Utilization of Mobile Mental Health Services among Syrian Refugees and Other Vulnerable Arab Populations—A Systematic Review

Abstract

The global refugee crisis is at its most critical state in history; Syria alone has produced 12 million internally displaced persons, with another 5 million refugees seeking protection across the globe. Faced with the heavy burden of mental distress carried by a massive refugee influx, many host nations lack the service capacity to respond adequately. While mobile mental health (mMHealth) applications and platforms have the potential to augment screenings and interventions for vulnerable populations, an insufficient gender and cultural adaptation of technology may drastically hamper its uptake in Arab refugees. Reporting only papers originating from Middle Eastern and/or Arab nations or refugee host nations, this systematic review evaluates the available literature published between 2000 and 2019 on the usage acceptability of mMHealth in Syrian refugees and other vulnerable Arab populations. We conducted a systematic review in PubMed, PsychInfo, Association of Computing Machinery (ACM) and the Directory of Open Access Journals (DOAJ) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies that addressed mMHealth implementation in these populations; of a total of 607 articles identified, only 10 (1.6%) available, unique articles met our search criteria. These studies discussed the feasibility and efficacy of mMHealth applications and the barriers to their uptake. The few existing studies show positive impacts of mMHealth on the access to services and on treatment outcomes but also reveal a paucity of literature on mMHealth for vulnerable Arab populations. These findings indicate a critical need for research on the barriers to mMHealth uptake, to bolster service capacity in the Arab Region and in the refugee diaspora of other, non-Arab host countries.

Telemental Health Use and Refugee Mental Health Providers Following COVID-19 Pandemic

“…Despite a substantial body of knowledge related to telemental health (Standing et al, 2018 ), there is scant evidence about telemental healthcare practices specifically with resettled refugee clients (Ashfaq et al, 2020 ). Resettled refugees have high rates of Post Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) (Lamkaddem et al, 2014 ).…”

“…Research on telemental health with refugee clients, displaced or resettled, is limited, despite a recognition in the literature that telemental health has the potential to address some mental healthcare disparities (Almoshmosh et al, 2020 ; Ashfaq et al, 2020 ; Soron et al, 2019 ). In fact, in a systematic review of telemental health with Arab refugees over a twenty-year period, only seven articles were identified (Ashfaq et al, 2020 ).…”

“…Research on telemental health with refugee clients, displaced or resettled, is limited, despite a recognition in the literature that telemental health has the potential to address some mental healthcare disparities (Almoshmosh et al, 2020 ; Ashfaq et al, 2020 ; Soron et al, 2019 ). In fact, in a systematic review of telemental health with Arab refugees over a twenty-year period, only seven articles were identified (Ashfaq et al, 2020 ). Within the handful of available studies is Jefee-Bahloul et al’s study ( 2014 ) on the acceptance of telepsychiatry in Syrian refugee camps, which found that although approximately 40% of Syrian refugees screened positive for PTSD, only 15% were open to telepsychiatry (Jefee-Bahloul et al, 2014 ).…”

<p>Telepsychiatry in the Arab World: A Viewpoint Before and During COVID-19</p>

“…It also revealed a paucity of literature about the topic in the Arab region. 78 Our results also pinpoint many limits for telepsychiatry that seem multifactorial in nature. Jefee-Bahloul discusses four similar barriers to implement telemental health in the Middle East: cultural (both patient-and healthcarerelated), and technical, financial, and regulatory (systemrelated).…”

Children’s prolonged exposure to the toxic stress of war trauma in the Middle East

“…Digital interventions and staff training can be delivered in conflict affected areas using smartphones 757677. These have been shown to be efficient in assessing, screening, evaluating, and intervening among children, adults, and practitioners in Middle Eastern countries, where smartphone use is common 78. Digital tools are relatively low cost and can be easily integrated to both response levels (box 6).…”