Examining Psychosocial Interventions for Refugees from Asia: A Meta-Analysis and Systematic Review on Efficacy, Effectiveness, and Cultural Tailoring
Date of Award
Master of Arts (MA)
Antonio Polo, PhD
Anne Saw, PhD
Background: Internally displaced persons (IDPs), refugees, and asylum seekers who have experienced forced migration are at a disproportionate disadvantage of experiencing distress and developing mental health problems. Research on psychosocial interventions for refugees indicated positive findings on symptom improvement in depression, posttraumatic stress disorder, and anxiety. However, previous meta-analyses and systematic reviews have primarily focused on randomized control trials (RCTs) to the exclusion of a large body of intervention research. In addition, many previous reviews have included studies that targeted at specific treatment types (e.g., cognitive behavioral therapy, narrative review therapy) or specific mental diagnoses (e.g., major depressive disorder, posttraumatic stress disorder). Furthermore, limited reviews have focused on Asia-origin refugees regarding treatment outcomes and cultural appropriateness. Refugees originating from Asia face unique challenges prior to, during, and after their resettlement process, but limited literature has examined whether interventions are culturally appropriate for this population.
Methods: The current study provided a comprehensive review of adult-focused interventions aiming at improving refugees’ psychosocial outcomes. RCTs and NRCTs were both evaluated. Article search was conducted in PsycINFO, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), PTSDpubs (formerly Published International Literature of Traumatic Stress [PILOTS]), World Health Organization - Global Index of Medicus, Education: Resources Information Center (ERIC), and ProQuest Dissertations and Theses. The preferred reporting instrument for systematic reviews and meta-analysis (PRISMA) was strictly followed. Meta-analytic synthesis and meta-regression analyses were conducted with outcomes from RCTs, and a narrative review was provided to synthesize outcomes from NRCTs. In addition, cultural tailoring was synthesized in a narrative review to evaluate whether interventions are culturally appropriate for Asia-origin refugees.
Results: An initial search of 23,652 articles were found, and following two more recent searches, a final total of 31 articles were included in the current synthesis (20 RCTs, 11 NRCTs). A total of 3,082 participants were included, with a mean age of 40.31 years (SD = 8.01) and mean resettlement length of 6.32 years (SD = 4.88). A broad range of intervention types were observed, and a narrative review was provided on detailed treatment and participant characteristics. Meta-analytic results indicated that when treatments were compared with control groups, refugees’ psychosocial outcomes across multiple domains significantly improved. However, due to high statistical heterogeneity and publication bias in most outcomes, only depressive symptoms at post-intervention (SMD = -0.42) and posttraumatic stress at follow-up (SMD = -0.52) had statistically significant pooled effect sizes. Moreover, meta-regression findings indicated significant subgroup differences among no-treatment control vs. some-treatment control groups, group vs. individual interventions, and requiring symptom threshold vs. no symptom requirement. A narrative review on NRCTs found similar results that interventions significantly improved refugees’ psychosocial outcomes, though some mixed findings were observed. Regarding cultural tailoring, all reported some cultural tailoring in their treatments, though the extent varied across studies. The most commonly tailored treatment components included language adaptation and treatment content tailoring.
Discussion: Findings indicated that evaluated interventions significantly improve Asia-origin refugees’ psychosocial outcomes. We also found that all interventions were tailored for refugees and their cultural backgrounds. Future research is needed to better assess efficacy and effectiveness of interventions for different psychosocial outcomes and the added benefit of cultural tailoring. Recommendations for researchers and providers are provided in detail.
Sun, Mengxue (Fiona), "Examining Psychosocial Interventions for Refugees from Asia: A Meta-Analysis and Systematic Review on Efficacy, Effectiveness, and Cultural Tailoring" (2022). College of Science and Health Theses and Dissertations. 431.