Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions

Abstract

Background:

According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children.

Methods:

Results and Conclusions:

The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.

Keywords

Promotion prevention migrants displacement forced migration youth refugees

Introduction

According to the United Nations, at the end of 2021, 89.3 million individuals worldwide were forcibly displaced as a result of persecution, conflict, violence, violation of human rights or events seriously disturbing public order. Among these, 53.2 million were internally displaced, 27.1 were refugees and over 4.6 million were awaiting a decision on their asylum application (Lasrado et al., 2021; Silove, 2021). These numbers are expected to rise due to the ongoing conflicts and to the impact of climate change leading to more frequent natural disasters (Beine & Jeusette, 2021; Braithwaite et al., 2019; Cattaneo et al., 2019; M. Chen & Caldeira, 2020; L. Perch-Nielsen et al., 2008; Mazhin et al., 2020).

According to the United Nations High Commissioner of Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development; as a result, they are more likely to experience mental health problems during migration (Bloomfield et al., 2021; M. D. Fazel et al., 2012; Griswold et al., 2021; Pezzella & Giordano, 2022; Williams & Etkins, 2021). Young refugees who were resettled in European Countries have prevalence rates of 53% for posttraumatic stress disorder (PTSD), 33% for depression, and up to 32% for anxiety disorders (Kien et al., 2019; Nickerson et al., 2011). However, there is a significant heterogeneity in the prevalence rates of mental health problems among studies, considering that some studies have found PTSD rates up to 87% in refugees (Blackmore et al., 2020; Vossoughi et al., 2018).

The risk factors for the onset of mental disorders in young refugees can be grouped in three categories, according to the chronological occurrence during the migratory experience (i.e. during pre-, peri, and post-migratory histories) (Hollis, 2022; Kieling et al., 2022; Lustig et al., 2004; Silove & Ventevogel, 2022). In addition to detention, food deprivation, and separation from their parents or guardians during the migration process, children and adolescents frequently endure interpersonal violence, poverty and living in needful conditions in their native countries (Cannon et al., 2022; E. Y. H. Chen & Wong, 2022; Fuentes & Vannelli, 2019). They continue to face difficulties once they get to the new country, some of which depend on the nature of the resettlement regions (Gleeson et al., 2020; Jannesari et al., 2020). High income countries (HIC) may guarantee safer conditions and basic necessities, but children and adolescents who are part of the population of refugees and asylum seekers (RAS) are frequently exposed to transcultural stressors (e.g. discrimination, difficulties learning a new language, dealing with bureaucratic challenges related to their asylum application or their school) (Almohamed & Vyas, 2016; Frounfelker et al., 2020; Kiselev et al., 2020; Tarsitani et al., 2020). Children and teenagers frequently reside in sizable, congested refugee camps in low- or middle-income countries (LMIC), under poor hygienic conditions, shortage of food, and high levels of violence (Arango et al., 2021; Beza et al., 2022; Leiler et al., 2019; Scharpf et al., 2021; Walther et al., 2020). Moreover, in addition to the traumatic events that occurred prior to migration, post-migratory stressors may pose a serious threat to the mental health and welfare of refugees (Bryant, 2022; Greenberg & Rafferty, 2021; Li et al., 2016; Miller & Rasmussen, 2010). Among the pre-migration risk factors, having pre-existing mental health problems can be considered one of the most significant factors contributing to increase vulnerability in child and adolescent refugees and asylum seekers. In particular, neurodevelopmental disorders, such as autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD) and learning disability (LDs), are the most frequently reported, with prevalence rates of 1.85% for ASD, 5.29% for ADHD and 16.65% for LDs. Migration is considered to be a risk factor for such diseases, making RAS children and adolescents at increased risk (Gao et al., 2022).

Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care, largely due to constrained mental health care services (Asgary & Segar, 2011; Fusar-Poli et al., 2021; Nordentoft et al., 2021; Satinsky et al., 2019). Furthermore, access to psychiatric care is frequently hampered by logistical, organizational, as well as linguistic and cultural barriers (Ohtani et al., 2015; Rosen & Salvador-Carulla, 2022; Tarsitani et al., 2022).

The provision of services to address the psychological conditions in RAS people is often offered by non-government organizations (NGOs) and coordinated by international organizations, including the World Health Organisation (WHO), the UNHCR, and the International Federation of Red Cross and Red Crescent Societies. An evidence-based response from health systems is either lacking or incomplete (Acarturk et al., 2022).

The mental health of RAS people has become a focus of attention from the scientific community only recently. Although several reviews on the effectiveness of mental health promotion, and on prevention and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons are already available (Cuijpers et al., 2021; Morina et al., 2018; Murray & Cannon, 2021; Uphoff et al., 2020), there is a lack of evidence on interventions for the promoting of mental health in child and adolescent refugees and migrants (Uphoff et al., 2020).

