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

2021 ◽  
Vol 6 (6) ◽  
pp. e005029
Author(s):  
Giulia Turrini ◽  
Federico Tedeschi ◽  
Pim Cuijpers ◽  
Cinzia Del Giovane ◽  
Ahlke Kip ◽  
...  
Keyword(s):  
Low Income ◽  
Asylum Seekers ◽  
Common Mental Disorders ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Risk Of Bias ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Treatment As Usual ◽  
Refugees And Asylum Seekers

IntroductionRefugees 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.MethodsRandomised 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.ResultsA 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.ConclusionCBT 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.

scholarly journals Tortura e disagio psichico tra i rifugiati e i richiedenti asilo

2019 ◽  
Author(s):  
Michela Nosè
Keyword(s):  
Asylum Seekers ◽  
Behavioral Interventions ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Ptsd Symptoms ◽  
Prevalence Rates ◽  
Post Traumatic Stress ◽  
Appropriate Treatment ◽  
Refugees And Asylum Seekers ◽  
Asylum Seekers And Refugees

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 comparison with the general population, refugees and asylum seekers have been shown to experience higher prevalence rates of a range of disorders, including Post-Traumatic Stress Disorder (PTSD). Although there is substantial variability in prevalence rates, PTSD is frequent and is much more likely in refugees and asylum seekers compared to host populations. In terms of psychosocial interventions, cognitive behavioral interventions and narrative exposure therapy are supported by some evidence of efficacy that would suggest the possibility of decreasing PTSD symptoms in this vulnerable group. Overall, psychosocial interventions for asylum seekers and refugees with PTSD were found to provide significant benefits in reducing PTSD symptoms. Therefore these data provide an evidence base to inform decisions in clinical practice and in policy making, considering that an appropriate treatment is a right of refugees and a way to better adaptation and integration in hosted country.

scholarly journals Psychosocial treatments for relapse prevention in schizophrenia: study protocol for a systematic review and network meta-analysis of randomised evidence

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e035073
Author(s):  
Irene Bighelli ◽  
Alessandro Rodolico ◽  
Gabi Pitschel-Walz ◽  
Wulf-Peter Hansen ◽  
Corrado Barbui ◽  
...  
Keyword(s):  
Relapse Prevention ◽  
Ethical Issues ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Risk Of Bias ◽  
Psychosocial Treatment ◽  
Sensitivity Analyses ◽  
Treatment As Usual ◽  
Psychosocial Treatments ◽  
Number Of Patients

IntroductionThere is evidence that different psychosocial interventions could reduce the risk of relapse in schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychosocial treatments for relapse prevention in schizophrenia according to their efficacy, acceptability and tolerability.Methods and analysisWe will include all RCTs comparing a psychosocial treatment aimed at preventing relapse in patients with schizophrenia with another psychosocial intervention or with a no treatment condition (waiting list, treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, acutely ill patients). Primary outcome will be the number of patients experiencing a relapse. Secondary outcomes will be acceptability (dropout), change in overall, positive, negative and depressive symptoms, quality of life, adherence, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using Confidence in Network Meta-Analysis (CINeMA). Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationNo ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.PROSPERO registration numberCRD42019147884.

scholarly journals Prevalence of depressive symptoms and symptoms of post-traumatic stress disorder among newly arrived refugees and asylum seekers in Germany: systematic review and meta-analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Andreas Hoell ◽  
Eirini Kourmpeli ◽  
Hans Joachim Salize ◽  
Andreas Heinz ◽  
Frank Padberg ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Asylum Seekers ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Pooled Prevalence ◽  
Prevalence Estimates ◽  
Post Traumatic ◽  
Refugees And Asylum Seekers

