{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T08:19:54Z","timestamp":1787905194292,"version":"build-2784847793"},"reference-count":34,"publisher":"Royal College of Psychiatrists","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"abstract":"<jats:sec id=\"S0007125026107557_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Millions of Ukrainians displaced since 2022 experience high rates of depression, anxiety and distress, with major barriers to in-person mental healthcare. Immersive avatar-based virtual reality environments may offer scalable psychosocial support while preserving key therapeutic elements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107557_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the efficacy of avatar-based virtual reality support groups versus in-person support groups and a waitlist control among Ukrainian refugees in Romania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107557_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>In this 3-arm randomised controlled trial, 156 participants were assigned to avatar virtual reality groups, in-person support groups or a waitlist control. Assessments were conducted at baseline, mid-intervention, post-intervention and at 3-month follow-up. Primary analyses used clustered intention-to-treat longitudinal mixed models with cluster-robust standard errors. Complementary baseline-adjusted analysis of covariance and sensitivity analyses were also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107557_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most between-group comparisons favoured the interventions but many lacked statistical significance, probably owing to attrition and clustering. In-person groups showed the strongest benefits, in particular, they were associated with greater perceived social support versus waitlist at post-intervention and reduced anxiety in end-point analyses. Avatar virtual reality effects were smaller and non-significant. Effects were largely attenuated at follow-up. Sensitivity analyses excluding participants with high levels of baseline trauma identified stronger treatment effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026107557_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In-person support groups demonstrated the strongest short-term psychosocial benefits, especially for perceived social support. Delivery of the avatar virtual reality intervention proved feasible, but the intervention did not show consistent superiority or equivalence to in-person groups. The findings support further refinement of immersive interventions with improved retention strategies and trauma-sensitive adaptations, particularly across populations with varying digital familiarity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2026.10755","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T08:03:42Z","timestamp":1787904222000},"page":"1-11","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the efficacy of support groups in the metaverse for Ukrainian refugees: randomised clinical trial"],"prefix":"10.1192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1260-6830","authenticated-orcid":false,"given":"Cezar","family":"Giosan","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02x2v6p15","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Bucharest"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalina M.","family":"Popoviciu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02x2v6p15","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Bucharest"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saltanat","family":"Zhamaliyeva","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02x2v6p15","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Bucharest"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iuliana","family":"Zaborot","sequence":"additional","affiliation":[{"name":"Dr Max Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Deac","sequence":"additional","affiliation":[{"name":"Capablanca.ai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert Skip","family":"Rizzo","sequence":"additional","affiliation":[{"name":"University of Southern California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"S0007125026107557_ref19","unstructured":"19 United Nations High Commissioner for Refugees (UNHCR). Operational Guidance, Mental Health & Psychosocial Support Programming for Refugee Operations. UNHCR, 2013 (https:\/\/www.unhcr.org\/media\/operational-guidance-mental-health-psychosocial-support-programming-refugee-operations [cited 25 May 2026])."},{"key":"S0007125026107557_ref18","first-page":"197","article-title":"Trauma-informed care and mental health","volume":"31","author":"Butler","year":"2011","journal-title":"Dir Psychiatry"},{"key":"S0007125026107557_ref4","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796016000172"},{"key":"S0007125026107557_ref23","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"S0007125026107557_ref16","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00583"},{"key":"S0007125026107557_ref27","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.658"},{"key":"S0007125026107557_ref29","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.2446"},{"key":"S0007125026107557_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2024.117442"},{"key":"S0007125026107557_ref2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003337"},{"key":"S0007125026107557_ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-024-01501-8"},{"key":"S0007125026107557_ref26","unstructured":"26 World Health Organization. Wellbeing Measures in Primary Health Care\/the DepCare Project: Report on a WHO Meeting: Stockholm, Sweden, 12\u201313 February 1998. WHO, 1998 (https:\/\/iris.who.int\/items\/07a5e1ac-9832-4088-a25d-0338088bdb05 [cited 25 May 2026])."},{"key":"S0007125026107557_ref33","volume-title":"The Presentation of Self in Everyday Life","author":"Goffman","year":"1959"},{"key":"S0007125026107557_ref7","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-081219-115923"},{"key":"S0007125026107557_ref11","doi-asserted-by":"publisher","DOI":"10.2196\/35960"},{"key":"S0007125026107557_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2022.102213"},{"key":"S0007125026107557_ref8","doi-asserted-by":"publisher","DOI":"10.1109\/TAFFC.2024.3352401"},{"key":"S0007125026107557_ref17","volume-title":"Cognitive Behavior Therapy: Basics and Beyond","author":"Beck","year":"2011"},{"key":"S0007125026107557_ref24","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"S0007125026107557_ref5","doi-asserted-by":"publisher","DOI":"10.1108\/MHSI-12-2017-0055"},{"key":"S0007125026107557_ref28","doi-asserted-by":"publisher","DOI":"10.1037\/t86974-000"},{"key":"S0007125026107557_ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"},{"key":"S0007125026107557_ref20","unstructured":"20 World Health Organization. Mental Health. WHO , n.d. (https:\/\/www.who.int\/health-topics\/mental-health [cited 25 May 2026])."},{"key":"S0007125026107557_ref31","doi-asserted-by":"crossref","unstructured":"31 Mozgai, S , Lucas, G , Gratch, J. To tell the truth: virtual agents and morning morality. In Intelligent Virtual Agents 17th International Conference, IVA 2017, Stockholm, Sweden, August 27\u201330, 2017, Proceedings (eds J Beskow, C Peters,\u00a0G Castellano,\u00a0C O\u2019Sullivan,\u00a0I Leite,\u00a0S Kopp): 283\u20136. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}