A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD

Bibliographic Data

ID21881243
AuthorsGiulia Turrini (0000-0001-7150-8862, University of Verona, corresponding author), Federico Tedeschi (0000-0002-4670-5335, University of Verona), Pim Cuijpers (0000-0001-5497-2743, Vrije Universiteit Amsterdam), Cinzia Del Giovane (0000-0002-5028-932X, University of Bern), Ahlke Kip (0000-0002-6399-2516, University of Münster), Naser Morina (0000-0002-2331-9140, University of Münster), Michela Nosè (0000-0002-3165-7772, University of Verona), Giovanni Ostuzzi (0000-0003-2248-9524, University of Verona), Marianna Purgato (0000-0002-3783-8195, University of Verona), Chiara Ricciardi (University of Verona), Marit Sijbrandij (0000-0001-5430-9810, Vrije Universiteit Amsterdam), Wietse A Tol (0000-0003-2216-0526, University of Copenhagen), Wietse Tol (University of Copenhagen), Corrado Barbui (0000-0003-1073-9282, University of Verona)
Year2021
Volume6
Issue6
Pagese005029
Publication date2021-06-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-005029
PMID34088735
OpenAlexW3164023611
LanguageEN
Citations received11
References cited86

INTRODUCTION: Refugees and asylum seekers are vulnerable to common mental disorders, including post-traumatic stress disorder (PTSD). Using a network meta-analysis (NMA) approach, the present systematic review compared and ranked psychosocial interventions for the treatment of PTSD in adult refugees and asylum seekers. METHODS: Randomised studies of psychosocial interventions for adult refugees and asylum seekers with PTSD were systematically identified. PTSD symptoms at postintervention was the primary outcome. Standardised mean differences (SMDs) and ORs were pooled using pairwise and NMA. Study quality was assessed with the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was assessed through the Confidence in Network Meta-Analysis application. RESULTS: A total of 23 studies with 2308 participants were included. Sixteen studies were conducted in high-income countries, and seven in low-income or middle-income countries. Most studies were at low risk of bias according to the Cochrane RoB tool. NMA on PTSD symptoms showed that cognitive behavioural therapy (CBT) (SMD=-1.41; 95% CI -2.43 to -0.38) and eye movement desensitisation and reprocessing (EMDR) (SMD=-1.30; 95% CI -2.40 to -0.20) were significantly more effective than waitlist (WL). CBT was also associated with a higher decrease in PTSD symptoms than treatment as usual (TAU) (SMD -1.51; 95% CI -2.67 to -0.36). For all other interventions, the difference with WL and TAU was not significant. CBT and EMDR ranked best according to the mean surface under the cumulative ranking. Regarding acceptability, no intervention had less dropouts than inactive interventions. CONCLUSION: CBT and EMDR appeared to have the greatest effects in reducing PTSD symptoms in asylum seekers and refugees. This evidence should be considered in guidelines and implementation packages to facilitate dissemination and uptake in refugee settings

Meta-analysis · Political science · Psychiatry · Psychological intervention · Psychosocial · Refugee · Medicine · Migration, Health and Trauma · Posttraumatic Stress Disorder Research · Psychology · Traumatic Brain Injury Research

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