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

Abstract

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 We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress.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

An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial

“…Randomised controlled trials (RCTs) comparing 2 active psychotherapies are relatively rare in the refugee mental health and the wider general trauma field [22]. Quantitative differences in outcomes are likely to be small in such comparisons because of the elements common to both arms of the treatment, including the placebo effect, the encounter with an empathic counsellor, the general tendency for regression to the mean over time, and ceiling effects, that is, the inclusion of nonresponders in both arms [23].…”

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

“…Interestingly, post-migration living difficulties (PMLDs) are also predictive of mental health problems [8][9][10][11], yet they are seldom addressed in psychological therapies or empirical research investigations [12]. The treatment evidence base for help-seeking refugees and asylum seekers is sparse and limited mainly to trauma-specific treatments [13][14][15][16], where in their recent review, Koesters, Barbui, and Purgato surmise: "Except for trauma-related conditions, there is almost no evidence on the efficacy of psychosocial interventions in this population" [12]. Trauma-focused therapies have demonstrated efficacy in reducing symptoms of PTSD, depression, and anxiety, but critically there are a limited number of studies considering other aspects such as daily functioning or quality of life; furthermore, it is not yet clear how to best manage distress by PMLDs [11,15].…”

“…Transdiagnostic approaches may be appropriate firstline treatments for help-seeking traumatized individuals; however, there is a lack of evidence for these treatments in refugee populations [28], where factors moderating treatment effectiveness should also be identified [15]. Problem Management Plus (PM+) is a recently developed, low-intensity, transdiagnostic treatment manual for individual settings and was developed by the World Health Organization (WHO) [29,30].…”

A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: A Randomized Controlled Trial

“…Interestingly, post-migration living difficulties (PMLDs) are also predictive of mental health problems (8)(9)(10)(11), yet they are seldomly addressed in psychological therapies or empirical research investigations (12). The treatment evidence base for help-seeking refugees and asylum seekers is sparse and mainly limited to trauma-specific treatments (13)(14)(15)(16), where in their recent review, Koesters, Barbui, and Purgato surmise: "Except for trauma-related conditions, there is almost no evidence on the efficacy of psychosocial interventions in this population" (12). Trauma-focused therapies have demonstrated efficacy in reducing symptoms of PTSD, depression, and anxiety, but critically there are a limited number of studies considering other aspects such as daily functioning or quality of life; furthermore, it is not yet clear how to best manage distress by PMLDs (15,11).…”

“…where factors moderating treatment effectiveness should also be identified (15). Problem Management Plus (PM+) is a recently developed, low-intensity, transdiagnostic treatment manual for individual-settings, that was developed by the World Health Organization (WHO; 30, 31).…”