Common mental disorders in asylum seekers and refugees: umbrella review of prevalence and intervention studies

Common mental disorders in asylum seekers and refugees: umbrella review of prevalence and intervention studies
Received: 8 June 2017 – Accepted: 19 August 2017 – Published: 25 August 2017

  • Giulia TurriniEmail author,
  • Marianna Purgato,
  • Francesca Ballette,
  • Michela Nosè,
  • Giovanni Ostuzzi and
  • Corrado Barbui
Abstract

Background
In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, humanitarian and public health implications. In this population, up-to-date information on the rate and characteristics of mental health conditions, and on interventions that can be implemented once mental disorders have been identified, are needed. This umbrella review aims at systematically reviewing existing evidence on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in adult and children asylum seekers and refugees resettled in low, middle and high income countries.
Methods
We conducted an umbrella review of systematic reviews summarizing data on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in asylum seekers and/or refugees. Methodological quality of the included studies was assessed with the AMSTAR checklist.
Results
Thirteen reviews reported data on the prevalence of common mental disorders while fourteen reviews reported data on the efficacy of psychological or pharmacological interventions. Although there was substantial variability in prevalence rates, we found that depression and anxiety were at least as frequent as post-traumatic stress disorder, accounting for up to 40% of asylum seekers and refugees. In terms of psychosocial interventions, cognitive behavioral interventions, in particular narrative exposure therapy, were the most studied interventions with positive outcomes against inactive but not active comparators.
Conclusions
Current epidemiological data needs to be expanded with more rigorous studies focusing not only on post-traumatic stress disorder but also on depression, anxiety and other mental health conditions. In addition, new studies are urgently needed to assess the efficacy of psychosocial interventions when compared not only with no treatment but also each other. Despite current limitations, existing epidemiological and experimental data should be used to develop specific evidence-based guidelines, possibly by international independent organizations, such as the World Health Organization or the United Nations High Commission for Refugees. Guidelines should be applicable to different organizations of mental health care, including low and middle income countries as well as high income countries.

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Des ateliers d’Art-Thérapie pour les personnes migrantes

LE migrant. Sculpture de Bruno Catalano. Venise.
Il s’agit de proposer un accompagnement multiple à un public de migrants confrontés à l’exil, aux persécutions ethniques, à la guerre et à la torture, à la précarité, aux violences politiques et sociales. Face au trauma, aux expériences extrêmes engageant le social, l’art-thérapie peut constituer une approche originale et novatrice favorisant la mise en place de différentes formes de narrativité : verbale, plastique, dramatique. Les médiations artistiques peuvent aider à explorer différents aspects du vécu interne des acteurs par la médiation d’un filtre permettant de contourner la confrontation directe à la remémoration traumatique.
A RIVO, Miguel peut dessiner, faire de l’artisanat, jouer avec de la pâte à modeler et bénéficier d’un soutien avec son thérapeute qui l’aide à surmonter ses craintes. « Les problèmes de santé mentale peuvent être un concept abstrait pour les personnes qui ne sont pas en contact direct avec les réfugiés souffrant de problèmes psychologiques », explique Véronique Harvey, porte-parole de RIVO et elle-même thérapeute.
« Il est important d’accroître la sensibilisation aux blessures émotionnelles de manière à les rendre visibles aux yeux du grand public et des gouvernements. »

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