat high sucrose diet and, secondly, the impact of the quantity and the quality of dietary lipids, on triglycerides (TG) and membranes phospholipids (PL) content and/or fatty acid composition and on lipid metabolism in the whole tissue and particularly in mitochondria. Indeed, mitochondria are both a major site for fat metabolism and the main source of reactive oxygen species in hepatocytes and they are postulated to play a central role in the pathogenesis of NAFLD and IR. Our results showed clearly that polyphenols modulate differently lipid metabolism in tissues. In liver, polyphenols prevent lipid accumulation and hepatic steatosis by activating fatty acid oxidation. In skeletal muscle, polyphenols regulate membrane fatty acids composition and fatty acid and glucose transporters expression, thus preventing lipid accumulation and enhancing glucose transport. These modifications may prevent IR in skeletal muscle. In addition, dietary fatty acids quantity and quality influenced significantly fatty acids composition of membrane phospholipids from liver mitochondria, particularly cardiolipin; and thus altered mitochondria functions and liver lipid metabolism which could play a role in the NAFLD pathogenesis

Modulation nutritionnelle du métabolisme lipidique et de la mitochondrie (structure et fonction) (effet des lipides et des polyphénols)

Dans les pays industrialisés, une alimentation riche en lipides et en sucres et le manque d'exercice sont responsables d'une épidémie d'obésité, d'insulino-résistance (IR) et de stéatose hépatique non-alcoolique (NAFLD). L'alimentation apporte différents types de lipides, et non seulement la quantité mais également la qualité des lipides alimentaires module le métabolisme lipidique et joue un rôle important dans le développement de ces pathologies. La nature des acides gras (AG) ingérés peut également influencer la composition des membranes biologiques, et ainsi leurs fonctions comme la fluidité membranaire, la signalisation cellulaire, la translocation des protéines vers la membrane ou à travers la membrane, et des activités enzymatiques variées. Le fonctionnement de la cellule toute entière dépend donc de la composition membranaire en lipides. Par ailleurs, certains microconstituants alimentaires, tels les polyphénols, pourraient moduler le métabolisme lipidique, prévenant ainsi la NAFLD et l'IR.L'objectif de ce travail de thèse est d'explorer, en même temps, l'impact potentiellement protecteur des polyphénols lors d'une surcharge en graisses et en saccharose d'un côté et l'effet de différents profils lipidiques nutritionnels d'un autre sur la composition en acides gras et les taux des différents lipides complexes (triglycérides (TG) tissulaires et phospholipides (PL) membranaires) et sur le métabolisme lipidique en s'intéressant au tissu tout entier et à la mitochondrie en particulier ; puisque de plus en plus d'arguments expérimentaux et cliniques suggèrent qu'un déficit de la chaîne respiratoire mitochondriale joue un rôle physiopathologique important dans la NAFLD et l'IR. Ainsi, ce travail de thèse nous a permis de montrer qu'une supplémentation en polyphénols à dose nutritionnelle modulerait différemment le métabolisme lipidique au niveau des tissus, (1) en activant l'oxydation des AG et prévenant l'accumulation des TG intra-hépatiques et la stéatose au niveau du foie ; et (2) en modulant la composition membranaire en AG des cellules musculaires ainsi que l'expression de certains transporteurs prévenant ainsi l'accumulation cytosolique des lipides et améliorant le transport du glucose ce qui préviendrait une IR au niveau du muscle. De plus, nous avons pu montrer que la qualité et la quantité des AG apportés par l'alimentation affecteraient de façon significative la composition en acide gras de l'ensemble des PL membranaires de la mitochondrie du foie, particulièrement le cardiolipide; altérant ainsi la fonction de la mitochondrie et le métabolisme lipidique au niveau du foie, ce qui pourrait jouer un rôle dans le développement de la NAFLD.High fat and high sugar diets and lack of physical activity are believed to contribute to the increasing rates of obesity in wealthy societies. This trend is associated with a parallel increase in the prevalence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). Diets contains different types of lipids, and not only the quantity but also the quality of dietary lipids modulates lipid metabolism and are involved in these nutritional associated pathologies. Moreover, the quality of dietary lipids influences the biological membrane composition and thus their functions. So, membrane fluidity, cellular signalisation pathways, protein translocation into and across the membrane and many enzymatic activities, which are crucial for cell functions, are influenced by membrane lipid composition. However, some dietary nutrients as polyphenols may also modulate lipid metabolism and thus prevent against hepatic steatosis and/or IR. In that aim, this work was designed to determine, firstly, the preventive effect of polyphenols in rats fed a high fat high sucrose diet and, secondly, the impact of the quantity and the quality of dietary lipids, on triglycerides (TG) and membranes phospholipids (PL) content and/or fatty acid composition and on lipid metabolism in the whole tissue and particularly in mitochondria. Indeed, mitochondria are both a major site for fat metabolism and the main source of reactive oxygen species in hepatocytes and they are postulated to play a central role in the pathogenesis of NAFLD and IR. Our results showed clearly that polyphenols modulate differently lipid metabolism in tissues. In liver, polyphenols prevent lipid accumulation and hepatic steatosis by activating fatty acid oxidation. In skeletal muscle, polyphenols regulate membrane fatty acids composition and fatty acid and glucose transporters expression, thus preventing lipid accumulation and enhancing glucose transport. These modifications may prevent IR in skeletal muscle. In addition, dietary fatty acids quantity and quality influenced significantly fatty acids composition of membrane phospholipids from liver mitochondria, particularly cardiolipin; and thus altered mitochondria functions and liver lipid metabolism which could play a role in the NAFLD pathogenesis.MONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF

