Restricted accessReview articleFirst published online 2024-11
Effectiveness of psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in low- and middle-income countries: A systematic review and meta-analysis
Refugees and asylum seekers are more prone to posttraumatic stress disorder (PTSD) than the general population. This systematic review aims to determine which psychosocial interventions effectively treat PTSD among refugees and asylum seekers in low- and middle-income countries (LMIC). Relevant papers were retrieved from the bibliographic databases. PTSD symptoms post-intervention was the primary outcome. Ten studies were selected with 1981 participants. In meta-analyses of Randomised control trials (RCTs), psychosocial interventions for PTSD (SMD −0.60, 95% CI −0.96 to −0.23; I2 = 91%; 95% CI 75–100; nine studies, 1789 participants) were shown to be clinically effective. Also, in case of depression (SMD −0.59, 95% CI −0.95 to −0.22; I2 = 84%; 95% CI 50–90; seven studies, 1248 participants). Eye Movement Desensitization and Reprocessing (EMDR) had the greatest effect size among psychosocial therapies for this demographic. However, the number of studies is small, and their methodological rigour is limited, thus future study should concentrate on performing more rigorous trials.
AcarturkCKonukECetinkayaM, et al (2015) EMDR for Syrian refugees with posttraumatic stress disorder symptoms: Results of a pilot randomized controlled trial. European Journal of Psychotraumatology6(1): 27414.
2.
AcarturkCKonukECetinkayaM, et al (2016) The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: Results of a randomized controlled trial. Psychologie Medicale46(12): 2583–2593.
BissonJAndrewM (2007) Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews3: CD003388.
6.
BissonJIRobertsNPAndrewM, et al (2013) Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews12: CD003388.
7.
BlakeDDWeathersFWNagyLM, et al (1995) The development of a clinician-administered PTSD scale. Journal of Traumatic Stress8(1): 75–90.
8.
BogicMAjdukovicDBremnerS, et al (2012) Factors associated with mental disorders in long-settled war refugees: Refugees from the former Yugoslavia in Germany, Italy and the UK. British Journal of Psychiatry Open200(3): 216–223.
9.
BooysenDDKageeA (2020) The feasibility of prolonged exposure therapy for PTSD in low- and middle-income countries: A review. European Journal of Psychotraumatology11(1): 1753941.
10.
BrackenPJGillerJESummerfieldD (1995) Psychological responses to war and atrocity: The limitations of current concepts. Social Science & Medicine (1967)40(8): 1073–1082.
11.
BradleyRGreeneJRussE, et al (2005) A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry162(2): 214–227.
12.
BryantRABawanehAAwwadM, et al (2022) Effectiveness of a brief group behavioral intervention for common mental disorders in Syrian refugees in Jordan: A randomized controlled trial. PLoS Medicine19(3): e1003949.
13.
CusackKJonasDEFornerisCA, et al (2016) Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review43: 128–141.
14.
de GraaffAMCuijpersPAcarturkC, et al (2020) Effectiveness of a peer-refugee delivered psychological intervention to reduce psychological distress among adult Syrian refugees in the Netherlands: Study protocol. European Journal of Psychotraumatology11(1): 1694347.
15.
DuaTBarbuiCClarkN, et al (2011) Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: Summary of WHO recommendations. PLoS Medicine8(11): e1001122.
16.
EskiciHSHintonDEJalalB, et al (2023) Culturally adapted cognitive behavioral therapy for Syrian refugee women in Turkey: A randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy15: 189–198.
17.
EtzelmuellerAVisCKaryotakiE, et al (2020) Effects of Internet-based cognitive behavioral therapy in routine care for adults in treatment for depression and anxiety: Systematic review and meta-analysis. Journal of Medical Internet Research22(8): e18100.
18.
FazelM (2018) Psychological and psychosocial interventions for refugee children resettled in high-income countries. Epidemiology and Psychiatric Sciences27(2): 117–123.
19.
FazelMWheelerJDaneshJ (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet365(9467): 1309–1314.
20.
FuZBurgerHArjadiR, et al (2020) Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: A systematic review and meta-analysis. The Lancet Psychiatry7(10): 851–864.
21.
FurukawaTABarbuiCCiprianiA, et al (2006) Imputing missing standard deviations in meta-analyses can provide accurate results. Journal of Clinical Epidemiology59(1): 7–10.
22.
HamiltonM (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry23(1): 56–62.
23.
HargreavesS (2002) A body of evidence: Torture among asylum seekers to the West. The Lancet359(9308): 793–794.
