Mental health care for adult refugees in high-income countries

Abstract

Approximately one-third of people who have obtained refugee status live in high-income countries. Over recent years, the number of refugees has been increasing, and there are questions on how many of them need mental health care and which type of interventions are beneficial. Meta-analyses showed highly variable rates of mental disorders in adult refugees. This variability is likely to reflect both real differences between groups and contexts, and methodological inconsistencies across studies. Overall prevalence rates after resettlement are similar to those in host populations. Only post-traumatic stress disorder (PTSD) is more prevalent in refugees. In long-term resettled refugees, rates of anxiety and depressive disorders are higher and linked to poor social integration. Research on mental health care for refugees in high-income countries has been extensive, but often of limited methodological quality and with very context-specific findings. The existing evidence suggests several general principles of good practice: promoting social integration, overcoming barriers to care, facilitating engagement with treatment and, when required, providing specific psychological treatments to deal with traumatic memories. With respect to the treatment of defined disorders, only for the treatment of PTSD there has been substantial refugee-specific research. For other diagnostic categories, the same treatment guidelines apply as to other groups. More systematic research is required to explore how precisely the general principles can be specified and implemented for different groups of refugees and in different societal contexts in host countries, and which specific interventions are beneficial and cost-effective. Such interventions may utilise new communication technologies. Of particular importance are long-term studies to identify when mental health interventions are appropriate and to assess outcomes over several years. Such research would benefit from sufficient funding, wide international collaboration and continuous learning over time and across different refugee groups.

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

“…In conclusion, this review provided evidence in support of the availability of psychological interventions with a trauma focus to refugees and asylum seekers. Specific evidence-based guidelines and implementation packages should be developed accordingly (Giacco and Priebe, 2018 ). Guidelines should be applicable to different social and health care organisations, and should be implemented to ensure that all people have equitable access to high-quality mental health care.…”

Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: systematic review and meta-analysis

“…Such knowledge may help in the development of prevention strategies and scalable treatment options that specifically could help those refugees in need of care. 103 In the current study we had only limited information on such pre-and post-migration factors. We tried to cluster reasons for fleeing, for example war or violence versus natural disasters.…”

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

“…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]. On balance, low-intensity treatments in general seem to be effective in reducing mental health problems [27,28].…”