New review looks at community-based interventions for improving mental health in refugee children and teenagers in high-income countries
Dr Noortje Uphoff shares the latest findings from a new Cochrane review on community-based interventions for improving mental health in refugee children and adolescents in high-income countries…
It has been six months since the Russian invasion of Ukraine. The latest reports estimate around 4 million Ukrainian people have fled their homes to find refuge in European Union countries and the United Kingdom. This has highlighted the need for robust evidence on how best to support the mental health needs of refugees, including children and adolescents.
A new Cochrane review out this month explores the evidence for mental health support for young refugees in high-income countries. The authors focused on evidence from randomised controlled trials. Only three trials, with teenage participants in Germany and Australia, were identified.
The interventions evaluated in these trials were:
music therapy,
Stabilization Training to help young people stabilise and cope with their symptoms,
a trauma-based psychological therapy called Teaching Recovery Techniques.
Key findings
There was no evidence that these interventions could improve mental health symptoms when compared to a waiting list group. There was no difference between the interventions and a waiting list for symptoms of post-traumatic stress, depression, psychological distress, or behavioural problems. For all outcomes, the review authors had low to very low confidence in the results being accurate and trustworthy.
What’s next?
The review authors suggest that the quality of research in this field should be improved. This is not an easy task. Researchers will need to consider carefully how to make participation in a trial possible for young people who may be traumatised, not in long-term housing, reluctant to take part in a mental health study, and who may not speak the language of the host country. The review authors also highlight issues with the evidence that could be resolved more easily, such as clear reporting of participant characteristics and the aim and target of interventions. This would make it easier to interpret evidence and to combine results from different studies together in a systematic review.
Until evidence from more robust randomised controlled trials are available, people commissioning and delivering mental health services may need to borrow from other sources. The review identified 35 non-randomised studies, and these may offer insights into working mechanisms of mental health support services and barriers and facilitators of successful implementation.
The review authors conclude:
‘Evidence from global mental health may offer insights into community-based mental health interventions that may be effective and acceptable. For example, interventions using trans-diagnostic approaches and treatment and prevention provided by primary care workers seem promising in settings with limited resources.’
The need for evidence to inform the commissioning and provision of specialist mental health services for refugees was always there. The war in Europe might be the sobering reality check we need to direct our efforts towards building the evidence base for mental health support for this vulnerable group of people.
