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,Verona,Italy.
Department of Psychology,Istanbul Sehir University,Orhantepe Mahallesi, Turgut Özal Bulvarı, Kartal/İstanbul,Turkey.
Epidemiol Psychiatr Sci. 2019 Aug;28(4):376-388. doi: 10.1017/S2045796019000027. Epub 2019 Feb 11.
AimsIn the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers.
We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason.
We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = -0.71; 95% confidence interval [CI] -1.01 to -0.41; I2 = 83%; 95% CI 78-88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = -1.02; 95% CI -1.52 to -0.51; I2 = 89%; 95% CI 82-93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = -1.05; 95% CI -1.55 to -0.56; I2 = 87%; 95% CI 79-92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life.
Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly.
背景：
近年来，全球被迫流离失所的移民人数空前增加，其中相当一部分是难民和寻求庇护者。难民和寻求庇护者可能经历高度的心理困扰，并表现出较高的心理健康状况。因此，评估当前的证据是否支持为这一人群提供心理社会干预措施是及时且特别相关的。我们对评估心理社会干预措施与对照条件（常规治疗/无治疗、等待名单、心理安慰剂）相比，在减少痛苦的难民和寻求庇护者的心理健康问题方面的疗效和可接受性的随机对照试验（RCT）进行了系统评价和荟萃分析。
方法：
我们使用 Cochrane 程序对评估心理社会干预措施在有心理困扰的成年和儿童寻求庇护者和难民中的疗效和可接受性的已发表和未发表的 RCT 进行了系统评价和荟萃分析。创伤后应激障碍（PTSD）、干预后的抑郁和焦虑症状是主要结局。次要结局包括：PTSD、抑郁和焦虑症状的随访、功能、生活质量和因任何原因退出。
结果：
我们纳入了 26 项研究，共 1959 名参与者。RCT 的荟萃分析显示，心理社会干预对 PTSD（标准化均数差[SMD] = -0.71；95%置信区间[CI] -1.01 至 -0.41；I² = 83%；95%CI 78-88；20 项研究，1370 名参与者；中等质量证据）、抑郁（SMD = -1.02；95%CI -1.52 至 -0.51；I² = 89%；95%CI 82-93；12 项研究，844 名参与者；中等质量证据）和焦虑结局（SMD = -1.05；95%CI -1.55 至 -0.56；I² = 87%；95%CI 79-92；11 项研究，815 名参与者；中等质量证据）有临床显著的有益效果。这种有益的效果在 1 个月或更长时间的随访中得到维持，这对暴露于持续的移民后压力源的人群来说非常重要。对于其他次要结局，我们发现心理社会干预有非显著的有利趋势。大多数证据支持基于认知行为疗法的干预措施，这些干预措施具有创伤为重点的组成部分。本综述的局限性包括收集的研究数量有限，参与者总数相对较低，以及关于功能和生活质量等积极结局的数据有限。
结论：
鉴于难民和寻求庇护者心理困扰和心理健康状况的流行病学相关性，以及心理社会干预措施有效性的现有数据，这些干预措施应作为痛苦的难民和寻求庇护者的医疗保健的常规内容提供。应相应制定循证指南和实施包。
