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Meta-Analysis
. 2024;15(1):2389702.
doi: 10.1080/20008066.2024.2389702. Epub 2024 Aug 30.

Brief CBT-based psychological interventions to improve mental health outcomes in refugee populations: a systematic review and meta-analysis

Nadia A Daniel  1   2 , Xin Liu  1   2 , Elizabeth T Thomas  3 , Emily Eraneva-Dibb  1   2 , Al-Maz Ahmad  4 , Carl Heneghan  3
Affiliations
Meta-Analysis

Brief CBT-based psychological interventions to improve mental health outcomes in refugee populations: a systematic review and meta-analysis

Nadia A Daniel et al. Eur J Psychotraumatol. 2024.

Abstract
in English, Spanish

Background: Refugees, asylum seekers, and internally displaced people experience a high burden of mental health problems owing to their experiencing traumas and stressful events.Objective: To summarise the available evidence and analyse the efficacy of brief psychological interventions (< 3 months) on improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD)-related symptoms in refugees.Method: We searched Medline, EMBASE, PsycINFO, CINAHL, and Global Index Medicus from inception to 19 December 2023. We included controlled studies using any cognitive behavioural therapy (CBT) or CBT-based therapies delivered over a short time (< 3 months), which reported mental health outcomes pre-and post-intervention. We conducted meta-analyses using random effects to derive pooled summary statistics. The quality of the evidence was assessed with the Cochrane Risk of Bias (RoB2) and ROBINS-I tools. This study is registered on the Open Science Framework, DOI 10.17605/OSF.IO/9CXU4.Results: 34 eligible studies across 37 publications were retrieved for analysis, and 33 studies with 4479 participants were included in the meta-analysis. There was an overall improvement in immediate mental health outcomes for all three domains, with analysis of 13 studies on anxiety outcomes (SMD -1.12, 95% CI -1.72 to -0.52), 20 studies on depression (SMD -1.04, 95% CI -1.97 to -0.11), and 24 studies on PTSD (SMD -0.82, 95% CI -1.20 to -0.45). At 3 to 6-month follow-up, however, analysis of mental health outcomes shows no significant change from baseline, with a SMD of 0.24 (95% CI -0.94 to 1.42) across 4 studies, -0.73 (95% CI -2.14 to 0.68) across 9 studies, and 0.29 (95% CI -0.94 to 1.53) across 12 studies for anxiety, depression, and PTSD respectively.Conclusion: Low-quality evidence shows brief psychological interventions have a positive immediate effect on refugees and internally displaced people's mental well-being. However, these effects do not persist in the short-term follow up. Heterogeneity was high, even among subgroups, impacting our findings' generalisability.

Antecedentes: Los refugiados, los solicitantes de asilo y las personas desplazadas internamente experimentan una gran carga de problemas de salud mental debido a la experiencia de traumas y eventos estresantes.

Objetivo: Resumir la evidencia disponible y analizar la eficacia de las intervenciones psicológicas breves (<3 meses) para mejorar los resultados de salud mental, incluidos los síntomas relacionados con la depresión, ansiedad y trastorno de estrés postraumático (TEPT) en refugiados.

Método: Realizamos búsquedas en Medline, EMBASE, PsycINFO, CINAHL y Global Index Medicus desde el inicio hasta el 19 de diciembre de 2023. Incluimos estudios controlados que utilizaban cualquier terapia cognitivo-conductual (TCC) o terapias basadas en TCC administradas durante un período corto (<3 meses), que informaban resultados de salud mental pre y post-intervención. Realizamos metanálisis utilizando efectos aleatorios para derivar estadísticas de resumen agrupadas. La calidad de la evidencia se evaluó con las herramientas Cochrane Risk of Bias (RoB2) y ROBINS-I. Este estudio está registrado en Open Science Framework, DOI 10.17605/OSF.IO/9CXU4.

Resultados: Se recuperaron 34 estudios elegibles para el análisis en 37 publicaciones, y se incluyeron 33 estudios con 4.479 participantes en el metanálisis. Hubo una mejoría general en los resultados inmediatos de salud mental para los tres dominios, con análisis de 13 estudios sobre resultados de ansiedad (SMD −1,12, IC del 95%: −1,72 a −0,52), 20 estudios sobre depresión (SMD −1,04, IC del 95%: −1,97 a −0,11) y 24 estudios sobre TEPT (SMD −0,82, IC del 95%: −1,20 a −0,45). Sin embargo, en el seguimiento de 3 a 6 meses, el análisis de los resultados de salud mental no muestra cambios significativos desde el basal, con una SMD de 0,24 (IC del 95%: −0,94 a 1,42) en 4 estudios, −0,73 (IC del 95%: −2,14 a 0,68) en 9 estudios y 0,29 (IC del 95%: −0,94 a 1,53) en 12 estudios para ansiedad, depresión y TEPT respectivamente.

