Expanding the evidence: key priorities for research on mental health interventions for refugees in high-income countries

Sijbrandij, Marit

doi:10.1017/s2045796017000713

Cited by 32 publications

(36 citation statements)

References 19 publications

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“…Potential participants may have limited command of the language of the host country, which complicates psychosocial treatments and obtaining informed consent for participating in research. Moreover, potential participants may not fully understand the health care system, the rules governing research and the reasons for being offered both a psychosocial intervention and participation in a research trial (Sijbrandij, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis

Turrini

Purgato

Acartürk

et al. 2019

Epidemiol Psychiatr Sci

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159

151

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AimsIn 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.MethodsWe 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 We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress.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.ResultsWe 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.ConclusionsConsidering 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.

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Section: Discussionmentioning

confidence: 99%

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis

Turrini

Purgato

Acartürk

et al. 2019

Epidemiol Psychiatr Sci

Self Cite

159

151

View full text Add to dashboard Cite

show abstract

“…Moreover, 39% of non-EU migrants (or 5.7 million) live in relative poverty, compared with 17% of host-country nationals [ 6 ]. Several factors can explain this economic discrepancy including language difficulties, cultural barriers, social isolation, and mental health issues [ 7 , 8 , 9 ] such as depression and post-traumatic stress disorder (PTSD) [ 8 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Nature Activities: A Step Toward the Labor Market for Traumatized Refugees

Poulsen

Pálsdóttir

Christensen³

et al. 2020

IJERPH

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Background: Globally, the number of refugees is growing. For many refugees, entering the labor market in their new country of residence is challenging. Some remain forever dependent on welfare services, and this not only weakens their chances of integration, but also harms their health and well-being. Methods: This qualitative single case study focused on a group of war-stricken refugees in Denmark. The study investigated the impact of an eight-month horticultural vocational program aimed at improving their ability to complete an education program or to work. A total of 29 interviews were conducted and analyzed using the interpretative phenomenological analysis (IPA) method. Results: The natural environment in the eco-village evoked a feeling of safety as well as positive memories in the participants, in contrast to the traumatic memories they had of their flight. Horticultural activities and the positive and respectful attitude from staff initiated a recovery process. New skills were achieved at an individual pace, and feelings of isolation decreased. These findings can be implicated in future interventions.

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“…Additionally, refugees from non-Western countries may have a different conceptualization of mental illness and its treatment [22], where Afghan refugees have a relatively low mental health literacy [23]. Indeed, culturally adapted and evidence-based treatments within stepped or collaborative care systems are needed [24]. Barriers toward treatment acceptance might be further reduced by low-intensity treatments that do not focus on traumatic experiences, facilitating motivation for more intense trauma focused therapy, if needed [25].…”

Section: Introductionmentioning

confidence: 99%

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

Knefel

Kantor

Nicholson

et al. 2020

Trials

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Background: Asylum seekers and refugees are at great risk for developing mental disorders. Afghan refugees are a particularly vulnerable group with a low average education and mental health literacy level. Traumatic experiences and hardship before and during migration are predictive of mental health problems. However, post-migration living difficulties (PMLDs) also account for a large proportion of mental distress in such populations, which, critically, are not sufficiently considered in treatment protocols and research investigations. Indeed, the evidence base for the treatment of refugees and asylum seekers is sparse and limited mainly to trauma-specific treatments, where refugees may likely suffer from other mental health problems such as depression or anxiety. Methods/design: This trial is the first evaluation of a short-term, transdiagnostic treatment protocol for treatmentseeking Afghan refugees which addresses mental health problems and PMLDs while using an adapted version of the Problem Management Plus (PM+) protocol. Here, we will investigate the efficacy of an intervention manual with a prospective, single-center, randomized, assessor-blind, two-group trial among refugees who are on a waiting list for professional mental health treatment. Furthermore, we will investigate participants' subjective experiences with the intervention manual via in-depth interviews. One hundred twenty people will be assessed and randomly allocated to either the intervention arm or a treatment-as-usual arm. Clinical psychologists will conduct the treatment, and the sessions will take place with a Dari interpreter. The protocol consists of six 90-min sessions. The primary endpoint is the general symptom distress measure, assessed with the General Health Questionnaire 28 (GHQ-28). Secondary endpoints are the Post-Migration Living Difficulties Checklist (PMLDC), the International Trauma Questionnaire (ITQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), the Psychological Outcome Profile (PSYCHLOPS), service and health care use (assessed with several items), and the Immigrant Integration Index (IPL-12). Discussion: This trial may provide substantial evidence for a brief transdiagnostic psychological intervention. Here, we intend to contribute to the treatment of mental health problems among Afghan refugees. The assessment of subjective experience with this treatment manual, as well as the evaluation of its clinical applicability, may optimize treatment acceptance and outcomes across a wide range of mental health problems among refugees.

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Expanding the evidence: key priorities for research on mental health interventions for refugees in high-income countries

Cited by 32 publications

References 19 publications

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis

Therapeutic Nature Activities: A Step Toward the Labor Market for Traumatized Refugees

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

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