Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis

Abstract

Treatment of post-traumatic stress disorder (PTSD) in refugees and asylum seekers resettled in high-income countries presents specific challenges. This systematic review examined the effectiveness of psychosocial interventions for this group. We searched the Cochrane Central Register of randomised trials, CINAHL, EMBASE, PILOTS, PsycINFO, PubMed and Web of Science up to July 2016. Studies included randomised and controlled clinical trials comparing psychosocial interventions with waiting list or treatment as usual in adult refugees and asylum seekers with PTSD resettled in high-income countries. PTSD symptoms post-intervention was the primary outcome. We computed standardized mean differences (SMD) with 95% confidence intervals (CI). This study is registered with PROSPERO: CRD42015027843. Twelve studies were included in the meta-analysis. Psychosocial interventions were effective in decreasing PTSD symptoms relative to control groups (SMD -1·03, 95% CI -1·55 to -0·51; number needed to treat 4·4; I2 86%; 95% CI 77 to 91). Narrative exposure therapy, a manualized short-term variant of cognitive behavioural therapy with a trauma focus, was the best-supported intervention (5 RCTs, 187 participants, SMD -0·78, 95% CI -1·18 to -0·38, I2 37%; 95% CI 0 to 77). Methodological quality of the included studies was limited. Overall, psychosocial interventions for asylum seekers and refugees with PTSD resettled in high-income countries were found to provide significant benefits in reducing PTSD symptoms. Yet, the number of studies is small and their methodological quality limited, so that more rigorous trials should be conducted in the future.

Transdiagnostic culturally adapted CBT with Farsi-speaking refugees: a pilot study

“…As compared to trauma-focused treatments, such as Narrative Exposure Therapy (Neuner et al, 2010), and in line with the transdiagnostic concept of the treatment, improvement in the total score of the GHQ-28 was much larger than in the PLC-5, suggesting that the primary effect of the treatment may have been stronger on general mental health than on specific symptoms of PTSD. The reduction of the PCL-5 was lower than the controlled effects of RCTs with trauma-focused treatments in a recent meta-analysis, among them Narrative Exposure Therapy as the best-evaluated (Nosè et al, 2017). However, the large effect size and the statistical trend in our study in the PCL-5 suggest that, given an adequate sample size, the reduction in PTSD symptoms would have reached statistical significance.…”

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

“…European mental health care services generally offer psychotherapist or psychiatrist delivered, specialized mental health services that may involve a wide range of treatments, such as Cognitive Behavioural Therapy (CBT), Narrative Exposure Therapy (NET) (Stenmark, Catani, Neuner, Elbert, & Holen, 2013), Eye Movement Desensitization and Reprocessing (EMDR) (Ter Heide, Mooren, Kleijn, de Jongh, & Kleber, 2011), and individual-based multimodal interventions for PTSD (see Nickerson, Bryant, Silove, & Steel, 2011; Nose et al, 2017; Slobodin & de Jong, 2015; van Wyk & Schweitzer, 2014 for reviews) in refugees and asylum seekers. With respect to evidence for such interventions, a recent meta-analysis that examined psychological interventions for symptoms of PTSD in refugees and asylum seekers resettled in high-income countries identified 14 randomized controlled trials (RCTs) (Nose et al, 2017).…”

“…With respect to evidence for such interventions, a recent meta-analysis that examined psychological interventions for symptoms of PTSD in refugees and asylum seekers resettled in high-income countries identified 14 randomized controlled trials (RCTs) (Nose et al, 2017). It was shown that these interventions, mostly NET and CBT, were effective in reducing symptoms of PTSD and depression, with the strongest evidence base being for NET (Nose et al, 2017). …”

Family Focused Care for Refugees and Displaced Populations: Global Opportunities for Family Therapists

“…Therapists who want to help refugees in recovering from traumatic experiences can facilitate practices such as religious faith, help‐seeking, strong parenting, engaging in community support, and a strong sense of identity, all of which are known to facilitate resilience but are often ignored in the literature. Therapists can also apply mental health interventions from treatment models that have empirical support, such as cognitive behavioral therapy and narrative exposure therapy (Nosè et al., ; Slobodin & de Jong, ). Finally, mental health providers working in these settings should consider psychosocial factors such as family adversity, marginalization from the community, domestic and community violence, and unmet basic needs, which predict psychopathology over time (Tol et al., ).…”