Epidemiology and Psychiatric Sciences
Volume 28, Issue 4, 2019, Pages 376-388

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: Systematic review and meta-analysis (Review) (Open Access)

Turrini G.* , Purgato M. , Acarturk C. , Anttila M. , Au T. , Ballette F. , Bird M. , Carswell K. , Churchill R. , Cuijpers P. , Hall J. , Hansen L.J. , Kösters M. , Lantta T. , Nosè M. , Ostuzzi G. , Sijbrandij M. , Tedeschi F. , Valimaki M. , Wancata J. , White R. , Van Ommeren M. , Barbui C.
  • a Cochrane Global Mental Health, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
  • b Cochrane Global Mental Health, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
  • c Department of Psychology, Istanbul Sehir University, Orhantepe Mahallesi, Turgut Özal Bulvarl, Kartal/Istanbul, Turkey
  • d University of Turku, Faculty of Medicine, Turku, Finland
  • e Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  • f Department of Dependence (SerD2), Azienda ULSS N. 8 Berica, Vicenza, Italy
  • g International Federation of Red Cross, Red Crescent Societies Reference Centre for Psychosocial Support/Danish Red Cross, Copenhagen, Denmark
  • h Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  • i Centre for Reviews and Dissemination, Cochrane Common Mental Disorders Review Group, University of York, York, United Kingdom
  • j Department of Clinical and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
  • k Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  • l International Federation of Red Cross, Red Crescent Societies Reference Centre for Psychosocial Support/Danish Red Cross, Copenhagen, Denmark
  • m Department of Psychiatry II, Ulm University, Ulm, Germany
  • n University of Turku, Faculty of Medicine, Turku, Finland
  • o Cochrane Global Mental Health, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
  • p Cochrane Global Mental Health, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
  • q Department of Clinical and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
  • r Cochrane Global Mental Health, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
  • s University of Turku, Faculty of Medicine, Turku, Finland, Hong Kong Polytechnic University, Hong Kong, Hong Kong
  • t Department of Psychiatry and Psychotherapy, Division for Social Psychiatry, Medical University of Vienna, Vienna, Austria
  • u Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
  • v Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  • w Cochrane Global Mental Health, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy

Abstract

Aims In the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers.Methods We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason.Results We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = -0.71; 95% confidence interval [CI] -1.01 to -0.41; I2 = 83%; 95% CI 78-88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = -1.02; 95% CI -1.52 to -0.51; I2 = 89%; 95% CI 82-93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = -1.05; 95% CI -1.55 to -0.56; I2 = 87%; 95% CI 79-92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life.Conclusions Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly. Copyright © Cambridge University Press 2019.

Author Keywords

Mental health Asylum seekers Refugees psychosocial interventions

Index Keywords

anxiety clinical outcome depression refugee anxiety disorder Randomized Controlled Trials as Topic randomized controlled trial (topic) follow up mental health human clinical effectiveness Refugees trend study Stress, Psychological mental stress cognitive behavioral therapy patient dropout ethnology intermethod comparison psychosocial care procedures meta analysis psychotherapy epidemiological data asylum seeker quality of life Humans psychology male female functional assessment Review placebo Outcome Assessment (Health Care) adult migration posttraumatic stress disorder distress syndrome Stress Disorders, Post-Traumatic patient attitude outcome assessment Patient Acceptance of Health Care systematic review program acceptability practice guideline evidence based medicine therapy effect Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85061389479&doi=10.1017%2fS2045796019000027&partnerID=40&md5=2376cca11709d246769ebcc90dfcec1d
DOI: 10.1017/S2045796019000027
ISSN: 20457960
Cited by: 4
Original Language: English