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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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.

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