Abstract
Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies. A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43-38.5), the prevalence of depression was 31.5% (95% CI 22.64-40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75-15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63-2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies. This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement.
Highlights
The numbers of refugees and asylum seekers have reached record highs [1]
Fazel and colleagues (2005) [6] conducted a systematic review and meta-analysis of refugees resettled in high-income countries, covering the period 1986–2004, and reported a prevalence of 9% for posttraumatic stress disorder (PTSD), 5% for major depressive disorder, and 4% for generalised anxiety disorder, based on studies reporting at least 200 participants
There is a lack of research investigating the full breadth of mental illness, as the literature has mainly focused on PTSD and depression, the need for a comprehensive, worldwide, systematic review to investigate mental illness in the current refugee populations
Summary
The numbers of refugees and asylum seekers have reached record highs [1]. Ongoing conflicts around the world raise challenging social, political, and humanitarian issues [2]. Fazel and colleagues (2005) [6] conducted a systematic review and meta-analysis of refugees resettled in high-income countries, covering the period 1986–2004, and reported a prevalence of 9% for posttraumatic stress disorder (PTSD), 5% for major depressive disorder, and 4% for generalised anxiety disorder, based on studies reporting at least 200 participants. A subsequent systematic review into the association between torture or other traumatic events and PTSD and depression, covering studies between 1987 and 2009 and comprising 81,866 refugees and conflict-affected populations, reported an unadjusted weighted prevalence of 30% for PTSD and 30% for depression [7]. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies
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