International migrant workers in the Netherlands commonly report symptoms of anxiety and depression linked to adverse work and living conditions yet underuse formal mental healthcare. To expand access, the RESPOND trial tested a remotely delivered, culturally adapted stepped-care program that first provides low-intensity guided online self-help and then offers brief individual psychological support for those who remain distressed.
The two intervention components evaluated were the guided online programme Doing What Matters in Times of Stress (DWM) and a brief individual psychological intervention delivered by videoconference, Problem Management Plus (PM+). Both steps were delivered by non-professional helpers after cultural adaptation for Polish-speaking migrant workers.
RESPOND was a parallel-group, two-arm superiority randomised controlled trial conducted in the Netherlands. Eligible participants were Polish-speaking migrant workers aged 18 years or older with elevated psychological distress, defined as a Kessler Psychological Distress Scale (K10) score of 16 or higher. Recruitment occurred between May 2022 and January 2024 through social media and Polish community venues.
All participants received Psychological First Aid (PFA) before allocation. Randomisation was 1:1 to either usual care or the stepped-care intervention (DWM with escalation to PM+ if K10 remained ≥ 16). Randomisation used computer-generated permuted blocks in Castor Electronic Data Capture. Participants and the main researcher were not blinded after allocation; research assistants handling incidental follow-up contacts remained blinded. Outcomes were self-reported.
Step 1 comprised guided online self-help using DWM. Participants who continued to have elevated distress (K10 ≥ 16) after DWM were offered Step 2, individual PM+ via videoconferencing. Both steps were delivered by trained non-professional helpers and were culturally adapted for Polish migrant workers.
Assessments were scheduled at four timepoints: baseline (week 1), post-DWM (week 7), post-PM+ (week 13), and 2-month follow-up (week 21). The primary endpoint for the trial was the follow-up assessment at week 21. The trial followed an intention-to-treat (ITT) analytical approach.
The primary outcome was a composite measure of anxiety and depression, the Patient Health Questionnaire–Anxiety and Depression Scale (PHQ-ADS), measured at all timepoints and analysed with linear mixed models adjusted for baseline PHQ-ADS scores.
Primary analyses used linear mixed models adjusted for baseline PHQ-ADS. Effect estimates reported included adjusted mean differences between groups and corresponding 95% confidence intervals, p-values, and standardized effect sizes (Cohen’s d). The primary endpoint was PHQ-ADS at the 2-month follow-up (week 21). Secondary timepoints included post-DWM and post-PM+ assessments.
A total of 218 participants were randomised and included in the ITT analysis (109 per arm). PHQ-ADS data at the primary endpoint were available for 94 participants in the intervention group and 101 in the control group.
At the 2-month follow-up (primary endpoint), adjusted mean PHQ-ADS scores were lower in the intervention group (14.8) than in the control group (21.3). The adjusted between-group mean difference, controlling for baseline PHQ-ADS, was −6.52 (95% CI −8.73 to −4.31), p < 0.001, corresponding to a moderate standardized effect size (Cohen’s d = −0.57).
Significant adjusted between-group differences were also observed at earlier timepoints: post-DWM showed an adjusted mean difference of −5.90 (95% CI −8.12 to −3.69), p < 0.001 (d = −0.56), and post-PM+ showed −4.87 (95% CI −7.18 to −2.56), p < 0.001 (d = −0.44).
Among intervention participants who completed the post-DWM assessment, most continued to meet the criteria for PM+ escalation (85 of 95, 89.5%), indicating that a large proportion remained above the K10 threshold after the self-help step and proceeded to the individual support step.
Eight serious adverse events were reported during the trial: two occurred in the intervention arm and six in the control arm. None of these events were judged to be related to the intervention.
The authors reported several limitations. Generalisability is limited because most participants were women and had lived in the Netherlands for several years, which may not reflect the wider population of migrant workers. The follow-up period was short, restricting conclusions about longer-term durability of effects. Additional limitations such as adherence rates, subgroup effects, or implementation barriers beyond what is reported were not detailed in the source summary.
In this sample of Polish migrant workers with elevated psychological distress, a culturally adapted, remotely delivered stepped-care program combining DWM and PM+ produced statistically and clinically meaningful reductions in symptoms of anxiety and depression compared with care-as-usual. The trial supports the potential utility of scalable remote stepped-care models, delivered by non-professional helpers, to increase access to psychological support for migrant worker populations. Further research is needed to assess longer-term outcomes, broader generalisability across migrant groups and genders, and implementation at scale.