Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis

Abstract

Background: People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders. Objective: To summarize evidence on the efficacy of psychosocial interventions aiming to promote mental health and/or to prevent mental symptoms by fostering transdiagnostic skills in forcibly displaced persons of all ages. Method: Four databases and reference lists were searched for randomized controlled trials on interventions in this population on 11 March 2022. Thirty-six studies were eligible, 32 studies (comprising 5299 participants) were included in random-effects multilevel meta-analyses examining the effects of interventions on mental symptoms and positive mental health (e.g. wellbeing) as well as moderators to account for heterogeneity. OSF Preregistration-ID: 10.17605/OSF.IO/XPMU3 Results: Our search resulted in 32 eligible studies, with 10 reporting on children/adolescents and 27 on adult populations. There was no evidence for favourable intervention effects in children/adolescents, with 44.4% of the effect sizes pointing to potentially negative effects yet remaining non-significant. For adult populations, our meta-analyses showed a close-to-significant favourable effect for mental symptoms, M (SMD) = 0.33, 95% CI [–0.03, 0.69], which was significant when analyses were limited to high-quality studies and larger for clinical compared to non-clinical populations. No effects emerged for positive mental health. Heterogeneity was considerable and could not be explained by various moderators (e.g. type of control, duration, setting, theoretical basis). Certainty of evidence was very low across all outcomes limiting the generalizability of our findings. Conclusion: The present review provides at most weak evidence for an effect favouring transdiagnostic psychosocial interventions over control conditions for adult populations but not for children and adolescents. Future research should combine the imperative of humanitarian aid in face of major crises with studying the diverse needs of forcibly displaced persons to improve and tailor future interventions.

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

“…Even though favorable effects of PM+ and SbS were found consistently across all outcome types, effect estimates were the largest for general distress at both timepoints (SMD=-0.55 to -0.44), which is in line with other transdiagnostic interventions 55 and may support the transdiagnostic nature of PM+. We found no evidence for overall differences between PM+, group PM+ and SbS; however, only three studies 39,40,45 (with 1,387 participants) delivered SbS.…”

Brief psychological interventions to improve mental health outcomes in refugee populations: A systematic review

“…Analysis of subgroups comprising studies conducted by trained psychologists and briefly trained lay persons found no significant difference in the effects of these interventions. Furthermore, psychological interventions conducted by lay persons had significant beneficial effects on PTSD symptoms, which is consistent with previous systematic reviews 21,22 . The effectiveness of these interventions may be attributed to the robustness of underlying therapeutic materials 18,19 .…”

“…This may be due to the lower rates of anxiety and depression compared to PTSD found in the refugee population 7 . Previous reviews have found similar findings in refugee populations 11,21,22,24 ; however, some only look at specific populations or single outcomes, or do not report the duration of interventional effects.…”

“…Studies were more likely to report PTSD compared to symptoms of depression and anxiety as compared to symptoms of PTSD. This may be due to the lower rates of anxiety and depression compared to PTSD found in the refugee population 7 Previous reviews have found similar findings in refugee populations11,21,22,24…”

“…There have been several recent systematic reviews looking at psychological interventions for refugees and asylum seekers. Two focus only on low-intensity, transdiagnostic interventions 21,22 ; one on psychological interventions in children 23 ; and one on psychosocial interventions for PTSD only in low- and middle-income countries 24 . To date, no systematic review has examined the effect of brief CBT-based interventions on varied outcomes of mental health symptoms.…”