A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD

Abstract

IntroductionRefugees and asylum seekers are vulnerable to common mental disorders, including post-traumatic stress disorder (PTSD). Using a network meta-analysis (NMA) approach, the present systematic review compared and ranked psychosocial interventions for the treatment of PTSD in adult refugees and asylum seekers.MethodsRandomised studies of psychosocial interventions for adult refugees and asylum seekers with PTSD were systematically identified. PTSD symptoms at postintervention was the primary outcome. Standardised mean differences (SMDs) and ORs were pooled using pairwise and NMA. Study quality was assessed with the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was assessed through the Confidence in Network Meta-Analysis application.ResultsA total of 23 studies with 2308 participants were included. Sixteen studies were conducted in high-income countries, and seven in low-income or middle-income countries. Most studies were at low risk of bias according to the Cochrane RoB tool. NMA on PTSD symptoms showed that cognitive behavioural therapy (CBT) (SMD=−1.41; 95% CI −2.43 to −0.38) and eye movement desensitisation and reprocessing (EMDR) (SMD=−1.30; 95% CI −2.40 to −0.20) were significantly more effective than waitlist (WL). CBT was also associated with a higher decrease in PTSD symptoms than treatment as usual (TAU) (SMD −1.51; 95% CI −2.67 to −0.36). For all other interventions, the difference with WL and TAU was not significant. CBT and EMDR ranked best according to the mean surface under the cumulative ranking. Regarding acceptability, no intervention had less dropouts than inactive interventions.ConclusionCBT and EMDR appeared to have the greatest effects in reducing PTSD symptoms in asylum seekers and refugees. This evidence should be considered in guidelines and implementation packages to facilitate dissemination and uptake in refugee settings.

A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: a randomized controlled trial

“…While previous studies showed the effectiveness of psychosocial interventions targeting PTSD in refugees resettled in high-income countries (Nosè et al, 2017 ; Turrini et al, 2021 ), the present study utilized a transdiagnostic intervention. Despite PTSD being a prominent diagnosis associated with forced migration, depression and anxiety are equally common in refugees (Turrini et al, 2017 ).…”

“…Despite the need for more rigorous clinical trials, there is growing evidence that psychosocial interventions for PTSD among refugees resettled in high-income countries are effective (Nosè et al, 2017 ; Turrini et al, 2021 ). In contrast, there is a lack of research investigating the efficacy of psychosocial interventions for other mental health problems such as anxiety and depression (Koesters, Barbui, & Purgato, 2018 ).…”

Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial

“…In recent years, a growing number of randomized studies, and subsequently systematic reviews and meta-analyses, have documented the efficacy of psychological and psychosocial interventions on mental health outcomes in migrant populations, especially refugees and asylum seekers ( 19 – 21 ). However, these interventions require extensive training and considerable time to be delivered, staff with a mental health background, a monitoring and supervision infrastructure, and a face-to-face individual delivery modality in most cases.…”

Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial

“…In order to address the development of mental health problems and disorders, a number of studies assessed the effectiveness of a wide range of interventions designed to decrease psychological symptoms in refugees and asylum seekers (Nosè et al ., 2017; Turrini et al ., 2017, 2021; Thompson et al ., 2018; Coventry et al ., 2020; Jericho et al ., 2021; Morina et al ., 2021). Overall, meta-analyses of these studies showed a beneficial effect of psychosocial interventions, with three main caveats: first, effectiveness has been shown in the short-term only, while no long-term data are available; second, mainly treatment interventions were investigated whereas no studies were carried out to investigate the prevention of mental disorders; and third, the intervention delivery required extensive training and supervision, and intense implementation modalities, limiting their scale-up to only settings with high-resources.…”