Nadia A Daniel, Xin Liu, Elizabeth T Thomas, Emily Eraneva-Dibb, Al-Maz Ahmad, Carl Heneghan
{"title":"基于CBT的简短心理干预,改善难民群体的心理健康结果:系统回顾和荟萃分析。","authors":"Nadia A Daniel, Xin Liu, Elizabeth T Thomas, Emily Eraneva-Dibb, Al-Maz Ahmad, Carl Heneghan","doi":"10.1080/20008066.2024.2389702","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> Refugees, asylum seekers, and internally displaced people experience a high burden of mental health problems owing to their experiencing traumas and stressful events.<b>Objective:</b> 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.<b>Method:</b> 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.<b>Results:</b> 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.<b>Conclusion:</b> 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. 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引用次数: 0
摘要
背景:难民、寻求庇护者和境内流离失所者由于经历创伤和压力事件,心理健康问题的负担很重:总结现有证据,分析简短心理干预(小于 3 个月)对改善难民心理健康结果(包括抑郁、焦虑和创伤后应激障碍 (PTSD) 相关症状)的效果:我们检索了 Medline、EMBASE、PsycINFO、CINAHL 和 Global Index Medicus 从开始到 2023 年 12 月 19 日的资料。我们纳入了使用任何认知行为疗法(CBT)或基于 CBT 的短期疗法(< 3 个月)的对照研究,这些研究报告了干预前后的心理健康结果。我们使用随机效应进行了荟萃分析,得出了汇总统计结果。证据质量采用 Cochrane Risk of Bias (RoB2) 和 ROBINS-I 工具进行评估。本研究已在开放科学框架(Open Science Framework)上注册,DOI 10.17605/OSF.IO/9CXU4.Results:检索了 37 份出版物中 34 项符合条件的研究,其中 33 项研究共 4479 名参与者被纳入荟萃分析。通过对 13 项焦虑结果研究(SMD-1.12,95% CI -1.72 至 -0.52)、20 项抑郁研究(SMD-1.04,95% CI -1.97 至 -0.11)和 24 项创伤后应激障碍研究(SMD -0.82,95% CI -1.20 至 -0.45)的分析,所有三个领域的即时心理健康结果均有总体改善。然而,在3至6个月的随访中,心理健康结果分析显示与基线相比没有显著变化,4项研究的SMD为0.24(95% CI -0.94至1.42),9项研究的SMD为-0.73(95% CI -2.14至0.68),12项研究的焦虑、抑郁和创伤后应激障碍的SMD分别为0.29(95% CI -0.94至1.53):低质量的证据显示,简短的心理干预对难民和境内流离失所者的心理健康有积极的直接影响。结论:低质量的证据显示,简短的心理干预措施对难民和境内流离失所者的心理健康有积极的直接影响,但这些影响在短期的后续治疗中不会持续。即使在亚群体中,异质性也很高,这影响了我们研究结果的普遍性。
Brief CBT-based psychological interventions to improve mental health outcomes in refugee populations: a systematic review and meta-analysis.
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.
期刊介绍:
The European Journal of Psychotraumatology (EJPT) is a peer-reviewed open access interdisciplinary journal owned by the European Society of Traumatic Stress Studies (ESTSS). The European Journal of Psychotraumatology (EJPT) aims to engage scholars, clinicians and researchers in the vital issues of how to understand, prevent and treat the consequences of stress and trauma, including but not limited to, posttraumatic stress disorder (PTSD), depressive disorders, substance abuse, burnout, and neurobiological or physical consequences, using the latest research or clinical experience in these areas. The journal shares ESTSS’ mission to advance and disseminate scientific knowledge about traumatic stress. Papers may address individual events, repeated or chronic (complex) trauma, large scale disasters, or violence. Being open access, the European Journal of Psychotraumatology is also evidence of ESTSS’ stand on free accessibility of research publications to a wider community via the web. The European Journal of Psychotraumatology seeks to attract contributions from academics and practitioners from diverse professional backgrounds, including, but not restricted to, those in mental health, social sciences, and health and welfare services. Contributions from outside Europe are welcome. The journal welcomes original basic and clinical research articles that consolidate and expand the theoretical and professional basis of the field of traumatic stress; Review articles including meta-analyses; short communications presenting new ideas or early-stage promising research; study protocols that describe proposed or ongoing research; case reports examining a single individual or event in a real‑life context; clinical practice papers sharing experience from the clinic; letters to the Editor debating articles already published in the Journal; inaugural Lectures; conference abstracts and book reviews. Both quantitative and qualitative research is welcome.