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

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

doi:10.1371/journal.pone.0171030

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

PLoS One. 2017 Feb 2;12(2):e0171030. doi: 10.1371/journal.pone.0171030. eCollection 2017.

Authors

Michela Nosè¹, Francesca Ballette¹, Irene Bighelli¹, Giulia Turrini¹, Marianna Purgato¹, Wietse Tol², Stefan Priebe³, Corrado Barbui¹

Affiliations

¹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
² Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
³ Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom.

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.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Cognitive Behavioral Therapy
Controlled Clinical Trials as Topic
Developed Countries
Humans
Implosive Therapy
Randomized Controlled Trials as Topic
Refugees / psychology*
Stress Disorders, Post-Traumatic / psychology*
Stress Disorders, Post-Traumatic / therapy*

Grants and funding

During the study period, the following funding was received: Internal funding from the University of Verona. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.