Turrini Giulia, Purgato Marianna, Ballette Francesca, Nosè Michela, Ostuzzi Giovanni, Barbui Corrado
Cochrane Global Mental Health and 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, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
Int J Ment Health Syst. 2017 Aug 25;11:51. doi: 10.1186/s13033-017-0156-0. eCollection 2017.
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.
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.
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.
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.
近年来，逃离原籍国的寻求庇护者和难民数量不断增加，这带来了重大的社会、经济、人道主义和公共卫生影响。对于这一群体，需要掌握有关心理健康状况的发生率和特征，以及在确诊精神障碍后可实施的干预措施的最新信息。本系统综述旨在系统地回顾现有证据，了解成年和儿童寻求庇护者及重新安置在低收入、中等收入和高收入国家的难民中常见精神障碍的患病率，以及心理社会和药物干预的疗效。
我们对系统综述进行了一项系统综述，总结了有关寻求庇护者和/或难民中常见精神障碍患病率以及心理社会和药物干预疗效的数据。使用AMSTAR清单评估纳入研究的方法学质量。
13篇综述报告了常见精神障碍患病率的数据，14篇综述报告了心理或药物干预疗效的数据。尽管患病率存在很大差异，但我们发现抑郁症和焦虑症的发生率至少与创伤后应激障碍一样高，在寻求庇护者和难民中占比高达40%。在心理社会干预方面，认知行为干预，特别是叙事暴露疗法，是研究最多的干预措施，与无干预对照相比有积极效果，但与积极对照相比效果不明显。
当前的流行病学数据需要通过更严格的研究加以扩充，这些研究不仅要关注创伤后应激障碍，还要关注抑郁症、焦虑症和其他心理健康状况。此外，迫切需要开展新的研究，不仅要评估心理社会干预与不治疗相比的疗效，还要评估它们之间相互比较的疗效。尽管存在当前的局限性，但现有的流行病学和实验数据应用于制定具体的循证指南，可能由世界卫生组织或联合国难民事务高级专员公署等国际独立组织来制定。这些指南应适用于不同的精神卫生保健组织，包括低收入和中等收入国家以及高收入国家。