The Dietary Total-Fat Content Affects the In Vivo Circulating C15:0 and C17:0 Fatty Acid Levels Independently.

Pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) have been described as dietary biomarkers of dairy-fat consumption, with varying degrees of reliability between studies. It remains unclear how the total amount of dietary fat, representing one of the main confounding factors in these biomarker investigations, affects C15:0 and C17:0 circulating concentrations independent of their relative intake. Additionally, it is not clear how changes in the dietary total-fat affects other fatty acids in circulation. Through two dietary studies with different total-fat levels but maintaining identical fatty acid compositions, we were able to see how the dietary total-fat affects the fatty acids in circulation. We saw that there was a statistically significant, proportionate, and robust decrease in the endogenous C15:0 levels with an increase in dietary total-fat. However, there was no significant change in the circulating C17:0 concentrations as the total-fat increased. To conclude, the dietary total-fat content and fat-type have a very complex influence on the relative compositions of circulating fatty acids, which are independent of the actual dietary fatty acid composition. Knowing how to manipulate circulating C15:0 and C17:0 concentrations is far-reaching in nutritional/pathological research as they highlight a dietary route to attenuate the development of metabolic disease (both by reducing risk and improving prognosis)

The Dietary Total-Fat Content Affects the <em>In Vivo</em> Circulating C15:0 and C17:0 Fatty Acid Concentrations Independently to the Dietary Fatty Acid Compositions; Highlighting Dietary Routes that may Attenuate the Development of Metabolic Disease

Pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) have been described as dietary biomarkers of dairy-fat consumption with varying degrees of reliability between studies. It remains unclear how the total amount of dietary fat; one of the main confounding factors in these biomarker investigations, affects C15:0 and C17:0 circulating compositions independently to their relative intake. Additionally, it is unknown how changes in the dietary total-fat affects other fatty acids in circulation. Through two dietary studies with different total-fat levels but maintaining individual fatty acid compositions we were able to see how the dietary total-fat affects the fatty acids in circulation. We saw that there was a significant, proportionate, and robust decrease in the endogenous C15:0 levels with an increase in dietary total-fat. However, there was an increase in the circulating C17:0 compositions as the total-fat increased. To conclude, the dietary total-fat content and fat-type have a very complex influence on the relative compositions of circulating fatty acids, which are independent to the actual dietary fatty acid composition. Knowing how to manipulate circulating C15:0 and C17:0 composition is far-reaching in nutritional/pathological research as they highlight a dietary route to attenuate the development of metabolic disease (both by reducing risk and improving prognosis)

The dietary total-fat content affects the in vivo circulating C15:0 and C17:0 fatty acid levels independently

Pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) have been described as dietary biomarkers of dairy-fat consumption, with varying degrees of reliability between studies. It remains unclear how the total amount of dietary fat, representing one of the main confounding factors in these biomarker investigations, affects C15:0 and C17:0 circulating concentrations independent of their relative intake. Additionally, it is not clear how changes in the dietary total-fat affects other fatty acids in circulation. Through two dietary studies with different total-fat levels but maintaining identical fatty acid compositions, we were able to see how the dietary total-fat affects the fatty acids in circulation. We saw that there was a statistically significant, proportionate, and robust decrease in the endogenous C15:0 levels with an increase in dietary total-fat. However, there was no significant change in the circulating C17:0 concentrations as the total-fat increased. To conclude, the dietary total-fat content and fat-type have a very complex influence on the relative compositions of circulating fatty acids, which are independent of the actual dietary fatty acid composition. Knowing how to manipulate circulating C15:0 and C17:0 concentrations is far-reaching in nutritional/pathological research as they highlight a dietary route to attenuate the development of metabolic disease (both by reducing risk and improving prognosis)

Mesure et prévision de l’ingestibilité des foins de prairies de demi-montagne chez le mouton et la génisse

National audienc

Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis

Introduction The World Health Organization’s (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees. Methods and analysis Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list. Ethics and dissemination Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals