Interventions on Preventing and Treating Mental Health Problems of Involuntary Migrants: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Qin ¹ , WANG Hong ¹ , WANG Wei ² , ZHANG Fan ¹ , LI Juan ¹ , SONG Wenfeng ¹ , LEI Xun ¹ , LI Lei ¹ ,  WANG Yang ¹

1. School of Public Health, Chongqing Medical University, Chongqing 400016, China; 2. Department of Health Care Management, Weifang Medical University, Shandong 261042, China;

Corresponding author：

WANG Yang, Email: wangyang8289@163.com

Keywords：

Involuntary migrants; Mental health; Intervention

DOI：

10.7507/1672-2531.20090164

Video：

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Objective 　To systematic review the international interventions on mental health of involuntary migrants, and evaluate the effects of different interventions.
Methods 　We searched 10 international electronic databases and 3 grey literature databases to November 2008. Websites of relevant organizations and Google were searched for any missing information. Research papers that reported describing or evaluating any interventions on preventing and treating mental health problems of involuntary migrants were included. Two reviewers independently screened, appraised and extracted the data, disagreements were resolved by discussion. Implemented interventions were summarized and analyzed by qualitative synthesis method. As there was heterogeneity in the type of interventions, study design, and outcomes, the study results were not pooled statistically in meta analysis.
Results 　Of the 35 studies included in the analysis, 16 studies aimed to describe intervention strategies, while 19 studies were to evaluate effectiveness of interventions. The targeted population were mainly refugees and asylum seekers caused by the war, violence and other tortures, while only one study targeted at reservoir migrants. All the psychological interventions were divided into prevention intervention and treatment intervention. The main interventions include: integrated psychological intervention, group treatment, cognitive behavior therapy, testimony, narrative exposure therapy, supportive counseling service, family support and therapy, etc. Of which, integrated psychological interventions are the most common intervention. Most of the studies evaluating effectiveness are observational studies, while only six are controlled trials. The results of most evaluation studies show that the implemented psychological interventions have positive impact on mental health of involuntary migrants.
Conclusions 　There are limited intervention studies on mental health of involuntary migrants, and evaluation studies are lack of rigorous design. More research especially preventive intervention study is required. High-quality trials with large sample and rigorous design are needed to evaluate the most effective psycho-interventions for different groups of involuntary migrants.

Citation： LIU Qin,WANG Hong,WANG Wei,ZHANG Fan,LI Juan,SONG Wenfeng,LEI Xun,LI Lei,WANG Yang. Interventions on Preventing and Treating Mental Health Problems of Involuntary Migrants: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(9): 929-937. doi: 10.7507/1672-2531.20090164 Copy

