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

Author(s):  
Michela Nosè

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.

2021 ◽  
Vol 6 (6) ◽  
pp. e005029
Author(s):  
Giulia Turrini ◽  
Federico Tedeschi ◽  
Pim Cuijpers ◽  
Cinzia Del Giovane ◽  
Ahlke Kip ◽  
...  

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.


BJPsych Open ◽  
2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Andreas Hoell ◽  
Eirini Kourmpeli ◽  
Hans Joachim Salize ◽  
Andreas Heinz ◽  
Frank Padberg ◽  
...  

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.


2020 ◽  
Author(s):  
Verena Semmlinger ◽  
Thomas Ehring

This guideline aims to inform and sensitize clinical researchers and therapists about dropout in general as well as specifically in the treatment of refugees and asylum seekers. We first describe the challenging situation, refugees resettled in high-income countries are facing and give a brief overview of the current evidence on the effectiveness of psychological and psychosocial interventions for this group. The definition of dropout and different operationalization methods are discussed and an overview of the reported prevalence rates of dropout from psychological treatments is given. Further, an overview of the empirical evidence regarding predictors and reasons for dropout is provided. The reduction of dropout is a major challenge in both clinical practice and clinical research. Therefore, effective measures to reduce the occurrence of premature termination of treatment are discussed and recommendations are given.


2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Faten Taki ◽  
Inmaculada de Melo-Martin

AbstractAn increase in global violence has forced the displacement of more than 70 million people, including 26 million refugees and 3.5 asylum seekers. Refugees and asylum seekers face serious socioeconomic and healthcare barriers and are therefore particularly vulnerable to physical and mental health risks, which are sometimes exacerbated by immigration policies and local social discriminations. Calls for a strong evidence base for humanitarian action have encouraged conducting research to address the barriers and needs of refugees and asylum seekers. Given the role of epigenetics factors to mediate the effect of psychological and environmental exposures, epigenetic modifications have been used as biomarkers for life adversity and disease states. Therefore, epigenetic research can be potentially beneficial to address some of the issues associated with refugees and asylum seekers. Here, we review the value of previous and ongoing epigenetic studies with traumatized populations, explore some of the ethical challenges associated with epigenetic research with refugees and asylees and offer suggestions to address or mitigate some of these challenges. Researchers have an ethical responsibility to implement strategies to minimize the harms and maximize the short and long-term benefits to refugee and asylee participants.


2021 ◽  
Vol 2 (4) ◽  
pp. 410-423
Author(s):  
Abdullah AlRefaie ◽  
Christopher Dowrick

Objectives: To assess the causes and risk factors of post-traumatic stress disorder (PTSD) in adult asylum seekers and refugees. To explore whether the causes and risk factors of PTSD between male and female adult refugees/asylum seekers are different. Study design: Systematic review of current literature. Data Sources: PubMed, Web of Science, Scopus and Google Scholar up until February 2019. Method: A structured, systematic search was conducted of the relevant databases. Papers were excluded if they failed to meet the inclusion and exclusion criteria. Afterwards, a qualitative assessment was performed on the selected papers. Results: 12 Studies were included for the final analysis. All papers were either case studies/reports or cross-sectional studies. Traumatic events experienced by refugees/asylum seekers are the most frequently reported pre-migration causes of PTSD development, while acculturative stress is the most common post-migration stressor. There were mixed reports regarding the causes of PTSD between both genders of refugees/asylum seekers. Conclusions: This review’s findings have potential clinical application in terms of helping clinicians to risk stratify refugees/asylum seekers for PTSD development and thus aid in embarking on earlier intervention measures. However, more rigorous research similar to this study is needed for it to be implemented into clinical practice.


Author(s):  
Rachel Tribe ◽  
Angelina Jalonen

This chapter reviews the socio-political environment and legal factors that provide the context and influence the lived experience of many refugees and asylum seekers. These factors are considered in relation to flight, arrival, and settlement in a new country. How these contextual factors may impact upon refugees and asylum seekers, their sense of identity, and mental health will be reviewed. The chapter reflects upon the possible challenges faced by many refugees and asylum seekers, as well as arguing that the strengths, resilience, and coping strategies that many asylum seekers and refugees exhibit need to be adequately considered by clinicians, if a meaningful service is to be provided. The importance of clinicians being culturally curious and listening to service users’ meaning-making is vital. An overview of some other issues that clinicians may need to consider is provided. The chapter contains a number of case studies to illustrate the related issues.


2020 ◽  
pp. 088626052097031
Author(s):  
Venke A. Johansen ◽  
Anne Marita Milde ◽  
Roy Miodini Nilsen ◽  
Kyrre Breivik ◽  
Dag Øystein Nordanger ◽  
...  

Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time ( p < .001); PSS were significantly correlated only between T1 and T2 ( p < .001), T1 and T3 ( p < .05), and between T2 and T3 ( p < .05). Cross-lagged analyses showed an inverse relationship between prior PSS and later PTSD symptoms across all time points ( ps < .05); not proved between prior PTSD symptoms and later PSS ( ps > .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions.


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