---
title: "Remotely delivered stepped-care (DWM→PM+) reduces anxiety and depression in Polish migrant workers"
id: "plos-medicine-0-effectiveness-of-a-scalable-remotely-delivered-stepped-care-intervention-for"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-0-effectiveness-of-a-scalable-remotely-delivered-stepped-care-intervention-for"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197"
published_at: "2026-08-17T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Remotely delivered stepped-care (DWM→PM+) reduces anxiety and depression in Polish migrant workers
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-0-effectiveness-of-a-scalable-remotely-delivered-stepped-care-intervention-for
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197)
- **Published At:** 2026-08-17T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The RESPOND randomised controlled trial evaluated a culturally adapted, remotely delivered **stepped-care** intervention for Polish migrant workers in the Netherlands combining guided online self-help (Doing What Matters; **DWM**) and brief individual videoconference support (Problem Management Plus; **PM+**). - Participants were Polish-speaking migrant workers aged ≥18 with elevated distress (K10 ≥ 16) recruited May 2022–Jan 2024; all received Psychological First Aid before randomisation. - 218 participants were randomised 1:1 to care-as-usual or stepped-care (109 per arm); intention-to-treat analyses used linear mixed models adjusted for baseline **PHQ-ADS**. - Assessments occurred at baseline (week 1), post-DWM (week 7), post-PM+ (week 13), and 2-month follow-up (week 21, primary endpoint). - At follow-up, adjusted mean **PHQ-ADS** scores were 14.8 in the intervention group vs 21.3 in control; adjusted between-group mean difference −6.52 (95% CI −8.73 to −4.31), p < 0.001; Cohen’s d = −0.57 (moderate effect). - Significant adjusted between-group differences also observed post-DWM (−5.90; 95% CI −8.12 to −3.69; d = −0.56) and post-PM+ (−4.87; 95% CI −7.18 to −2.56; d = −0.44). - Most intervention participants completing post-DWM still met criteria for PM+ (85/95, 89.5%); stepped escalation was applied to those with persistent K10 ≥ 16. - Eight serious adverse events occurred (2 intervention, 6 control); none were judged related to the intervention. - Limitations reported: limited generalisability because most participants were women and long-term residents in the Netherlands, and short follow-up limiting conclusions about longer-term effects. - Authors conclude that a remotely delivered, scalable stepped-care model combining **DWM** and **PM+** can significantly reduce symptoms of anxiety and depression among migrant workers with elevated psychological distress.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1005197) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#citedHeader) * 64 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197#discussedHeader) Open Access Peer-reviewed Research Article # Effectiveness of a scalable, remotely delivered stepped-care intervention for psychological distress among Polish migrant workers in the Netherlands: The RESPOND randomised controlled trial * Rinske Roos , Roles Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Visualization, Writing – original draft, Writing – review & editing * E-mail: r.roos@vu.nl Affiliations Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0000-2245-1169 ](https://orcid.org/0009-0000-2245-1169 "ORCID Registry") ⨯ * Anke B. Witteveen, Roles Methodology, Project administration, Supervision, Validation, Writing – review & editing Affiliations Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-9636-7522 ](https://orcid.org/0000-0002-9636-7522 "ORCID Registry") ⨯ * José Luis Ayuso-Mateos, Roles Conceptualization, Funding acquisition, Methodology, Writing – review & editing Affiliations Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain ⨯ * Corrado Barbui, Roles Funding acquisition, Methodology, Writing – review & editing Affiliation WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-1073-9282 ](https://orcid.org/0000-0003-1073-9282 "ORCID Registry") ⨯ * Richard A. Bryant, Roles Conceptualization, Methodology, Writing – review & editing Affiliations School of Psychology, University of New South Wales, Sydney, New South Wales, Australia, Black Dog Institute, Sydney, New South Wales, Australia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-9607-819X ](https://orcid.org/0000-0002-9607-819X "ORCID Registry") ⨯ * Zlata Dontsova, Roles Data curation, Investigation, Writing – review & editing Affiliation Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ⨯ * Mireia Felez-Nobrega, Roles Methodology, Writing – review & editing Affiliation Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu (IRSJD), Sant Boi de Llobregat, Barcelona, Spain ⨯ * Zofia Głowacka, Roles Data curation, Investigation, Writing – review & editing Affiliation Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0005-6863-5859 ](https://orcid.org/0009-0005-6863-5859 "ORCID Registry") ⨯ * Josep Maria Haro, Roles Conceptualization, Funding acquisition, Methodology, Writing – review & editing Affiliations Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu (IRSJD), Sant Boi de Llobregat, Barcelona, Spain, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-3984-277X ](https://orcid.org/0000-0002-3984-277X "ORCID Registry") ⨯ * Raffael Kalisch, Roles Conceptualization, Funding acquisition, Methodology, Writing – review & editing Affiliations Leibniz Institute for Resilience Research, Mainz, Germany, Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany ⨯ * Vincent Lorant, Roles Funding acquisition, Methodology, Writing – review & editing Affiliation Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-2663-332X ](https://orcid.org/0000-0002-2663-332X "ORCID Registry") ⨯ * David McDaid, Roles Conceptualization, Funding acquisition, Methodology, Writing – review & editing Affiliation Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-0744-2664 ](https://orcid.org/0000-0003-0744-2664 "ORCID Registry") ⨯ * Roberto Mediavilla, Roles Methodology, Software, Writing – review & editing Affiliations Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-6411-9439 ](https://orcid.org/0000-0001-6411-9439 "ORCID Registry") ⨯ * Maria Melchior, Roles Funding acquisition, Methodology, Writing – review & editing Affiliation Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Épidémiologie Sociale, Santé Mentale et Addictions, Paris, France [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-2377-619X ](https://orcid.org/0000-0002-2377-619X "ORCID Registry") ⨯ * Pablo Nicaise, Roles Funding acquisition, Methodology, Writing – review & editing Affiliation Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-5637-5766 ](https://orcid.org/0000-0001-5637-5766 "ORCID Registry") ⨯ * Emilia Olechno, Roles Data curation, Investigation, Writing – review & editing Affiliation Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0003-8271-6343 ](https://orcid.org/0009-0003-8271-6343 "ORCID Registry") ⨯ * A-La Park, Roles Conceptualization, Funding acquisition, Methodology, Writing – review & editing Affiliation Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-4704-4874 ](https://orcid.org/0000-0002-4704-4874 "ORCID Registry") ⨯ * Papoula Petri-Romão, Roles Methodology, Writing – review & editing Affiliation Leibniz Institute for Resilience Research, Mainz, Germany [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-4675-170X ](https://orcid.org/0000-0003-4675-170X "ORCID Registry") ⨯ * Marianna Purgato, Roles Conceptualization, Funding acquisition, Methodology, Project administration, Writing – review & editing Affiliation WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-3783-8195 ](https://orcid.org/0000-0002-3783-8195 "ORCID Registry") ⨯ * Aleksandra M. Sobolewska, Roles Data curation, Investigation, Writing – review & editing Affiliation Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0005-3542-6698 ](https://orcid.org/0009-0005-3542-6698 "ORCID Registry") ⨯ * Annemieke van Straten, Roles Conceptualization, Methodology, Supervision, Writing – review & editing Affiliations Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-6875-2215 ](https://orcid.org/0000-0001-6875-2215 "ORCID Registry") ⨯ * Andrea Tortelli, Roles Writing – review & editing Affiliations Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Épidémiologie Sociale, Santé Mentale et Addictions, Paris, France, GHU Psychiatrie Neurosciences, Paris, France [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-0437-3018 ](https://orcid.org/0000-0003-0437-3018 "ORCID Registry") ⨯ * James Underhill, Roles Conceptualization, Methodology, Resources, Writing – review & editing Affiliation Independent Research Consultant, Brighton, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0009-6254-8868 ](https://orcid.org/0009-0009-6254-8868 "ORCID Registry") ⨯ * Marit Sijbrandij, Roles Conceptualization, Funding acquisition, Project administration, Resources, Supervision, Writing – review & editing Affiliations Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-5430-9810 ](https://orcid.org/0000-0001-5430-9810 "ORCID Registry") ⨯ * [ ... ], * on behalf of the RESPOND Consortium ¶Membership of the RESPOND Consortium is provided in the Acknowledgments. ⨯ * [ view all ] * [ view less ] # Effectiveness of a scalable, remotely delivered stepped-care intervention for psychological distress among Polish migrant workers in the Netherlands: The RESPOND randomised controlled trial * Rinske Roos, * Anke B. Witteveen, * José Luis Ayuso-Mateos, * Corrado Barbui, * Richard A. Bryant, * Zlata Dontsova, * Mireia Felez-Nobrega, … * Zofia Głowacka, * Josep Maria Haro, * Raffael Kalisch ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 17, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1005197) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005197) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005197) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1005197) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#abstract1) * [Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#sec004) * [Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#sec006) * [Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#sec012) * [Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#sec019) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#sec021) * [Acknowledgments](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#ack) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005197) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005197) ## Abstract ### Background Many international migrant workers (IMWs) in the Netherlands experience symptoms of anxiety and depression, often linked to adverse work and living conditions, yet underutilise mental healthcare. Stepped-care approaches may improve access by offering low-intensity support, followed by more intensive treatment if needed. We evaluated the effectiveness of a culturally adapted, remotely delivered, scalable stepped-care intervention combining guided online self-help (Doing What Matters in Times of Stress; DWM; step 1) and individual psychological support via videoconferencing (Problem Management Plus; PM+; step 2) both delivered by non-professional helpers, among Polish migrant workers living in the Netherlands. ### Methods and findings In this parallel-group, two-arm, superiority randomised controlled trial, conducted in the Netherlands, Polish-speaking migrant workers aged 18 years or older with elevated psychological distress (Kessler Psychological Distress Scale; K10 ≥ 16) were recruited between May 2022 and January 2024 via social media and Polish community spaces. All participants received Psychological First Aid (PFA) before being informed about their allocation. Participants were randomly assigned 1:1 to care-as-usual or stepped-care (DWM, followed by PM+ if distress persisted; K10 ≥ 16) using computer-generated randomisation with permuted blocks in Castor Electronic Data Capture (Castor EDC). Participants and the main researcher were not blinded after allocation; outcomes were self-reported, and research assistants handling later incidental follow-up contact remained blinded. Assessments occurred at four timepoints: baseline (week 1), post-DWM (week 7), post-PM+ (week 13), and 2-month follow-up (week 21). The primary outcome was a composite measure of anxiety and depression (Patient Health Questionnaire-Anxiety and Depression Scale; PHQ-ADS), measured at all timepoints, with the primary endpoint at follow-up. Primary analyses followed the intention-to-treat (ITT) principle using linear mixed models adjusted for baseline PHQ-ADS values. In total, 218 participants were randomised and included in the ITT analysis (109 in each group); PHQ-ADS data at the primary endpoint were available for 94 participants in the intervention group and 101 in the control group. At follow-up, adjusted mean PHQ-ADS scores were lower in the intervention group than in the control group (14.8 versus 21.3), with a between-group mean difference adjusted for baseline PHQ-ADS score of −6.52 (95% confidence interval [CI] [−8.73, −4.31]; _p_ < 0.001; Cohen’s _d_ = −0.57), reflecting a moderate effect. Significant between-group differences adjusted for baseline PHQ-ADS were also observed post-DWM (−5.90; 95% CI [−8.12, −3.69]; _p_ < 0.001; _d_ = −0.56) and post-PM+ (−4.87; 95% CI [−7.18, −2.56]; _p_ < 0.001; _d_ = −0.44). Most participants in the intervention group who completed the post-DWM assessment still met criteria for PM+ (85/95, 89.5%). Eight serious adverse events occurred (intervention: _n_ = 2; control: _n_ = 6), and none were considered related to the intervention. The main limitations were limited generalisability, as most participants were women and had lived in the Netherlands for several years, and limited conclusions about longer-term effects due to the short follow-up period. ### Conclusion The DWM/PM+ stepped-care intervention significantly reduced symptoms of anxiety and depression among Polish migrant workers in the Netherlands. These findings support the use of a remotely delivered stepped-care model combining scalable psychological interventions for migrant workers with elevated psychological distress. ## Author summary ### Why was this study done? * Many international migrant workers in the Netherlands experience symptoms of anxiety and depression but often face barriers to accessing mental healthcare. * Scalable psychological support delivered remotely may help reach people who might otherwise not receive help, but evidence for such approaches among international migrant workers is limited. * We tested whether a remotely delivered stepped-care programme, combining guided online self-help _(Doing What Matters in Times of Stress; DWM)_ with brief individual psychological support via video calls _(Problem Management Plus; PM+)_ when needed, could reduce symptoms of anxiety and depression among Polish migrant workers. ### What did the researchers do and find? * We conducted a randomised controlled trial including 218 Polish migrant workers living in the Netherlands who reported psychological distress, who were randomly assigned to receive either care-as-usual or a remotely delivered stepped-care psychological intervention (DWM/PM+). * Participants receiving the intervention showed greater reductions in symptoms of anxiety and depression over time than those receiving care-as-usual. * Many participants improved after the online self-help step (DWM), while additional individual support (PM+) helped reduce symptoms further among those who continued to experience higher levels of distress. ### What do these findings mean? * Remotely delivered stepped-care psychological support may help reduce symptoms of anxiety and depression among internation
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