A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD
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A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD. / Turrini, Giulia; Tedeschi, Federico; Cuijpers, Pim; Del Giovane, Cinzia; Kip, Ahlke; Morina, Nexhmedin; Nosè, Michela; Ostuzzi, Giovanni; Purgato, Marianna; Ricciardi, Chiara; Sijbrandij, Marit; Tol, Wietse; Barbui, Corrado.
In: BMJ Global Health, Vol. 6, No. 6, e005029, 2021.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD
AU - Turrini, Giulia
AU - Tedeschi, Federico
AU - Cuijpers, Pim
AU - Del Giovane, Cinzia
AU - Kip, Ahlke
AU - Morina, Nexhmedin
AU - Nosè, Michela
AU - Ostuzzi, Giovanni
AU - Purgato, Marianna
AU - Ricciardi, Chiara
AU - Sijbrandij, Marit
AU - Tol, Wietse
AU - Barbui, Corrado
N1 - Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - mental health & psychiatry
KW - public health
KW - traumatology
U2 - 10.1136/bmjgh-2021-005029
DO - 10.1136/bmjgh-2021-005029
M3 - Journal article
C2 - 34088735
AN - SCOPUS:85107930663
VL - 6
JO - BMJ Global Health
JF - BMJ Global Health
SN - 2059-7908
IS - 6
M1 - e005029
ER -
ID: 276331413