In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. For the purpose of the present study, a psychosocial intervention is defined as “any action intended to interfere with and stop or modify a process, as in treatment undertaken to halt, manage, or alter the course of the pathological process of a disease or disorder,” according with the Dictionary of Psychology of the American Psychological Association (APA) (APA, 2023). According to the WHO, promotion and prevention interventions are effective if the social, individual, and structural determinants of mental health are identified in order to reduce risk factors, build resilience and establish supportive environments for mental health (WHO, 2022). Mental health promotion interventions include those promoting global functioning and well-being rather than addressing a specific mental illness, and they might be targeted to the entire population or to high-risk populations, such as the RAS group. Interventions for the prevention of common mental disorders are usually focused on general mental health or on specific common mental disorders. Preventive interventions can be universal, selective (focused on at risk individuals or groups) or indicated (for individuals that show symptoms of mental health problems but have no diagnosis). Prevention focuses on avoiding disease and associated risk factors, while promotion aims at improving mental health (Singh et al., 2022).

Methods

The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using (“immigrants” OR “migration” OR “asylum seekers” OR “refugees”) AND (“promotion” OR “prevention”) AND (“mental health” OR “mental disorders” OR “psych*”) AND (“children” OR “adolescents” OR “young adults”) as search string. Studies were included in the review if they: (1) involved subjects aged 0–18 years and with a history of migration; (2) included the administration of an intervention for the promotion of mental health or the prevention of mental disorders in RAS children and adolescents; (3) were written in English.

Studies including parents or families of RAS children and adolescents were included in the review only if it was possible to extrapolate the effect of the interventions on the child/adolescent. Feasibility studies and qualitative studies were excluded. Pilot studies were included only if they could bare data on the study effectiveness other than its feasibility.

In addition, the reference lists of all included studies and of relevant existing systematic reviews were checked for possible studies. After removing duplicates, full reports of potentially relevant studies were obtained, and three authors (BDR, RB, CT) independently extracted content by the papers.

Data on study design, sample characteristics, age range of recruited subjects, type of intervention, presence of a control group, and main outcomes were extracted independently by three authors (RB, CT, BDR); discrepancies were resolved by discussion with a senior expert (ML).

A narrative synthesis was then undertaken. All studies included in the review were analyzed in order to group them in categories, and main results were summarized.

Results

Entering the key words in the relevant databases, 3,935 papers were identified; 1942 were excluded as duplicates. After reading the abstracts, 1979 additional papers were eliminated because they did not meet the inclusion criteria, leaving out 14 papers to be included in our review (Figure 1).

Figure 1.

PRISMA flow-chart.

Most of the interventions (10 out of 14) were carried out in high income countries. Five out of 14 were directed at children (0–12 years of age), four at adolescents (13–18 years of age) and five at both age ranges. A brief description of every intervention is provided in Table 1.

Table 1.

Description of interventions included in the review.

