Psychosocial interventions for Post-Traumatic Stress Disorder in refugees and asylum seekers

Author/s Giulia Turrini, Corrado Barbui, Michela Nosè
Publishing Year 2017 Issue 2017/3 Language English
Pages 16 P. 51-66 File size 696 KB
DOI 10.3280/RSF2017-003004
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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 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. These data provide an evidence base to inform decisions in clinical practice and policy making, considering that an appropriate treatment is a right of refugees and a way to better adaptation and integration in host country.

Keywords: Refugee, asylum seeker, prevalence, intervention, psychosocial, PTSD.

  1. UNHCR. Global trends. Forced displacement in 2015. Geneva: United Nations High Commissioners for Refugees; 2016.
  2. Jefee-Bahloul H, Bajbouj M, Alabdullah J, Hassan G, Barkil-Oteo A. Mental health in Europe’s Syrian refugee crisis. Lancet Psychiatry 2016; 3(4):315-7. DOI: 10.1016/S2215-0366(16)00014-6
  3. UNHCR. Convention and protocol relating to the status of refugees. Geneva: United Nations High Commissioners for Refugees; 2017.
  4. Miller KE, Rasmussen A. The mental health of civilians displaced by armed conflict: an ecological model of refugee distress. Epidemiology and Psychiatric Sciences 2016; 4;1-10. DOI: 10.1017/S2045796016000172
  5. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 2005; 365: 1309±14. DOI: 10.1016/S0140-6736(05)61027-
  6. Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC International Health and Human Rights 2015; 15: 29.
  7. Slewa-Younan S, Uribe Guajardo MG, Heriseanu A, Hasan T. A Systematic review of post-traumatic stress disorder and depression amongst Iraqi refugees located in western countries. Journal of Immigrant and Minority Health 2015; 17:1231±9.
  8. Li SS, Liddell BJ, Nickerson A. The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports 2016; 18(9):82.
  9. Chen W, Hall BJ, Ling L, Renzaho AM. Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect of postmigration stressors: findings from the first wave data of the BNLA cohort study. Lancet 2017; 4(3):218–29. DOI: 10.1016/S2215-0366(17)30032-9
  10. Tay AK, Rees S, Chen J, Kareth M, Silove D. The structure of post-traumatic stress disorder and complex post-traumatic stress disorder amongst west Papuan refugees. BMC Psychiatry 2015; 7;15:111.
  11. Basoglu M, Livanou M, Crnobaric C. Torture vs other cruel, inhuman, and degrading treatment: is the distinction real or apparent? Archives of General Psychiatry 2007; 64(3):277–85.
  12. Herman JL. Trauma and recovery. New York: Basic Books; 1992.
  13. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Arlington: VA; 1994.
  14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. Arlington: VA; 2013.
  15. Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM, et al. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry 2013; 12(3):198–206.
  16. McDonnell M, Robjant K, Katona C. Complex posttraumatic stress disorder and survivors of human rights violations. Current Opinion in Psychiatry 2013; 26:1–6.
  17. Palic S, Elklit A. Psychosocial treatment of posttraumatic stress disorder in adult refugees: a systematic review of prospective treatment outcome studies and a critique. Journal of Affective Disorders 2011; 131(1-3):8-23.
  18. Turrini G, Purgato M, Ballette F, Nosè M, Ostuzzi G, Barbui C. Common mental disorders in asylum seekers and refugees: umbrella review of prevalence and intervention studies. International Journal of Mental Health Systems 2017; 11:51.
  19. Steel Z, Chey T, Silove D, Marnane C, Bryant R, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. JAMA 2009; 5: 537-549.
  20. Silove D. Treatment of refugees at the crossroads: the need for an evidence base. Australian and New Zealand Journal of Psychiatry 2012; 46: 921-923.
  21. Patel N, Kellezi B, Williams AC. Psychological, social and welfare interventions for psychological health and well-being of torture survivors. The Cochrane Database of Systematic Reviews 2014; 11: CD009317. DOI: 10.1002/14651858.CD009317