1.	联合国世界移民趋势报告: 中国成新兴目的国. 中国经济网, 2006, 6: http://news.xinhuanet.com/newscenter/2006-06/08/ content_4663370.htm.
2.	Harpham T. Urbanization and mental health in developing countries: a research role for social scientists, public health professionals and social psychiatrists. Social Science & Medicine, 1994, 39(2): 233-245.
3.	Pernice R, Trlin A, Henderson A, et al. Employment and mental health of three groups of immigrants to New Zealand. New Zealand Journal of Psychology, 2000, 29(1): 24-29.
4.	Bhugra D. Migration and schizophrenia. Acta Psychiatrica Scandinavica. Supplementum, 2000, 102: 68-73.
5.	Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Journal of American Medical Association, 2005, 294: 602-612.
6.	Scudder T, Colson E. Involuntary migration and resettlement: the pattern and responses of dislocated people. Westview Press, 1982: 269.
7.	Bhugra D, Jones P. Migration and mental health. Advances in Psychiatric Treatment, 2001, 7: 216-222.
8.	Hodes M. Psychologically distressed refugee children in the United Kingdom. Child Psychology and Psychiatry Review, 2000, 5: 57-68. 9 Weine SM, Dzubur Kulnovic A, Pavkovic I, et al. Testimony psychotherapy in Bosnian refugees: A pilot study. Am J Psychiatry, 1998, 155: 1720-1726. 10 宋英. 心理辅导解决移民心理问题对照研究. 中国公共卫生, 2006, 22(2): 140-141. 11 Nicholl C, Thompson A. The psychological treatment of post traumatic stress disorder (PTSD) in adult refugees: A review of the current state of psychological therapies. Journal of Mental Health, 2004, 13(4): 351-362.
9.	Ehntholt KA, Yule W. Practitioner Review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychology and Psychiatry, 2006, 47(12): 1197-1210.
10.	Williams CL, Berry JW. Primary prevention of acculturative stress among refugees: application of psychological theory and practice. American Psychologist, 1991, 46(6): 632-641.
11.	Hoffpauir SA, Woodruff LA. Effective Mental Health Response to Catastrophic Events: Lessons Learned From Hurricane Katrina. Family & Community Health, 2008, 31(1): 17-22.
12.	Birman D, Beehler S, Harris EM, et al. International family, adult, and child enhancement services (FACES): A community-based comprehensive services model for refugee children in resettlement. American Journal of Orthopsychiatry, 2008, 78(1): 121-132.
13.	Kinzie JD, Leung P, Bui A, et al. Group Therapy with Southeast Asian Refugees. Community Mental Health Journal, 1988, 24(2): 157-166.
14.	Nicholson BL, Kay DM. Group treatment of traumatized Cambodian women: A culture-specific approach. Social Work, 1999, 44(5): 470-479.
15.	Stevan MW, Alma DK, Ivan P, et al. Testimony Psychotherapy in Bosnian Refugees: A Pilot Study. Am J Psychiatry, 1998, 155: 1720-1726.
16.	Gafner G, Benson S. Indirect Ego-Strengthening in Treating PTSD in Immigrants from Central America. Contemporary Hypnosis, 2001, 18 (3): 135-144.
17.	Jaranson JM, Bamford P. Program Models for Mental Health Treatment of Refugees. Report 1987.
18.	Schulz PM, Resick PA, Huber LC, et al. The Effectiveness of Cognitive Processing Therapy for PTSD with Refugees in a Community Setting. Cognitive and Behavioral Practice, 2006, 13(4): 322-331.
19.	Khamphakdy-Brown S, Jones LN, Nilsson JE, et al. The Empowerment Program: An Application of an Outreach Program for Refugee and Immigrant Women. Journal of Mental Health Counseling, 2006, 28(1): 38-47.
20.	Boehnlein JK, Kinzie JD, Sekiya U, et al. A Ten-Year Treatment Outcome Study of Traumatized Cambodian Refugees. The Journal of Nervous and Mental Disease, 2004, 192(10): 658-663.
21.	Fischman Y, Ross J. Group Treatment of Exiled Survivors of Torture. American Journal of Orthopsychiatry, 1990, 60(1): 135-142.
22.	Hinton DE, Chhean D, Pich V, et al. A Randomized Controlled Trial of Cognitive-Behavior Therapy for Cambodian Refugees With Treatment-Resistant PTSD and Panic Attacks: A Cross-Over Design. Journal of Traumatic Stress, 2005, 18(6): 617-629.
23.	Moore LJ, Boehnlein JK. Treating psychiatric disorders among Mien refugees from highland Laos. Soc Sci Med, 1991, 32(9): 1029-1036.
24.	Weine SM, Raina DJ, Zhubi M, et al. The Tafes Multi-family Group Intervention for Kosovar Refugee: A Feasibility Study. The Journal of Nervous and Mental Disease, 2003, 191(2): 100-107.
25.	Nieves-Grafals S. Brief therapy of civil war-related trauma: a case study. Cultur Divers Ethnic Minor Psychol, 2001, 7(4): 387-398.
26.	Oras R, Ezpeleta SC, Ahmad A. Treatment of traumatized refugee children with Eye Movement Desensitization and Reprocessing in a psychodynamic context. Nordic Journal of Psychiatry, 2004, 58(3): 199-203.
27.	Basoglu M, Ekblad S, Ba ̈a ̈rnhielm S, et al. Cognitive-behavioral treatment of tortured asylum seekers: a case study. Journal of Anxiety Disorders, 2004, 18(3): 357-369. 31Rousseau C, Drapeau A, Lacroix L, et al. Evaluation of a classroom program of creative expression workshops for refugee and immigrant children. Journal of Child Psychology and Psychiatry, 2005, 46: 2, 180-185.
28.	Rousseau C, Benoit M, Gauthier MF, et al. Classroom Drama Therapy Program for Immigrant and Refugee Adolescents: A Pilot Study. Clinical Child Psychology and Psychiatry, 2007, 12(3): 451-465.
29.	Luebben S. Testimony work with Bosnian refugees: living in legal limbo. British Journal of Guidance & Counselling, 2003, 31(4): 393-402.
30.	Mohlen H, Parzer P, Resch F, et al. Psychosocial support for war- traumatized child and adolescent refugees: evaluation of a short term treatment program. Australian & New Zealand Journal of Psychiatry, 2005, 39(1-2): 81-87.
31.	O’Shea B, Hodes M, Down G, et al. A School-based Mental Health Service for Refugee Children. Clinical Child Psychology & Psychiatry, 2000, 5(2): 189-201.
32.	Barrett PM, Moore AF, Sonderegger R. The FRIENDS program for young former-Yugoslavian refugees in Australia: A pilot study. Behaviour Change, 2000, 17(3): 124-133.
33.	Carlsson JM, Mortensen EL, Kastrup M. A Follow-Up Study of Mental Health and Health-Related Quality of Life in Tortured Refugees in Multidisciplinary Treatment. The Journal of Nervous and Mental Disease, 2005, 193(10): 651-657.
34.	VanDijk JA, Schoutrop MJA, Spinhoven P. Testimony therapy: Treatment method for traumatized victims of organized violence. American Journal of Psychotherapy, 2003. 57(3): 361-373.
35.	Betancourt TS. Stressors, supports and the social ecology of displacement: Psychosocial dimensions of an emergency education program for Chechen adolescents displaced in Ingushetia, Russia. Culture Medicine and Psychiatry, 2005, 29(3): 309-340.
36.	Miller KE, Billings DL. Playing to Grow: A Primary Mental Health Intervention With Guatemalan Refugee Children. American Journal of Orthopsychiatry, 1994, 64(3): 346-356.
37.	Ley K. Bread and roses: supporting refugee women in a multicultural group. Intervention, 2006, 4(1): 47-52.
38.	Tribe R, Silva PD. Psychological intervention with displaced widows in Sri Lanka. International Review of Psychiatry, 1999, 11(2/3): 184-190.
39.	Onyut LP, Neuner F, Schauer E, et al. The Nakivale Camp Mental Health Project: Building local competency for psychological assistance to traumatised refugees. Intervention: International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 2004, 2(2): 90-107.
40.	Onyut LP, Neuner F, Schauer E, et al. Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: two case reports and a pilot study in an African refugee settlement. Bmc Psychiatry, 2005, 5: 7.
41.	Neuner F, Schauer M, Klaschik C, et al. A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement. Journal of Consulting and Clinical Psychology, 2004, 72(4): 579-587.
42.	Gupta L, Zimmer C. Psychosocial intervention for war-affected children in Sierra Leone. The British Journal of Psychiatry, 2008, 192(3): 212-216.
43.	Stepakoff S, Hubbard J, Katoh M, et al. Trauma healing in refugee camps in Guinea: A psychosocial program for Liberian and Sierra Leonean survivors of torture and war. American Psychologist, 2006, 61(8): 921-932.
44.	Prilleltensky JS. Cultural diversity and mental health. Towards integrative practice. Clinical Psychology Review, 2002, 22(8): 1133-1154.
45.	Brune M, Haasen C, Krausz M, et al. Belief systems as coping factors for traumatised refugees: A pilot study. European Psychiatry, 2002, 17: 451-458.
46.	Veer Van der G. Counseling and therapy with refugees and victims of trauma. 1998, 2nd edn. London: Wiley & Sons.
47.	Watters C. Emerging paradigms in the mental health care of refugees. Social Science and Medicine, 2001, 52: 1709-1718.
48.	Summerfield D. Asylum seekers, refugees and mental health services in the UK. Psychiatric Bulletin, 2001, 25: 161-163.

