Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis.

Michela Nosè,Wietse Tol,Francesca Ballette,Corrado Barbui,Marianna Purgato,Giulia Turrini,Irene Bighelli,Stefan Priebe,Christian Schmahl

doi:10.1371/journal.pone.0171030

Abstract

Treatment of post-traumatic stress disorder (PTSD) in refugees and asylum seekers resettled in high-income countries presents specific challenges. This systematic review examined the effectiveness of psychosocial interventions for this group. We searched the Cochrane Central Register of randomised trials, CINAHL, EMBASE, PILOTS, PsycINFO, PubMed and Web of Science up to July 2016. Studies included randomised and controlled clinical trials comparing psychosocial interventions with waiting list or treatment as usual in adult refugees and asylum seekers with PTSD resettled in high-income countries. PTSD symptoms post-intervention was the primary outcome. We computed standardized mean differences (SMD) with 95% confidence intervals (CI). This study is registered with PROSPERO: CRD42015027843. Twelve studies were included in the meta-analysis. Psychosocial interventions were effective in decreasing PTSD symptoms relative to control groups (SMD -1·03, 95% CI -1·55 to -0·51; number needed to treat 4·4; I2 86%; 95% CI 77 to 91). Narrative exposure therapy, a manualized short-term variant of cognitive behavioural therapy with a trauma focus, was the best-supported intervention (5 RCTs, 187 participants, SMD -0·78, 95% CI -1·18 to -0·38, I2 37%; 95% CI 0 to 77). Methodological quality of the included studies was limited. Overall, psychosocial interventions for asylum seekers and refugees with PTSD resettled in high-income countries were found to provide significant benefits in reducing PTSD symptoms. Yet, the number of studies is small and their methodological quality limited, so that more rigorous trials should be conducted in the future.

Highlights

Worldwide, around 65 million people are forcibly displaced because of conflict and persecution, including 21.3 million refugees and over 3 million individuals awaiting resolution of theirPLOS ONE | DOI:10.1371/journal.pone.0171030 February 2, 2017Interventions for post-traumatic stress disorder in refugees and asylum seekers asylum application
As number of sessions and length of follow-up were arbitrarily categorised, we further investigated a potential association between effect size and these continuous variables by means of unrestricted maximum likelihood random effects meta-regression analysis, as implemented in Comprehensive Meta-analysis (CMA) [33]
The meta-analysis of the primary outcome (12 studies, 543 patients) showed that psychosocial interventions were effective in decreasing post-traumatic stress disorder (PTSD) symptoms relative to inactive controls (SMD -1Á03, 95% confidence intervals (CI) -1Á55 to -0Á51) (Fig 2)

Summary

Introduction

Around 65 million people are forcibly displaced because of conflict and persecution, including 21.3 million refugees and over 3 million individuals awaiting resolution of theirPLOS ONE | DOI:10.1371/journal.pone.0171030 February 2, 2017Interventions for post-traumatic stress disorder in refugees and asylum seekers asylum application. In 2015, the United Nations High Commissioner for Refugees (UNHCR) reported over one million refugees reaching Europe by sea, and a further 34,000 crossing from Turkey into Bulgaria and Greece by land [2]. Traumatic events, such as torture and war exposure, are disproportionately experienced by refugees and asylum seekers before and during displacement [3,4]. Despite the range of mental disorders of relevance to conflict-affected populations, the best studied mental health outcome in refugees remains post-traumatic stress disorder (PTSD). PTSD is 10 times more likely in refugees and asylum seekers compared to host populations [8,9,10]

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