Background
Methods
Data source and search strategy
Quality assessment
Data extraction and presentation
Results
Quality assessment of included studies
Study | 1. Priori design provided | 2. Duplicate study selection and data extraction | 3. Comprehensive literature search | 4. Status of publication an inclusion criteria | 5. List of studies provided (included and excluded) | 6. Characteristics of studies provided | 7. Scientific quality of studies assessed | 8. Scientific quality used appropriately in formulating conclusions | 9. Appropriate methods used to combine study findings | 10. Likelihood of publication bias assessed | 11. Conflict of interest included | Overall quality rating |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Prevalence | ||||||||||||
Alemi et al. [10] | ✘ | ✘ | ✘ | ✘ | ✔ | ✔ | ✔ | ✘ | ✔b
| ✘ | ✔ | 5/11 (moderate) |
Bogic et al. [17] | ✔a
| ✔ | ✔ | ✔ | ✘ | ✔ | ✔ | ✔ | ✔b
| ✔ | ✔ | 10/11 (high) |
Bronstein and Montgomery [13] | ✔ | ✘ | ✔ | ✔ | ✘ | ✔ | ✔ | ✔ | ✔b
| ✘ | ✘ | 7/11 (moderate) |
Fazel et al. [8] | ✘ | ✘ | ✔ | ✔ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✔ | 5/11 (moderate) |
Keyes [18] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | ✘ | ✘ | ✘ | 2/11 (low) |
Lindert et al. [9] | ✔ | ✘ | ✘ | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | 3/11 (low) |
Mills et al. [14] | ✘ | ✔ | ✔ | ✔ | ✘ | ✔ | ✘ | ✘ | ✔b
| ✘ | ✔ | 6/11 (moderate) |
Mills et al. [15] | ✘ | ✔ | ✔ | ✔ | ✘ | ✔ | ✘ | ✘ | ✔b
| ✘ | ✘ | 5/11 (moderate) |
Quosh et al. [16] | ✘ | ✘ | ✔ | ✔ | ✘ | ✔ | ✘ | ✘ | ✔b
| ✘ | ✘ | 4/11 (low) |
Robjant et al. [11] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | ✘ | ✘ | ✔ | 3/11 (low) |
Slewa-Younan et al. [12] | ✘ | ✔ | ✔ | ✘ | ✘ | ✔ | ✔ | ✔ | ✘ | ✘ | ✘ | 5/11 (moderate) |
Steel et al. [2] | ✘ | ✘ | ✔ | ✘ | ✔ | ✔ | ✘ | ✘ | ✔ | ✔ | ✔ | 6/11 (moderate) |
Storm and Enberg [19] | ✘ | ✔ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | ✔b
| ✘ | ✔ | 5/11 (moderate) |
Intervention | ||||||||||||
Crumlish and O’Rourke [21] | ✘ | ✘ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔b
| ✘ | ✘ | 7/11 (moderate) |
Mc Farlane and Kaplan [22] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✔ | ✘ | ✔b
| ✘ | ✘ | 4/11 (low) |
Nickerson et al. [23] | ✘ | ✘ | ✔ | ✘ | ✔ | ✔ | ✘ | ✘ | ✘ | ✘ | ✘ | 3/11 (low) |
Nosè et al. [20] | ✔ | ✘ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 10/11 (high) |
Palic and Elklit [24] | ✘ | ✘ | ✔ | ✘ | ✔ | ✔ | ✔ | ✘ | ✔b
| ✘ | ✔ | 8/11 (moderate) |
Patel et al. [25] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 11/11 (high) |
Peltonen and Punamäki [26] | ✘ | ✘ | ✘ | ✘ | ✘ | ✔ | ✔ | ✔ | ✔ | ✘ | ✘ | 4/11 (low) |
Robjant and Fazel [27] | ✘ | ✘ | ✔ | ✔ | ✘ | ✔ | ✘ | ✘ | ✘ | ✘ | ✘ | 3/11 (low) |
Slobodin and de Jong [28] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | ✘ | ✘ | ✔ | 3/11 (low) |
Sonne et al. [29] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | ✔b
| ✘ | ✔ | 4/11 (low) |
Sullivan and Simonson [30] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | ✔b
