The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Abstract

Background: The United Nations reported that in 2016 over 65 million people worldwide have forcibly left home. Over 50% are children and adolescents; a substantial number has been traumatized and displaced by war. Objective: To provide an overview of the effectiveness of psychosocial interventions in this group we conducted a narrative review and a meta-analysis of intervention studies providing data on posttraumatic stress symptoms (PTSS), depression, anxiety, grief, and general distress. Method: We searched PILOTS, MEDLINE, WoS, Embase, CENTRAL, LILACS, PsycINFO, ASSIA, CSA, and SA for studies on treatment outcomes for war-traumatized displaced children and adolescents. Between-group effect sizes (ES) and pre-post ES were reconstructed for each trial. Overall pre-post ES were calculated using a random effects model. Results: The narrative review covers 23 studies with a variety of treatments. Out of the 35 calculated between-group ES, only six were significant, all compared to untreated controls. Two of them indicated significant adverse effects on symptoms of general distress or depression. When calculating pre-post effect sizes, the positive between-group results of cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) were reproduced and singular other treatments showed significant positive effects. However, the mean pre-post effects for PTSS and depression could not be interpreted due to the high heterogeneity of the included studies (PTSS: ES = 0.78; I2 = 88.6%; depression: ES = 0.35; I2 = 93.1%). Only the mean pre-post effect for seven active CBT treatment groups for depression (ES = 0.30, 95% CI [0.18, 0.43]) was interpretable (Q = 3.3, df = 6, p = .77). Conclusion: Given the large number of children and adolescents displaced by war there were regrettably few treatment studies available, and many of them were of low methodological quality. The effect sizes lagged behind the effects observed in traumatized minors in general, and often were small or non-significant. However, CBT and IPT showed promising results that need further replication.

Mental health and associated stress factors in accompanied and unaccompanied refugee minors resettled in Germany: a cross-sectional study

“…A case series examining TF-CBT for URM in Germany [51] has shown promising results for the feasibility of this evidence-based treatment for PTSD in refugee youths. Nevertheless, research regarding the effectiveness of psychosocial interventions for ASC is still scarce [52].…”

A decennial review of psychotraumatology: what did we learn and where are we going?

“…A meta-analysis on the effectiveness of psychosocial interventions for displaced war-traumatized minors (Nocon, Eberle-Sejari, Unterhitzenberger, & Rosner, 2017) identified a lack of evidence-based interventions for children and adolescents. Many interventions were tested only once, quite often in small samples and in designs with methodological shortcomings.…”

“…Analyses of common ingredients of effective treatments have identified some common mechanisms such as change in negative personal meanings of the trauma and activation and change of trauma memories, which may help with making interventions more focused and possibly increasing their efficacy and efficiency further (Brown, Belli, Asnaani, & Foa, 2019;Olff et al, in press;Schnyder et al, 2015). In addition, research into innovative approaches such as pharmacological enhancers in exposure therapy (De Kleine, Rothbaum, & van Minnen, 2013) or neurofeedback (Lanius et al, 2015) There have been increased efforts to adapt and evaluate evidence-based interventions for children and adolescents (Kramer & Landolt, 2011;Nocon et al, 2017) and patients with multiple traumatic events and complex needs such as military veterans (Kitchiner, Roberts, Wilcox, & Bisson, 2012), refugees (see also section 7) (Lely et al, 2019;Nocon et al, 2017), survivors of childhood sexual abuse (Cloitre et al, 2010;Steil et al, 2018) and patients with comorbid personality disorders (Slotema, van Den Berg, Driessen, Wilhelmus, & Franken, 2019). Metaanalyses suggest that the same types of treatment, trauma-focused treatments, obtain the greatest effect sizes in most of these populations (Ehring et al, 2014;NICE, 2018).…”

A Systematic Review of Social Service Programs Serving Refugees

“…Much of the academic research published focuses on physical health services (Ehiri et al, 2014;Hadgkiss & Renzaho, 2014) including sanitation (Cronin et al, 2008), maternal health (Almeida, Caldas, Ayres-de-Campos, Salcedo-Barrientos, & Dias, 2013), tuberculosis (Arshad, Bavan, Gajari, Paget, & Baussano, 2009;Greenaway et al, 2011), oral health (Woodland, Burgner, Paxton, & Zwi, 2010), and nutrition (Wang, Min, Harris, Khuri, & Anderson, 2016). Research on mental health services is prolific, with a number of reviews summarizing findings on mental healthfocused interventions among refugees (Anders & Christiansen, 2016;Lambert, 2015;Murray, Davidson, & Schweitzer, 2010;Nocon, Eberle-Sejari, Unterhitzenberger, Rosner, 2017;Nosè et al, 2017;Palic & Elklit, 2011;Turrini et al, 2017;van Wyk & Schweitzer, 2014;Williams & Thompson, 2011). Although attention to health and mental health is critical, there is less research examining social services generally, which may supplement or connect people to health and mental health services or may address other critical individual, family, and community needs.…”