  22. Robertson CL, Savik K, Mathiason-Moore M, Mohammed A, Hoffman S. Modeling psychological functioning in refugees. Journal of the American Psychiatric Nurses Association 2016; 22(3):225-32. DOI: 10.1177/1078390316641489
  23. Schick M, Zumwald A, Knopfli B, Nickerson A, Bryant RA, Schnyder U et al. Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees. European Journal of Psychotraumatology 2016; 7: 28057.
  24. Uribe Guajardo MG, Slewa-Younan S, Smith M, Eagar S, Stone G. Psychological distress is influenced by length of stay in resettled Iraqi refugees in Australia. International Journal of Mental Health Systems 2016; 10: 4.
  25. Ullmann E, Barthel A, Tache S, Bornstein A, Licinio J, Bornstein SR. Emotional and psychological trauma in refugees arriving in Germany in 2015. Molecular Psychiatry 2015; 20: 1483±4.
  26. Priebe S, Giacco D, El-Nagib R. Public health aspects of mental health among migrants and refugees: a review of the evidence on mental health care for refugees, asylum seekers and irregular migrants in the WHO European Region (2016).,-asylum-seekers-and-irregular-migrants-inthe-who-european-region-2016.
  27. Schauer M, Neuner F, Elbert T. Narrative exposure therapy: a short term treatment for traumatic stress disorders (2nd edition). Cambridge: Hogrefe Publishing; 2011.
  28. Hinton DE, Rivera EI, Hofmann SG, Barlow DH, Otto MW. Adapting CBT for traumatized refugees and ethnic minority patients: examples from culturally adapted CBT (CA-CBT). Transcultural Psychiatry 2012; 49(2):340-65. DOI: 10.1177/1363461512441595
  29. Shapiro F. Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress Studies 1989; 2: 199–223.
  30. Shapiro F. Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). New York: Guilford Press; 2001.
  31. Shapiro F. Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford Press; 1995.
  32. Nickerson A, Bryant RA, Silove D, Steel Z. A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review 2011; 31(3):399-417.
  33. Nosè M, Ballette F, Bighelli I, Turrini G, Purgato M, Tol W et al. Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis. PLoS One 2017; 12(2):e0171030.
  34. Crumlish N, O’rourke K. A systematic review of treatments for post-traumatic stress disorder among refugees asylum-seekers. The Journal of Nervous and Mental Disease 2010; 198: 237-51.
  35. Gwozdziewycz N, Mehl-Madrona L. Meta-analysis of the use of narrative exposure therapy for the effects of trauma among refugee populations. The Permanente Journal 2013; 17: 70-6. DOI: 10.7812/TPP/12-058
  36. World Health Organization: Guidelines for the Management of Conditions Specifically Related to Stress. Geneva: WHO, 2013.
  37. The National Institute for Health and Care Excellence: Post-traumatic stress disorder: management. 2005.
  38. World Health Organization and United Nations High Commissioner for Refugees: mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO, 2015.
  39. Gazzetta Ufficiale della Repubblica Italiana. Linee guida per la programmazione degli interventi di assistenza e riabilitazione nonché per il trattamento dei disturbi psichici dei titolari dello status di rifugiato e dello status di protezione sussidiaria che hanno subito torture, stupri o altre forme gravi di violenza psicologica, fisica o sessuale (2017).
  40. Inter-Agency Standing Committee (IASC): IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. 2007.
  41. United Nations High Commissioner for Refugees, International Organization for Migration and Mental Health and Psychosocial Support Network: Mental health and Psychosocial Support for Refugees, Asylum Seekers and Migrants on the move in Europe: a Multi-Agency Guidance note. 2015.

  • Feasibility and predictors of change of narrative exposure therapy for displaced populations: a repeated measures design Rina S. Ghafoerkhan, Henriette E. van Heemstra, Willem F. Scholte, Joriene R. J. van der Kolk, Jackie June F. ter Heide, Simone M. de la Rie, Linda M. Verhaak, Evelien Snippe, Paul A. Boelen, in Pilot and Feasibility Studies 69/2020
    DOI: 10.1186/s40814-020-00613-1

Giulia Turrini, Corrado Barbui, Michela Nosè, Psychosocial interventions for Post-Traumatic Stress Disorder in refugees and asylum seekers in "RIVISTA SPERIMENTALE DI FRENIATRIA" 3/2017, pp 51-66, DOI: 10.3280/RSF2017-003004