| ✘ | ✘ | 3/11 (low) |
Tyrer and Fazel [31] | ✘ | ✘ | ✔ | ✔ | ✘ | ✔ | ✔ | ✔ | ✔b
| ✘ | ✔ | 7/11 (moderate) |
van Wyk and Schweitzer [32] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✘ | ✘ | ✘ | ✘ | ✘ | 2/11 (low) |
Williams and Thompson [33] | ✘ | ✘ | ✔ | ✘ | ✘ | ✔ | ✔ | ✘ | ✘ | ✘ | ✘ | 3/11 (low) |
Prevalence studies in populations resettled in high-income countries
Systematic reviews | Target population | No studies (patients) | Mental disorders | Prevalence range | Average |
---|---|---|---|---|---|
Alemi et al. [10] | Afghan asylum seekers or refugees of all age groups, resettled in western countries, with a length of residence between 3 days and 21 years | 17 (1250) | PTSD | 25.4–50% | Not reported |
Depression | 54.7–57% | ||||
Anxiety | 12–39.3% | ||||
Bogic et al. [17] | Adult war-refugees 5 years or longer after displacement (including a proportion residing outside western countries) | 29 (16,010) | PTSD | 4.4–86% | Not reported |
Depression | 2.3–80% | ||||
Anxiety | 20.3–88% | ||||
Bronstein and Montgomery [13] | Refugee children and adolescents (<25 years) resettled in western countries | 22 (3003) | PTSD | 19–54% | 36.0% |
Depression | 3–30% | 18.0% | |||
Fazel et al. [8] | Refugees of all age groups resettled in western countries | 25 (7003) | PTSDa
| 3–18% | 9.0% (99% CI 8.0–10.0%) |
Depressiona
| 2–10% | 5% (99% CI 4.0–6.0%) | |||
Anxietya
| Not reported | 4% (99% CI 3.0–6.0%) | |||
Keyes [18] | Adult and children refugees resettled in low, middle and high income countries | 12 (2065) | PTSD | 12–86% | Not reported |
Depression | 16–80% | ||||
Anxiety | 6% | ||||
Lindert et al. [9] | Adult and adolescent refugees resettled in low, middle and high income countries | 35 (24,051) | PTSD | 4–68% | 36.0% (95% CI 23.0–49.0%) |
Depression | 3–81% | 44.0% (95% CI 27.0–62.0%) | |||
Anxiety | 5–90% | 40.0% (95% CI 17.0–64.0%) | |||
Mills et al. [14] | Adult and children Tibetan refugees in lower middle income country | 5 (926) | PTSD | 11–23% | Not reported |
Depression | 11.5–57% | ||||
Anxiety | 25–77% | ||||
Mills et al. [15] | Bhutanese torture refugees resettled in refugee camps in Nepal | 6 (4712) | PTSD | 14–43% | Not reported |
Depression | 2–25% | ||||
Anxiety | 4–43% | ||||
Quosh et al. [16] | Adult and children Iraqi and Syrian refugees resettled in lower and upper middle income countries | 44 (about 65,000) | PTSD | 0.2–76.5% | Not reported |
Depression | 16.67–89.5% | ||||
Anxiety | 15.6–81.6% | ||||
Robjant et al. [11] | Adult, adolescent or children detained asylum seekers or refugees resettled in Australia, UK, USA | 10 (877) | PTSD | 27–50% | Not reported |
Depression | 59–100% | ||||
Anxiety | 77% | ||||
Slewa-Younan et al. [12] | Adult Iraqi asylum seekers or refugees resettled in western countries | 8 (2148) | PTSD | 8–37.2% | 25.0% |
Depression | 28.3–75% | 43.0% | |||
