Article Text

A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD
  1. Giulia Turrini1,
  2. Federico Tedeschi1,
  3. Pim Cuijpers2,
  4. Cinzia Del Giovane3,
  5. Ahlke Kip4,
  6. Nexhmedin Morina4,
  7. Michela Nosè1,
  8. Giovanni Ostuzzi1,
  9. Marianna Purgato1,
  10. Chiara Ricciardi1,
  11. Marit Sijbrandij2,
  12. Wietse Tol5,6,7,
  13. Corrado Barbui1
  1. 1Cochrane Global Mental Health and WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
  2. 2Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  3. 3Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  4. 4Institute of Psychology, University of Münster, Munster, Germany
  5. 5Section of Global Health, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
  6. 6Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  7. 7Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, New York, USA
  1. Correspondence to Dr Giulia Turrini; giulia.turrini{at}


Introduction Refugees and asylum seekers are vulnerable to common mental disorders, including post-traumatic stress disorder (PTSD). Using a network meta-analysis (NMA) approach, the present systematic review compared and ranked psychosocial interventions for the treatment of PTSD in adult refugees and asylum seekers.

Methods Randomised studies of psychosocial interventions for adult refugees and asylum seekers with PTSD were systematically identified. PTSD symptoms at postintervention was the primary outcome. Standardised mean differences (SMDs) and ORs were pooled using pairwise and NMA. Study quality was assessed with the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was assessed through the Confidence in Network Meta-Analysis application.

Results A total of 23 studies with 2308 participants were included. Sixteen studies were conducted in high-income countries, and seven in low-income or middle-income countries. Most studies were at low risk of bias according to the Cochrane RoB tool. NMA on PTSD symptoms showed that cognitive behavioural therapy (CBT) (SMD=−1.41; 95% CI −2.43 to −0.38) and eye movement desensitisation and reprocessing (EMDR) (SMD=−1.30; 95% CI −2.40 to −0.20) were significantly more effective than waitlist (WL). CBT was also associated with a higher decrease in PTSD symptoms than treatment as usual (TAU) (SMD −1.51; 95% CI −2.67 to −0.36). For all other interventions, the difference with WL and TAU was not significant. CBT and EMDR ranked best according to the mean surface under the cumulative ranking. Regarding acceptability, no intervention had less dropouts than inactive interventions.

Conclusion CBT and EMDR appeared to have the greatest effects in reducing PTSD symptoms in asylum seekers and refugees. This evidence should be considered in guidelines and implementation packages to facilitate dissemination and uptake in refugee settings.

  • mental health & psychiatry
  • public health
  • traumatology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Soumyadeep Bhaumik

  • Contributors GT and CB conceptualised the network meta-analysis and wrote the protocol. GT and CR screened titles and abstracts for inclusion and inspected the full texts for inclusion. GT and CR performed data extraction and quality assessment. GT, MP and MN took part in collecting data. Analysis was performed by FT, CDG and GO. GT wrote the first manuscript draft. CB and MP reviewed it. Successive versions have been written with feedback from PC, AK, NM, MS, WT. All authors read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency, commercial or not-for-profit sectors

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.