24.
HigginsJThomasJChandlerJ, et al (2022) Cochrane Handbook for Systematic Reviews of Interventions. Version 6.3. Cochrane. Available at: http://www.training.cochrane.org/handbook (accessed 15 August 2022).
25.
HollifieldMWarnerTDLianN, et al (2002) Measuring trauma and health status in refugees: A critical review. JAMA288(5): 611–621.
26.
KipAPriebeSHollingH, et al (2020) Psychological interventions for posttraumatic stress disorder and depression in refugees: A meta-analysis of randomized controlled trials. Clinical Psychology & Psychotherapy27(4): 489–503.
27.
KruseJJoksimovicLCavkaM, et al (2009) Effects of trauma-focused psychotherapy upon war refugees. Journal of Traumatic Stress22(6): 585–592.
28.
LewisCRobertsNPAndrewM, et al (2020) Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology11(1): 1729633.
29.
MollicaRFCardozoBLOsofskyHJ, et al (2004) Mental health in complex emergencies. The Lancet364(9450): 2058–2067.
30.
MollicaRFCaspi-YavinYBolliniP, et al (1992) The Harvard Trauma Questionnaire. The Journal of Nervous and Mental Disease180(2): 111–116.
31.
NasehMMacgowanMJWagnerEF, et al (2019) Cultural adaptations in psychosocial interventions for post-traumatic stress disorder among refugees: A systematic review. Journal of Ethnic & Cultural Diversity in Social Work28(1): 76–97.
32.
NeunerFOnyutPLErtlV, et al (2008) Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial. Journal of Consulting and Clinical Psychology76(4): 686–694.
33.
NeunerFSchauerMKlaschikC, et al (2004) A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology72(4): 579–587.
34.
NickersonABryantRASiloveD, et al (2011) A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review31(3): 399–417.
35.
NosèMBalletteFBighelliI, et al (2017) Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis. PLoS One12(2): e0171030.
36.
PageMJMoherDBossuytPM, et al (2021) PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ372: n160.
37.
PatelVChowdharyNRahmanA, et al (2011) Improving access to psychological treatments: Lessons from developing countries. Behaviour Research and Therapy49(9): 523–528.
38.
RahmanAMalikASikanderS, et al (2008) Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. The Lancet372(9642): 902–909.
39.
RawlinsonRAslamRWBurnsideG, et al (2020) Lay-therapist-delivered, low-intensity, psychosocial intervention for refugees and asylum seekers (PROSPER): Protocol for a pilot randomised controlled trial. Trials21(1): 367.
40.
ShawSAWardKPPillaiV, et al (2019) A group mental health randomized controlled trial for female refugees in Malaysia. The American Journal of Orthopsychiatry89(6): 665–674.
41.
SuttonACampbellF (2022) The ScHARR LMIC filter: Adapting a low- and middle-income countries geographic search filter to identify studies on preterm birth prevention and management. Research Synthesis Methods13(4): 447–456.
42.
TayAKMungHKMiahMAA, et al (2020) An integrative adapt therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial. PLoS Medicine17(3): e1003073.
43.
ThompsonCTVidgenARobertsNP (2018) Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: A systematic review and meta-analysis. Clinical Psychology Review63: 66–79.
44.
TolWLekuMRLakinDP, et al (2019) Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: A cluster randomized trial. SSRN Electronic Journal. DOI: 10.2139/ssrn.3396026.
45.
TolWABarbuiCBissonJ, et al (2014) World Health Organization guidelines for management of acute stress, PTSD, and bereavement: Key challenges on the road ahead. PLoS Medicine11(12): e1001769.
46.
TolWABarbuiCvan OmmerenM (2013) Management of acute stress, PTSD, and bereavement. JAMA310(5): 477–478.
47.
TurriniGPurgatoMAcarturkC, et al (2019) Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: Systematic review and meta-analysis. Epidemiology and Psychiatric Sciences28(4): 376–388.
48.
TurriniGTedeschiFCuijpersP, et al (2021) A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD. BMJ Global Health6(6): e005029.
Van OmmerenMSaxenaSSaracenoB (2005) Mental and social health during and after acute emergencies: Emerging consensus?Bulletin of the World Health Organization83(1): 71–75.
YurtseverAKonukEAkyüzT, et al (2018) An eye movement desensitization and reprocessing (EMDR) group intervention for Syrian refugees with post-traumatic stress symptoms: Results of a randomized controlled trial. Frontiers in Psychology9: 493.
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