Steel et al. [2] | Adult asylum seekers or refugees and other conflict-affected populations resettled in low, middle and high income countries | 161 (81,866) | PTSD | 0–99% | 30.6% (95% CI 26.3–35.2%) |
Depression | 3–85.5% | 30.8% (95% CI 26.3–35.6%) | |||
Storm and Engberg [19] | Adult detained asylum seekers, torture survivors and refugees resettled in low, middle and high income countries | 15 (1716) | PTSD | 50–86% | Not reported |
Depression | 76.4–100% | ||||
Anxiety | 72–77% |
Prevalence studies in populations resettled in low- and middle-income countries
Prevalence studies in populations resettled in low-, middle- and high-income countries
Overall summary of prevalence studies
Efficacy of interventions on PTSD and trauma-related outcomes
Outcomes | Interventions | Comparison | Study design | No of patients | Systematic reviews | ||
---|---|---|---|---|---|---|---|
RCTs | CCTs | Pre-post | |||||
PTSD/trauma-related symptoms | NET | Inactive (N = 8) | ●●●●●●●● | 640 | |||
Supportive counseling, stress inoculation training, trauma counselling (N = 3) | ●●○ | ||||||
Without control group (N = 1) | ▲ | ||||||
KIDNET | Inactive (N = 1) | ● | 26 | ||||
EMDR | Stabilisation (no exposure) (N = 1) | ○ | 20 | Patel et al. [25] | |||
CBT/culturally sensitivity CBT/CPT | Inactive (N = 8) | ●●●●○○ | ■■ | 455 | |||
Exposure therapy (N = 1) | ○ | ||||||
Without control group (N = 3) | ▲▲△ | ||||||
Testimony therapy | Without control group (N = 1) | ▲ | 20 | ||||
Trauma-focused therapy | Inactive (N = 2) | ■■ | 197 | ||||
Child-centered play therapy (N = 1) | ○ | ||||||
Without control group (N = 1) | ▲ | ||||||
Multimodal interventions/multidisciplinary treatments | Without control group (N = 7) | ▲▲▲△△△△ | 248 | ||||
Antidepressantsa
| Without control group (N = 1) | ▲ | 32 | ||||
Antidepressantsb + supportive therapy | Without control group (N = 2) | ▲▲ | 68 | Sonne et al. [29] | |||
Psychotropic medication + psychodinamic therapy | Inactive (N = 1) | 50 | |||||
Anxiety symptoms | NET | Inactive (N = 1) | ○ | 43 | |||
Supportive counseling (N = 1) | ○ | ||||||
EMDR | Stabilisation (no exposure) (N = 1) | ○ | 20 | Patel et al. [25] | |||
CBT/culturally sensitivity CBT/CPT | Inactive (N = 4) | ●●● | 189 | ||||
Exposure therapy (N = 1) | ○ | ■ | |||||
Without control group (N = 2) | ▲△ | ||||||
Multimodal interventions/multidisciplinary treatments | Without control group (N = 6) | ▲▲△△△△ | 218 | ||||
Depressive symptoms | NET | Inactive (N = 5) | ●●○○○ | □ | 250 | ||
Supportive counseling, stress inoculation training (N = 2) | ○○ | ||||||
Without control group (N = 1) | ▲ | ||||||
EMDR | Stabilisation (no exposure) (N = 1) | ○ | 20 | Patel et al. [25] | |||
CBT/culturally Sensitivity CBT/CPT | Inactive (N = 5) | ●●○○ | 389 | ||||
Exposure therapy (N = 1) | ○ | ||||||
Without control group (N = 3) | ▲▲△ | ||||||
Testimony therapy | Without control group (N = 1) | ▲ | 20 | ||||
Multimodal interventions/multidisciplinary treatments | Without control group (N = 7) | ▲▲▲△△△△ | 248 | ||||
Antidepressantsc
| Without control group (N = 1) | 32 |