The Efficacy of Brief Cognitive Behavioral Therapy (Brief CBT) in reducing suicidal ideation among economically distressed migrant workers in the Middle East: a randomized controlled trial

Abstract Background Migrant workers in the Middle East experience severe economic hardship and psychosocial stressors, putting them at great risk of mental illness, including suicidal thoughts. Evidence-based, culturally appropriate, and accessible treatments such as Brief Cognitive Behavioral Therapy (Brief CBT) are understudied for this unique, vulnerable group. The purpose of this research was to compare the effectiveness of a culturally modified Brief CBT intervention with Treatment as Usual (TAU) in decreasing suicidal thoughts in economically distressed migrant workers. Methods A parallel-group randomized controlled trial (RCT) with two arms was implemented among 120 economically distressed migrant workers (Filipino, other Asian countries, Middle Eastern, and Western) in the United Arab Emirates. Participants were randomly allocated to either an 8-session culturally adapted Brief CBT program or TAU. The primary outcome was suicidal ideation severity, as measured by the Beck Scale for Suicide Ideation (BSS) at baseline, 4 weeks (mid-treatment), 8 weeks (post-treatment), and 3-month follow-up. Secondary outcomes were depression (Patient Health Questionnaire-9; PHQ-9), anxiety and stress (Depression, Anxiety, and Stress Scale-21; DASS-21), and financial stress (InCharge Financial Distress/Financial Well-Being Scale; IFDFW). Results A linear mixed-effects model analysis revealed a significant group-by-time interaction for BSS scores ( F (3, 345) = 9.14, p < .001), indicating a substantially greater reduction in suicidal ideation for the Brief CBT group compared to the TAU group. At the 3-month follow-up, the Brief CBT group showed a large effect size for reduction in suicidal ideation (Cohen's d = 1.12). Significant improvements were also observed in the Brief CBT group for depression (PHQ-9), anxiety (DASS-21 Anxiety), stress (DASS-21 Stress), and financial stress (IFDFW) (all p < .01). No significant moderation by nationality was found. Attrition was lower in the Brief CBT group (15.0%) compared to the TAU group (28.3%). Conclusions Adapted Brief CBT is a very effective treatment for decreasing suicidal ideation and improving related psychological and financial distress in economically strained migrant workers in the Middle East. The findings provide support for the introduction of scalable, culturally adapted psychological support systems to meet the urgent mental health needs of this at-risk population.