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跨诊断心理社会干预措施促进强迫流离失所者的心理健康:系统评价和荟萃分析。

Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis.

机构信息

Leibniz Institute for Resilience Research (LIR), Mainz, Germany.

Institute for Evidence in Medicine (IfEM), Medical Center - University of Freiburg, Freiburg, Germany.

出版信息

Eur J Psychotraumatol. 2023;14(2):2196762. doi: 10.1080/20008066.2023.2196762.


DOI:10.1080/20008066.2023.2196762
PMID:37305944
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10262817/
Abstract

People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders. To summarize evidence on the efficacy of psychosocial interventions aiming to promote mental health and/or to prevent mental symptoms by fostering transdiagnostic skills in forcibly displaced persons of all ages. Four databases and reference lists were searched for randomized controlled trials on interventions in this population on 11 March 2022. Thirty-six studies were eligible, 32 studies (comprising 5299 participants) were included in random-effects multilevel meta-analyses examining the effects of interventions on mental symptoms and positive mental health (e.g. wellbeing) as well as moderators to account for heterogeneity. OSF Preregistration-ID: 10.17605/OSF.IO/XPMU3 Our search resulted in 32 eligible studies, with 10 reporting on children/adolescents and 27 on adult populations. There was no evidence for favourable intervention effects in children/adolescents, with 44.4% of the effect sizes pointing to potentially negative effects yet remaining non-significant. For adult populations, our meta-analyses showed a close-to-significant favourable effect for mental symptoms, (SMD) = 0.33, 95% CI [-0.03, 0.69], which was significant when analyses were limited to high-quality studies and larger for clinical compared to non-clinical populations. No effects emerged for positive mental health. Heterogeneity was considerable and could not be explained by various moderators (e.g. type of control, duration, setting, theoretical basis). Certainty of evidence was very low across all outcomes limiting the generalizability of our findings. The present review provides at most weak evidence for an effect favouring transdiagnostic psychosocial interventions over control conditions for adult populations but not for children and adolescents. Future research should combine the imperative of humanitarian aid in face of major crises with studying the diverse needs of forcibly displaced persons to improve and tailor future interventions.

摘要

被迫离开家园的人,如难民和国内流离失所者,在被迫流离失所期间会面临各种压力源,使他们面临精神障碍的风险。总结旨在促进所有年龄段的被迫流离失所者的心理健康和/或通过培养跨诊断技能来预防精神症状的心理社会干预措施的疗效证据。2022 年 3 月 11 日,在四个数据库和参考文献列表中搜索了针对该人群的干预措施的随机对照试验。36 项研究符合条件,32 项研究(包括 5299 名参与者)被纳入随机效应多级荟萃分析,以检验干预措施对精神症状和积极心理健康(如幸福感)的影响,以及对异质性的调节因素。OSF 预注册-ID:10.17605/OSF.IO/XPMU3我们的搜索结果有 32 项符合条件的研究,其中 10 项报告了儿童/青少年,27 项报告了成年人群体。在儿童/青少年中没有证据表明干预措施有有利影响,44.4%的效应大小指向潜在的负面影响,但仍不显著。对于成年人群体,我们的荟萃分析显示,精神症状的干预效果接近显著(SMD=0.33,95%CI[-0.03,0.69]),当分析仅限于高质量研究时,该效果具有显著性,对于临床人群比非临床人群的效果更大。积极心理健康方面没有出现效果。异质性非常大,无法用各种调节因素(如对照类型、持续时间、设置、理论基础)来解释。所有结果的证据确定性都非常低,限制了我们研究结果的普遍性。本综述最多为成人人群体的跨诊断心理社会干预措施优于对照条件提供了弱证据,但对儿童和青少年则不然。未来的研究应将在重大危机面前提供人道主义援助的必要性与研究被迫流离失所者的各种需求结合起来,以改善和调整未来的干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/f62ff9a38d3b/ZEPT_A_2196762_F0004_OB.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/686f9f2f4043/ZEPT_A_2196762_F0001_OB.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/7529d51a6561/ZEPT_A_2196762_F0002_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/03def1b9ada5/ZEPT_A_2196762_F0003_OB.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/f62ff9a38d3b/ZEPT_A_2196762_F0004_OB.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/686f9f2f4043/ZEPT_A_2196762_F0001_OB.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/7529d51a6561/ZEPT_A_2196762_F0002_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/03def1b9ada5/ZEPT_A_2196762_F0003_OB.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fda1/10262817/f62ff9a38d3b/ZEPT_A_2196762_F0004_OB.jpg

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本文引用的文献

[1]
Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: systematic review.

BJPsych Open. 2022-8-8

[2]
Using Transdiagnostic Mechanistic Targets to Advance Prevention Science.

Clin Psychol (New York). 2021-12

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Mental health professionals' perspective on a brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees.

Eur J Psychotraumatol. 2022

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Cochrane Database Syst Rev. 2022-5-9

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Engaging Refugees With a Culturally Adapted Digital Intervention to Improve Sleep: A Randomized Controlled Pilot Trial.

Front Psychiatry. 2022-2-23

[10]
New directions in the mental health care of migrants, including refugees-A randomized controlled trial investigating the efficacy of value-based counselling.

Clin Psychol Psychother. 2022-7

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