1. 联合国世界移民趋势报告: 中国成新兴目的国. 中国经济网, 2006, 6: http://news.xinhuanet.com/newscenter/2006-06/08/ content_4663370.htm.
2. Harpham T. Urbanization and mental health in developing countries: a research role for social scientists, public health professionals and social psychiatrists. Social Science & Medicine, 1994, 39(2): 233-245.
3. Pernice R, Trlin A, Henderson A, et al. Employment and mental health of three groups of immigrants to New Zealand. New Zealand Journal of Psychology, 2000, 29(1): 24-29.
4. Bhugra D. Migration and schizophrenia. Acta Psychiatrica Scandinavica. Supplementum, 2000, 102: 68-73.
5. Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Journal of American Medical Association, 2005, 294: 602-612.
6. Scudder T, Colson E. Involuntary migration and resettlement: the pattern and responses of dislocated people. Westview Press, 1982: 269.
7. Bhugra D, Jones P. Migration and mental health. Advances in Psychiatric Treatment, 2001, 7: 216-222.
8. Hodes M. Psychologically distressed refugee children in the United Kingdom. Child Psychology and Psychiatry Review, 2000, 5: 57-68. 9 Weine SM, Dzubur Kulnovic A, Pavkovic I, et al. Testimony psychotherapy in Bosnian refugees: A pilot study. Am J Psychiatry, 1998, 155: 1720-1726. 10 宋英. 心理辅导解决移民心理问题对照研究. 中国公共卫生, 2006, 22(2): 140-141. 11 Nicholl C, Thompson A. The psychological treatment of post traumatic stress disorder (PTSD) in adult refugees: A review of the current state of psychological therapies. Journal of Mental Health, 2004, 13(4): 351-362.
9. Ehntholt KA, Yule W. Practitioner Review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychology and Psychiatry, 2006, 47(12): 1197-1210.
10. Williams CL, Berry JW. Primary prevention of acculturative stress among refugees: application of psychological theory and practice. American Psychologist, 1991, 46(6): 632-641.
11. Hoffpauir SA, Woodruff LA. Effective Mental Health Response to Catastrophic Events: Lessons Learned From Hurricane Katrina. Family & Community Health, 2008, 31(1): 17-22.
12. Birman D, Beehler S, Harris EM, et al. International family, adult, and child enhancement services (FACES): A community-based comprehensive services model for refugee children in resettlement. American Journal of Orthopsychiatry, 2008, 78(1): 121-132.
13. Kinzie JD, Leung P, Bui A, et al. Group Therapy with Southeast Asian Refugees. Community Mental Health Journal, 1988, 24(2): 157-166.
14. Nicholson BL, Kay DM. Group treatment of traumatized Cambodian women: A culture-specific approach. Social Work, 1999, 44(5): 470-479.
15. Stevan MW, Alma DK, Ivan P, et al. Testimony Psychotherapy in Bosnian Refugees: A Pilot Study. Am J Psychiatry, 1998, 155: 1720-1726.
16. Gafner G, Benson S. Indirect Ego-Strengthening in Treating PTSD in Immigrants from Central America. Contemporary Hypnosis, 2001, 18 (3): 135-144.
17. Jaranson JM, Bamford P. Program Models for Mental Health Treatment of Refugees. Report 1987.
18. Schulz PM, Resick PA, Huber LC, et al. The Effectiveness of Cognitive Processing Therapy for PTSD with Refugees in a Community Setting. Cognitive and Behavioral Practice, 2006, 13(4): 322-331.
19. Khamphakdy-Brown S, Jones LN, Nilsson JE, et al. The Empowerment Program: An Application of an Outreach Program for Refugee and Immigrant Women. Journal of Mental Health Counseling, 2006, 28(1): 38-47.
20. Boehnlein JK, Kinzie JD, Sekiya U, et al. A Ten-Year Treatment Outcome Study of Traumatized Cambodian Refugees. The Journal of Nervous and Mental Disease, 2004, 192(10): 658-663.
21. Fischman Y, Ross J. Group Treatment of Exiled Survivors of Torture. American Journal of Orthopsychiatry, 1990, 60(1): 135-142.
22. Hinton DE, Chhean D, Pich V, et al. A Randomized Controlled Trial of Cognitive-Behavior Therapy for Cambodian Refugees With Treatment-Resistant PTSD and Panic Attacks: A Cross-Over Design. Journal of Traumatic Stress, 2005, 18(6): 617-629.
23. Moore LJ, Boehnlein JK. Treating psychiatric disorders among Mien refugees from highland Laos. Soc Sci Med, 1991, 32(9): 1029-1036.
24. Weine SM, Raina DJ, Zhubi M, et al. The Tafes Multi-family Group Intervention for Kosovar Refugee: A Feasibility Study. The Journal of Nervous and Mental Disease, 2003, 191(2): 100-107.
25. Nieves-Grafals S. Brief therapy of civil war-related trauma: a case study. Cultur Divers Ethnic Minor Psychol, 2001, 7(4): 387-398.
