Abstract
Culture, tradition, structural violence, and mental health-related stigma play a major role in global mental health for refugees. Our aim was to understand what factors determine the success or failure of community-based psychotherapy for trauma-affected refugees and discuss implications for primary health care programs. Using a systematic realist-informed approach, we searched five databases from 2000 to 2018. Two reviewers independently selected RCTs for inclusion, and we contacted authors to obtain therapy training manuals. Fifteen articles and 11 training manuals met our inclusion criteria. Factors that improved symptoms of depression, anxiety, and PTSD included providing culturally adapted care in a migrant-sensitive setting, giving a role to other clinical staff (task-shifting), and intervention intensity. Precarious asylum status, constraining program monitoring requirements, and diverse socio-cultural and gender needs within a setting may reduce the effectiveness of the program. Primary care programs may enable community based mental health care and may reduce mental health-related stigma for refugees and other migrants. More research is needed on the cultural constructs of distress, programs delivered in primary care, and the role of cultural and language interpretation services in mental health care.
Highlights
There are 25.9 million refugees in the world [1]
We focused exclusively on randomized controlled trials because they are designed around a clear hypothesis; their design minimizes the risk of confounding, and their effectiveness findings are likely to be closer to the true effect than the findings generated by other research methods [21]
We considered any type of comparator and included mental health outcomes of interest: posttraumatic stress disorder (PTSD), depression, or anxiety symptomatology
Summary
There are 25.9 million refugees in the world [1]. More community clinicians are providing global mental health care. Exposure to violence and forced migration increases the risk for common mental health disorders, chronic pain, and other somatic complaints [2]. Global mental health research considers disease prevalence, traditional beliefs, idioms of distress and stigma [3]. Pharmacotherapy may play an important role in common mental health disorders [2]; this study focuses on community-based psychotherapy and trauma-informed care programs (see Table 1). Res. Public Health 2020, 17, 4618; doi:10.3390/ijerph17134618 www.mdpi.com/journal/ijerph
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