Treatments for traumatised refugees: more complex interventions needed

Treatments for traumatised refugees: more complex interventions needed
2 août 2017
Posted by Mina Fazel
This systematic review into psychosocial interventions for adult refugees (Tribe et al, 2017) is covering an increasingly important area.
The numbers forced to leave their homes as a result of organised violence are higher now than any time since the second world war (UNHCR, 2017). There are approximately 60 million displaced people in the world, of whom 22 million are currently refugees (having crossed an international border).
Epidemiological data consistently highlights the increased prevalence of mental health difficulties in refugee populations (see Mina’s previous blogs), although refugee populations are highly heterogenous having experienced a considerable range of different experiences and then, through various means of travel and exposures to insecurity, settle (either temporality or permanently) in a range of different post-migration contexts. The studies have thus far clearly highlighted the combined influences of exposure to previous traumatic events and post-migration stressors as having the greatest impact on mental health outcomes (Miller et al, 2010).


Worldwide, the number of people forced to leave their homes as a result of organised violence are higher now than any time since the second world war.

Methods

This review took a broad selection of intervention studies primarily investigating post-traumatic stress disorder (PTSD) although they included depression and anxiety in the outcomes of interest, yet these disorders were not included in their search terms. They searched four databases and only included English language studies.
They included clinic samples as well as RCTs of general population samples and to ensure as much data as possible was included, only studies with less than 10 participants were excluded.

Results

Of the 5,300 articles that were screened, 40 studies were included. These are presented in a table as well as described according to intervention type.
Narrative Exposure Therapy (NET) was the most empirically supported intervention and has been studied using lay counsellors as well as mental health professionals, providing an indication as to its potential scalability (Robjant et al, 2010). It is usually given in around 6-10 treatment sessions with a study reporting few sustained effects of brief (3 session) NET on refugees experiencing multiple traumatic events.
Eye Movement Desensitisation and Reprocessing (EMDR) had some data with limited overall evidence as 2 RCTs reported effectiveness and 2 reported no effects.
Culturally sensitive CBT was reported to be studied with good effects by one team in a clinic setting and standard CBT was studied in 2 RCTs with limited evidence to support its use.
A range of other interventions are reported including Trauma-Focused CBT interventions, multidisciplinary interventions and a range of other interventions.
The table below displays the studies with the largest numbers of participants.

Limitations

• As with many studies on refugee populations there is a difficulty to generalise findings given the many different sources of heterogeneity.
• Only English language studies were included and the search terms only looked at PTSD-related terms and not the range of psychological symptoms and disorders.
• The samples were often very different, most prominent were the studies reporting on outcomes from specialist clinic, such as a London trauma clinic, versus those in more general community settings, such as a refugee camp in Sub-Saharan Africa.
• Possible space limitations for the table might have forced some omissions, which might have been of use, such as the location of the study and although the studies were assessed according to a quality checklist, this data was not presented.

Pour lire les conclusions et la suite de l’article, cliquez sur le logo de The Mental Elf

En Palestine, soigner une société traumatisée

Publié le 02.06.2017
Par Gwenaëlle Lenoir
1967-2017 : Faire face à l’occupation (article n°1)
Cinquante ans après la conquête par Israël de la Cisjordanie, de Jérusalem Est et de la Bande de Gaza, et près d’un quart de siècle après les Accords d’Oslo, l’occupation pèse de tout son poids sur la société palestinienne.
Le Palestinian Counselling Center (PCC), important centre de santé mental partenaire du CCFD-Terre Solidaire, tente d’en soigner les traumatismes.
Etre Palestinien, c’est être soumis à une pression continue. C’est vivre, jour après jour, des événements traumatisants : expansion des colonies, incursions militaires, barrages, arrestations, détentions, destructions de maisons, pauvreté, chômage. Le sentiment d’insécurité et la frustration sont permanents, aggravés par l’absence de perspective d’avenir.
Les psychologues et les travailleurs sociaux du Palestinien Counselling Center (PCC) en Cisjordanie et à Jérusalem Est apportent depuis 1983 une aide aux individus les plus exposés à ces traumatismes. Yoad Ghanadre, psychologue depuis près de deux décennies, décrit simplement la société palestinienne :

« Nous sommes des personnes normales dans une situation anormale. »

Les 42 employés, psychologues, conseillers, animateurs du PCC utilisent la psychologie clinique, l’art thérapie, la musicothérapie, en face à face ou en groupe. Chargée du plaidoyer, Rima Awad explique que le travail du PCC vise un objectif plus large :

« Nous voulons renforcer notre société. Outre la thérapie, nous nous attachons à la prévention des risques et au développement des compétences. Par exemple, nous apprenons aux enfants à se protéger, nous travaillons avec les jeunes sur leur identité. Nous offrons aussi des formations aux éducateurs. »

Le PCC reçoit des patients de tous âges, enfants, femmes et hommes.

Pour lire l’article, cliquez sur le logo de ccfd-terre solidaire