Background In total numbers, Germany has faced the largest number of refugees and asylum seekers (RAS) in Europe in the past decade. Although a considerable proportion have experienced traumatic and stressful life events, there is no systematic review to date examining the prevalence of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms in RAS in Germany. Aims To calculate the prevalence of depressive symptoms and PTSD symptoms in the general population of RAS living in Germany after the year 2000 and explore the impact of study- and participant-related characteristics on prevalence estimates. Method We systematically searched PubMed, CINAHL, PsycINFO, PSYNDEX, Academic Search Complete, Science Direct and Web of Science from January 2000 to May 2020 to identify articles reporting prevalence of depressive symptoms and PTSD in RAS in Germany (PROSPERO registration number: CRD42020182796). Results In total, 31 different surveys met inclusion criteria with 20 surveys reporting prevalence estimates of depressive symptoms and 25 surveys symptoms of PTSD. Based on screening tools, the pooled prevalence estimate of PTSD symptoms was 29.9% (95% CI 20.8–38.7%) and of depressive symptoms 39.8% (95% CI 29.8–50.1%). Heterogeneity was large within and between subgroups. In multivariate meta-regressions on depressive symptoms, heterogeneity was largely explained by survey period, length of field period and study quality. Conclusions Prevalence rates of depressive symptoms and PTSD symptoms in RAS are notably large. They exceed the prevalence in the general German population. As a result of high heterogeneity, however, pooled prevalence rates should be interpreted with caution.

scholarly journals Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis

2019 ◽  
Vol 28 (04) ◽  
pp. 376-388 ◽  
Author(s):  
G. Turrini ◽  
M. Purgato ◽  
C. Acarturk ◽  
M. Anttila ◽  
T. Au ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Psychological Distress ◽  
Asylum Seekers ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Moderate Quality ◽  
Refugees And Asylum Seekers ◽  
Quality Evidence

AbstractAimsIn 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.MethodsWe 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.ResultsWe 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.ConclusionsConsidering 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.

scholarly journals Pharmacotherapy for post-traumatic stress disorder: Systematic review and meta-analysis

2015 ◽  
Vol 206 (2) ◽  
pp. 93-100 ◽  
Author(s):  
Mathew Hoskins ◽  
Jennifer Pearce ◽  
Andrew Bethell ◽  
Liliya Dankova ◽  
Corrado Barbui ◽  
...  
Keyword(s):  
Systematic Review ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stress Disorder ◽  
Positive Impact ◽  
Meta Analysis ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Post Traumatic

BackgroundPharmacological treatment is widely used for post-traumatic stress disorder (PTSD) despite questions over its efficacy.AimsTo determine the efficacy of all types of pharmacotherapy, as monotherapy, in reducing symptoms of PTSD, and to assess acceptability.MethodA systematic review and meta-analysis of randomised controlled trials was undertaken; 51 studies were included.ResultsSelective serotonin reuptake inhibitors were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.23, 95% CI −0.33 to −0.12). For individual pharmacological agents compared with placebo in two or more trials, we found small statistically significant evidence of efficacy for fluoxetine, paroxetine and venlafaxine.ConclusionsSome drugs have a small positive impact on PTSD symptoms and are acceptable. Fluoxetine, paroxetine and venlafaxine may be considered as potential treatments for the disorder. For most drugs there is inadequate evidence regarding efficacy for PTSD, pointing to the need for more research in this area.

scholarly journals Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis

2017 ◽  
Vol 210 (5) ◽  
pp. 324-332 ◽  
Author(s):  
Danyael Lutgens ◽  
Genevieve Gariepy ◽  
Ashok Malla
Keyword(s):  
Systematic Review ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Detailed Examination ◽  
Behavioural Therapy ◽  
Integrated Treatment ◽  
Treatment As Usual

BackgroundNegative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.AimsTo conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.MethodWe searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.ResultsA total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive–behavioural therapy (pooled SMD −0.34, 95% CI −0.55 to −0.12), skills-based training (pooled SMD −0.44, 95% CI −0.77 to −0.10), exercise (pooled SMD −0.36, 95% CI −0.71 to −0.01), and music treatments (pooled SMD −0.58, 95% CI −0.82 to −0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD −0.38, 95% CI −0.53 to −0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.ConclusionsSpecific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.

Dropout from psychological interventions for refugees and asylum seekers: A meta-analysis.

2021 ◽  
Vol 89 (9) ◽  
pp. 717-730
Author(s):  
Verena Semmlinger ◽  
Keisuke Takano ◽  
Hannah Schumm ◽  
Thomas Ehring
Keyword(s):  
Asylum Seekers ◽  
Meta Analysis ◽  
Psychological Interventions ◽  
Refugees And Asylum Seekers
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