Conclusión: La evidencia de baja calidad muestra que las intervenciones psicológicas breves tienen un efecto inmediato positivo en el bienestar mental de los refugiados y las personas desplazadas internamente. Sin embargo, estos efectos no persisten en el seguimiento a corto plazo. La heterogeneidad fue alta, incluso entre los subgrupos, lo que afecta la generalización de nuestros hallazgos.

Keywords: CBT; PTSD; Refugees; Refugiados; TCC; TEPT; ansiedad; anxiety; asylum seekers; brief psychological intervention; depresión; depression; internally displaced persons; intervención psicológica breve; meta-analysis; metaanálisis; personas desplazadas internamente; revisión sistemática; solicitantes de asilo; systematic review.

Plain language summary

We analysed the evidence on the use of brief CBT-based psychological interventions to improve mental health outcomes in forcibly displaced persons.These interventions had a positive effect on anxiety, depression and PTSD, though there was high heterogeneity between studies.Positive effects on mental health disappeared at long-term follow-up.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
PRISMA flowchart of the study selection process.
Figure 2.
Figure 2.
Effectiveness of brief CBT-based psychological interventions in treating anxiety in refugees and asylum seekers.
Figure 3.
Figure 3.
Effectiveness of brief CBT-based psychological interventions in treating depression in refugees and asylum seekers.
Figure 4.
Figure 4.
Effectiveness of brief CBT-based psychological interventions in treating PTSD in refugees and asylum seekers.
Figure 5.
Figure 5.
a. Effectiveness of interventions carried out by lay persons versus trained professionals in treating anxiety. b. Effectiveness of interventions carried out by lay persons versus trained professionals in treating depression. c. Effectiveness of interventions carried out by lay persons versus trained professionals in treating anxiety, depression, and PTSD.
Figure 5.
Figure 5.
a. Effectiveness of interventions carried out by lay persons versus trained professionals in treating anxiety. b. Effectiveness of interventions carried out by lay persons versus trained professionals in treating depression. c. Effectiveness of interventions carried out by lay persons versus trained professionals in treating anxiety, depression, and PTSD.
Figure 6.
Figure 6.
a. Effectiveness of interventions on adult and child populations for anxiety. b. Effectiveness of interventions on adult and child populations for depression. c. Effectiveness of interventions on adult and child populations for PTSD.
Figure 6.
Figure 6.
a. Effectiveness of interventions on adult and child populations for anxiety. b. Effectiveness of interventions on adult and child populations for depression. c. Effectiveness of interventions on adult and child populations for PTSD.
Figure 7.
Figure 7.
a. Sensitivity analysis: effectiveness of interventions carried out in studies with low, moderate, or high risk of bias for anxiety. b. Sensitivity analysis: effectiveness of interventions carried out in studies with low, moderate, or high risk of bias for depression. c. Sensitivity analysis: effectiveness of interventions carried out in studies with low, moderate, or high risk of bias for PTSD.
Figure 7.
Figure 7.
a. Sensitivity analysis: effectiveness of interventions carried out in studies with low, moderate, or high risk of bias for anxiety. b. Sensitivity analysis: effectiveness of interventions carried out in studies with low, moderate, or high risk of bias for depression. c. Sensitivity analysis: effectiveness of interventions carried out in studies with low, moderate, or high risk of bias for PTSD.
Figure 8.
Figure 8.
a. Sensitivity analysis: effectiveness of interventions carried out in studies carried out as either RCTs or CCTs on anxiety. b. Sensitivity analysis: effectiveness of interventions carried out in studies carried out as either RCTs or CCTs on depression. c. Sensitivity analysis: effectiveness of interventions carried out in studies carried out as either RCTs or CCTs on PTSD.
Figure 8.
Figure 8.
a. Sensitivity analysis: effectiveness of interventions carried out in studies carried out as either RCTs or CCTs on anxiety. b. Sensitivity analysis: effectiveness of interventions carried out in studies carried out as either RCTs or CCTs on depression. c. Sensitivity analysis: effectiveness of interventions carried out in studies carried out as either RCTs or CCTs on PTSD.
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