BACKGROUND: An unprecedented number of people around the world are experiencing forced displacement due to natural or man-made events. More than 50% of refugees worldwide are children or adolescents. In addition to the challenges of settling in a new country, many have witnessed or experienced traumatic events. Therefore, refugee children and adolescents are at risk of developing mental health problems such as post-traumatic stress disorder, and require appropriate and effective support within communities.
OBJECTIVES: To assess the effectiveness and acceptability of community-based interventions (RCTs only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post-traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high-income countries.
SEARCH METHODS: Databases searches included the Cochrane Common Mental Disorders Controlled Trials Register (all available years), CENTRAL/CDSR (2021, Issue 2), Ovid MEDLINE, Embase, six other databases, and two trials registries to 21 February 2021. We checked reference lists of included study reports. SELECTION CRITERIA: Studies of any design were eligible as long as they included child or adolescent refugees and evaluated a community-based mental health intervention in a high-income country. At a second stage, we selected randomised controlled trials.
DATA COLLECTION AND ANALYSIS: For randomised controlled trials, we extracted data relating to the study and participant characteristics, and outcome data relating to the results of the trial. For studies using other evaluation methods, we extracted data relating to the study and participant characteristics. W derived evidence on the efficacy and availability of interventions from the randomised controlled trials only. Data were synthesised narratively.
MAIN RESULTS: We screened 5005 records and sought full-text manuscripts of 62 relevant records. Three randomised controlled trials were included in this review. Key concerns in the risk of bias assessments included a lack of clarity about the randomisation process, potential for bias is outcome measurement, and risk of bias in the selection of results. Primary outcomes There was no evidence of an effect of community-based interventions when compared with a waiting list for symptoms of post-traumatic stress (mean difference (MD) -1.46, 95% confidence interval (CI) -6.78 to 3.86: 1 study; low-certainty evidence), symptoms of depression (MD 0.26, 95% CI -2.15 to 2.67: 1 study; low-certainty evidence), and psychological distress (MD -10.5, 95% CI -47.94 to 26.94; 1 study; very low-certainty evidence). There were no data on adverse events. Secondary outcomes Three trials reported on short-term changes in child behaviour, using different measures, and found no evidence of an effect of the intervention versus a waiting list (low to very low certainty). None of the trials reported on quality of life or well-being, participation and functioning, or participant satisfaction.
AUTHORS' CONCLUSIONS: There is insufficient evidence to determine the efficacy and acceptability of community-based mental health interventions for refugee children and adolescents.
Bibliographical noteFunding Information:
Sponsorship source: research was supported by BRIS and formed part of a wider project funded by the KavliTrust (Grant: ID: A-321629)
Sponsorship source: Robert Wood Johnson Foundation through the Caring Across Communities Initiative and by the Substance Abuse Mental Health Services Administration
Sponsorship source: financing of participant incentives was supported by ProFOR+, a funding programme of the Catholic University of Eichstätt-Ingolstadt. The publication of this work was supported by the German Research Foundation (DFG) within the funding programme Open Access Publishing.
Sponsorship source: Blue Cross Blue Shield of Michigan Foundation Student Award (Lana Ruvolo Grasser), Blue Cross Blue Shield of Michigan Foundation Physician Investigator Award (Arash Javan-bakht), Detroit Medical Center Foundation Grant (Arash Javanbakht), and State of Michigan Lyca-ki/Young Foundation (Arash Javanbakht).
Sponsorship source: Ideas for Life Foundation, Skandia and the National Public Health Agency, #20161220 as well as the joint grant from FORMAS, Vetenskapsrådet, FAS and VINNOVA (Grant number 259-2012-68)
Sponsorship source: research funded by a Social Sciences and Humanities Research Council (SSHRC) grant.
Cochrane Common Mental Disorders (CCMD) supported the authors in the development of this review. We are grateful to the CCMD editorial team for guidance provided during review production. The following people conducted the editorial process for this article. Sign-off Editor (final editorial decision): Nick Meader, University of Newcastle. Managing Editor (selected peer reviewers, collated peer-reviewer comments, provided editorial guidance to authors, edited the article): Jessica Hendon, CCMD, Centre for Reviews and Dissemination, University of York. Information Specialist (developed the search strategies, provided editorial guidance to authors, edited the article): Sarah Dawson, CCMD and University of Bristol. Peer-reviewers (provided comments and recommended an editorial decision): Markus Kösters, Department of Psychiatry II, Ulm University (content review); Claire Allen, Operations Manager, Evidence Aid (consumer review); Kerry Dwan, Cochrane Central Methods Unit (methods review); Lindsay Robertson, CCMD, Centre for Reviews and Dissemination, University of York (methods review). Copy Editor (copy-editing and production): Anne Lawson The authors and the CCMD Editorial Team are grateful to the peer reviewers for their time and comments. They would also like to thank Cochrane Copy Edit Support for the team's help. We thank those who translated studies for us: Filip Lyng Lindgren, MD (Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark); Dr Connor TA Brenna (Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto (ON), Canada); Mohammed Altameemi, MD. Filip Lyng Lindgren, MD (Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark); Dr Connor TA Brenna (Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto (ON), Canada); Mohammed Altameemi, MD. We also thank the authors of primary studies who responded to our requests for information about their studies. Cochrane Review Group funding acknowledgement: the National Institute for Health Research (NIHR) is the largest single funder of the CCMD Group. Disclaimer: the views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the NIHR, the National Health Service, or the Department of Health and Social Care.
Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
- Developed Countries
- Mental Health
- Quality of Life