Evidence of scalable psychological interventions for forcibly displaced persons: A systematic review

There is evidence to suggest that simplified and lay facilitated psychological interventions could contribute to reducing human resource for mental health shortages and disparities among forcibly displaced migrants. The review aimed to identify the evidence for the effectiveness of scalable psychological interventions for this sub-populations and the barriers and facilitators to their implementation. A systematic review was conducted, using peer-reviewed evidence published up until September 2017. Quantitative and mixed methods intervention studies were screened from Medline, Embase, Scopus, PsychINFO and CINAHL. Only English-language studies in which non-specialists administered the intervention were included. Narrative synthesis was used to analyse the study findings on effectiveness and the barriers and facilitators to implementation were identified through thematic analysis. Out of 2,766 relevant citations and abstracts screened, 13 met the inclusion criteria. We found high quality evidence with mixed results on the effectiveness of Narrative Exposure Therapy in reducing PTSD symptoms in children and adults. Medium-high quality evidence was found for the effectiveness of parenting skills interventions in reducing children’s behavioural problems and for interventions with components of Cognitive Behavioural Therapy in reducing psychological distress. High-quality evidence was also found for a simplified version of IPT-G administered by lay facilitators indicating significant reductions in depression symptoms among adolescent among girls, but not boys, aged 14-17 years. We also found medium-high quality evidence showing no effect of psycho-education in reducing psychological distress. Cultural adaptation was identified as a facilitator to implementation and the training of non-specialists was described as both a barrier and facilitator. There is scarce but good quality evidence for the effectiveness of scalable psychological interventions for forcibly displaced persons. Further research on the effectiveness of these interventions on adults is urgently needed. Future studies should detail the process of adapting the training material, the supervision, and training received by non-specialists to assess fidelity, allow future replications, and facilitate scale-up.