Understanding Supporting and Hindering Factors in Community-Based Psychotherapy for Refugees: A Realist-Informed Systematic Review

Douglas Gruner, Olivia Magwood, Lissa Bair, Liezl Duff, Shiva Adel and Kevin Pottie
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Douglas Gruner: Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, ON K1G 5Z3, Canada
Olivia Magwood: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
Lissa Bair: Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
Liezl Duff: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
Shiva Adel: Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, ON K1G 5Z3, Canada
Kevin Pottie: Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, ON K1G 5Z3, Canada

IJERPH, 2020, vol. 17, issue 13, 1-27

Abstract: Culture, tradition, structural violence, and mental health-related stigma play a major role in global mental health for refugees. Our aim was to understand what factors determine the success or failure of community-based psychotherapy for trauma-affected refugees and discuss implications for primary health care programs. Using a systematic realist-informed approach, we searched five databases from 2000 to 2018. Two reviewers independently selected RCTs for inclusion, and we contacted authors to obtain therapy training manuals. Fifteen articles and 11 training manuals met our inclusion criteria. Factors that improved symptoms of depression, anxiety, and PTSD included providing culturally adapted care in a migrant-sensitive setting, giving a role to other clinical staff (task-shifting), and intervention intensity. Precarious asylum status, constraining program monitoring requirements, and diverse socio-cultural and gender needs within a setting may reduce the effectiveness of the program. Primary care programs may enable community based mental health care and may reduce mental health-related stigma for refugees and other migrants. More research is needed on the cultural constructs of distress, programs delivered in primary care, and the role of cultural and language interpretation services in mental health care.

Keywords: global mental health; refugees and asylum seekers; primary health care; NET; CETA; CBT (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (6)

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