Unit for Social and Community Psychiatry,WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London,London,UK.
Epidemiol Psychiatr Sci. 2018 Apr;27(2):109-116. doi: 10.1017/S2045796017000609. Epub 2017 Oct 25.
Approximately one-third of people who have obtained refugee status live in high-income countries. Over recent years, the number of refugees has been increasing, and there are questions on how many of them need mental health care and which type of interventions are beneficial. Meta-analyses showed highly variable rates of mental disorders in adult refugees. This variability is likely to reflect both real differences between groups and contexts, and methodological inconsistencies across studies. Overall prevalence rates after resettlement are similar to those in host populations. Only post-traumatic stress disorder (PTSD) is more prevalent in refugees. In long-term resettled refugees, rates of anxiety and depressive disorders are higher and linked to poor social integration. Research on mental health care for refugees in high-income countries has been extensive, but often of limited methodological quality and with very context-specific findings. The existing evidence suggests several general principles of good practice: promoting social integration, overcoming barriers to care, facilitating engagement with treatment and, when required, providing specific psychological treatments to deal with traumatic memories. With respect to the treatment of defined disorders, only for the treatment of PTSD there has been substantial refugee-specific research. For other diagnostic categories, the same treatment guidelines apply as to other groups. More systematic research is required to explore how precisely the general principles can be specified and implemented for different groups of refugees and in different societal contexts in host countries, and which specific interventions are beneficial and cost-effective. Such interventions may utilise new communication technologies. Of particular importance are long-term studies to identify when mental health interventions are appropriate and to assess outcomes over several years. Such research would benefit from sufficient funding, wide international collaboration and continuous learning over time and across different refugee groups.
约三分之一获得难民身份的人生活在高收入国家。近年来,难民人数不断增加,人们开始关注有多少难民需要心理健康护理,以及哪种类型的干预措施是有益的。荟萃分析显示,成年难民的精神障碍发病率差异很大。这种变异性可能既反映了群体和环境之间的真实差异,也反映了研究之间方法学的不一致性。重新安置后的总体患病率与宿主人群相似。只有创伤后应激障碍(PTSD)在难民中更为普遍。在长期重新安置的难民中,焦虑症和抑郁症的发病率更高,与社会融合不良有关。高收入国家针对难民的心理健康护理研究已经广泛开展,但通常方法学质量有限,且研究结果非常具体。现有证据表明了一些良好实践的一般原则:促进社会融合、克服护理障碍、促进与治疗的接触,以及在需要时提供特定的心理治疗来处理创伤记忆。至于特定障碍的治疗,只有针对 PTSD 的治疗才有大量针对难民的具体研究。对于其他诊断类别,同样的治疗指南适用于其他群体。需要进行更系统的研究,以探讨如何针对不同群体的难民和收容国不同的社会环境具体说明和实施这些一般原则,以及哪些具体干预措施是有益和具有成本效益的。此类干预措施可能会利用新的通信技术。特别重要的是开展长期研究,以确定何时需要进行心理健康干预,并评估多年来的结果。此类研究将受益于充足的资金、广泛的国际合作以及随着时间的推移和不同难民群体的不断学习。
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