26. Oras R, Ezpeleta SC, Ahmad A. Treatment of traumatized refugee children with Eye Movement Desensitization and Reprocessing in a psychodynamic context. Nordic Journal of Psychiatry, 2004, 58(3): 199-203.
27. Basoglu M, Ekblad S, Ba ̈a ̈rnhielm S, et al. Cognitive-behavioral treatment of tortured asylum seekers: a case study. Journal of Anxiety Disorders, 2004, 18(3): 357-369. 31Rousseau C, Drapeau A, Lacroix L, et al. Evaluation of a classroom program of creative expression workshops for refugee and immigrant children. Journal of Child Psychology and Psychiatry, 2005, 46: 2, 180-185.
28. Rousseau C, Benoit M, Gauthier MF, et al. Classroom Drama Therapy Program for Immigrant and Refugee Adolescents: A Pilot Study. Clinical Child Psychology and Psychiatry, 2007, 12(3): 451-465.
29. Luebben S. Testimony work with Bosnian refugees: living in legal limbo. British Journal of Guidance & Counselling, 2003, 31(4): 393-402.
30. Mohlen H, Parzer P, Resch F, et al. Psychosocial support for war- traumatized child and adolescent refugees: evaluation of a short term treatment program. Australian & New Zealand Journal of Psychiatry, 2005, 39(1-2): 81-87.
31. O’Shea B, Hodes M, Down G, et al. A School-based Mental Health Service for Refugee Children. Clinical Child Psychology & Psychiatry, 2000, 5(2): 189-201.
32. Barrett PM, Moore AF, Sonderegger R. The FRIENDS program for young former-Yugoslavian refugees in Australia: A pilot study. Behaviour Change, 2000, 17(3): 124-133.
33. Carlsson JM, Mortensen EL, Kastrup M. A Follow-Up Study of Mental Health and Health-Related Quality of Life in Tortured Refugees in Multidisciplinary Treatment. The Journal of Nervous and Mental Disease, 2005, 193(10): 651-657.
34. VanDijk JA, Schoutrop MJA, Spinhoven P. Testimony therapy: Treatment method for traumatized victims of organized violence. American Journal of Psychotherapy, 2003. 57(3): 361-373.
35. Betancourt TS. Stressors, supports and the social ecology of displacement: Psychosocial dimensions of an emergency education program for Chechen adolescents displaced in Ingushetia, Russia. Culture Medicine and Psychiatry, 2005, 29(3): 309-340.
36. Miller KE, Billings DL. Playing to Grow: A Primary Mental Health Intervention With Guatemalan Refugee Children. American Journal of Orthopsychiatry, 1994, 64(3): 346-356.
37. Ley K. Bread and roses: supporting refugee women in a multicultural group. Intervention, 2006, 4(1): 47-52.
38. Tribe R, Silva PD. Psychological intervention with displaced widows in Sri Lanka. International Review of Psychiatry, 1999, 11(2/3): 184-190.
39. Onyut LP, Neuner F, Schauer E, et al. The Nakivale Camp Mental Health Project: Building local competency for psychological assistance to traumatised refugees. Intervention: International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 2004, 2(2): 90-107.
40. Onyut LP, Neuner F, Schauer E, et al. Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: two case reports and a pilot study in an African refugee settlement. Bmc Psychiatry, 2005, 5: 7.
41. Neuner F, Schauer M, Klaschik C, et al. A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement. Journal of Consulting and Clinical Psychology, 2004, 72(4): 579-587.
42. Gupta L, Zimmer C. Psychosocial intervention for war-affected children in Sierra Leone. The British Journal of Psychiatry, 2008, 192(3): 212-216.
43. Stepakoff S, Hubbard J, Katoh M, et al. Trauma healing in refugee camps in Guinea: A psychosocial program for Liberian and Sierra Leonean survivors of torture and war. American Psychologist, 2006, 61(8): 921-932.
44. Prilleltensky JS. Cultural diversity and mental health. Towards integrative practice. Clinical Psychology Review, 2002, 22(8): 1133-1154.
45. Brune M, Haasen C, Krausz M, et al. Belief systems as coping factors for traumatised refugees: A pilot study. European Psychiatry, 2002, 17: 451-458.
46. Veer Van der G. Counseling and therapy with refugees and victims of trauma. 1998, 2nd edn. London: Wiley & Sons.
47. Watters C. Emerging paradigms in the mental health care of refugees. Social Science and Medicine, 2001, 52: 1709-1718.
48. Summerfield D. Asylum seekers, refugees and mental health services in the UK. Psychiatric Bulletin, 2001, 25: 161-163.

Chinese Journal of Evidence-Based Medicine

Interventions on Preventing and Treating Mental Health Problems of Involuntary Migrants: A Systematic Review

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