INTERVENTIONS FOR THE PREVENTION OF MENTAL DISORDERS AND THE PROMOTION OF MENTAL HEALTH
Family Strengthening Intervention for Refugees (FSI-R) Betancourt et al (2020)	The FSI-R is listed in the National Registry of Effective Programs. It stems from the Family Based Preventive Intervention (FBPI). It is a strengths-based intervention whose core-components include a family narrative that draws out family challenges, strengths, and collective future hopes that can be achieved through improved communication (FBPI). This model was also applied to FSI-R. In addition, refugees from the participating communities who had prior experience in social services or case management (but no advanced mental health degrees) were trained so that they could deliver the intervention themselves. The FSI-R intervention consists in approximately ten 90-minutes weekly home-visiting sessions provided by well-trained interventionists from the refugee community, who were weekly supervised by licensed clinical social workers and every two months by a larger team, including clinical supervisors and research staff. Each module covers topics such as improving communication, navigating the US education system, and learning positive parenting strategies. Through the family narrative component, families choose important family events to discuss, while the interventionist highlights the family’s strengths and resiliency. Sessions could be added if needed.
Teaching Recovery Techniques (TRT) Sarkadi et al (2018); El Kahni et al (2021)	TRT is an evidence-based manualized intervention with a clear protocol and step-by-step practical workbook, directed to children aged 8 and older in conflict and displacement settings. It teaches skills and techniques helpful in coping with the effects of war and violence on mental health, in order to reduce the need for later treatment. TRT is composed of five 2h child sessions delivered to groups of up to 15 children. In these sessions, themes such as nightmares, memories, flashbacks, difficulties in relaxing, concentrating or sleeping, and fears associated with war are covered. Two parallel 2h sessions covering normalizing children’s reactions and helping caregivers to help themselves are conducted with parents/caregivers. Three additional caregiver TRT sessions were included to develop the TRT+Parenting (TRT-P) intervention, with new parenting skill components, such as understanding behavioral changes, increasing positive parent-child interaction, establishing routines even in difficult contexts, encouraging play, listening and communicating, planning for the future and building communities in settings of displacement.
FIRST STEPS intervention on mother-child dyads Lebiger-Vogel et al (2022)	FIRST STEPS intervention, a psychoanalytically-oriented prevention program for immigrant families, focuses on the “specific challenges and needs of families with an immigrant background” seeking “to optimize the early developmental environment of children at risk of growing up disadvantaged due to their parents’ acute migration” (LebigerVogel et al., 2015, p. 3; see also Leuzinger-Bohleber and LebigerVogel, 2016; Lebiger-Vogel et al., 2020). The project has been inspired by the psychoanalytically oriented First Steps program by Meurs et al. (2006) in Belgium, which started in 2000.
Entre Dos Mundos Bacallao et al (2009)	Entre Dos Mundos is an 8-week prevention program that uses a multifamily group in weekly sessions to discuss acculturation stressors and challenges. Each session is devoted to a theme that has been empirically linked to acculturation stress. Entre Dos Mundos session themes are posed as questions for families and as homeworks between sessions. Eight lessons are included. Session content for each theme is experiential, based on psychodramatic strategies for exploring intrapersonal and interpersonal situations, and encourages practicing behavioral change in a supportive group environment.
FRIENDS program for anxiety and depression Barrett et al (2003)	The FRIENDS program (Barrett, Lowry-Webster, & Turner, 2000a, 2000b, 2000c, 2000d) is an internationally recognized early intervention program for children and adolescents. It promotes important personal development skills, such as building self-esteem, problem-solving and self-expression of ideas and beliefs. It is meant to teach children and adolescents how to cope with and manage anxiety and depression, to prevent the development of serious mental disorders, impairment in social functioning and emotional distress through the establishment of good relationships with peers, parents, and adults. The FRIENDS program features parallel versions for elementary school children (Barrett et al., 2000a) and high school adolescents (Barrett et al., 2000c). It is composed of 10 structured 1-hour sessions. The term FRIENDS is an acronym that remembers participants and family members the coping and problem-solving steps to follow. These include: Feeling Worried?; Relax and feel good; Inner thoughts; Explore plans of action; Nice work, reward yourself; Don’t forget to practice; Stay cool and calm. Students participate in group discussions, team activities, and individual exercises featured in the accompanying workbooks.
Project SHIFA (Supporting the Health of Immigrant Families and Adolescents) Ellis et al (2013)	The SHIFA (Supporting the Health of Immigrant Families and Adolescents; SHIFA means health in Somali) project is a school and community based multi-tiered program. In this model, broad-based prevention and community resilience building is provided to the whole population of interest, more targeted prevention and stress-reduction interventions are provided to identified at-risk groups, and intensive intervention is provided for those with significant psychological distress. Gateway providers are used to engage key community members (family, community leaders, and school personnel) in identifying and referring youths for care. Moreover, they helped building trust and relationships between families and clinical staff before the intervention’s start and destigmatize treatment by connecting it with broad-reaching services for the general population. The intervention is divided into 4 different tiers: -Tier 1 is the broadest level of service, which includes community engagement and parent outreach. -Tier 2 consists in school-based groups open to all English language learner students in the participating school. Other than providing skill building around managing acculturative stress and emotions, these groups facilitate engagement in a non-stigmatizing setting and allow providers to more easily identify those in need of more intensive intervention. Tiers 3 and 4 involve direct mental health intervention for students with significant mental health need. They represent the most targeted levels of service.
A group-based resilience-focused program Clauss et al. 2022	It is a group-based behavioral intervention for adolescents focusing on teaching emotion recognition skills and strategies for managing distressing thoughts and emotions. The first session consists in the establishment of the ground rules, and ice breaker activities identify commonalities among participants. The skills learned during the session are then consolidated and generalized through home practice assignments. Activities related to learning emotion recognition skills include: instruction in emotion self-monitoring, “emotion detective” exercises, instruction in the thought-feeling-behavior behavioral model of specific emotions (e.g., commonly associated thoughts, somatic sensations, body language, facial expressions), and vignettes depicting interpersonal interactions that trigger emotional reactions as a stimulus for learning about how to recognize the emotional states of others (i.e., mentalization). A caregiver session focusing on emotion recognition and regulation skills is also available.
Expressive Workshops Rousseau et al (2005, 2007, 2009)	-The creative expression workshops program consists of 2-hour 12 weekly sessions carried out during the regular school day by an art therapist and a psychologist in conjunction with the teacher. The proposed activities combine verbal and non-verbal means of expression (drawing or painting a picture and telling or writing a story) with moments of personal work and time when the child goes back to his group to listen or present his work. -Dramatic Workshop (Adolescents): The students take part in nine 75-minute weekly sessions. A play director coordinates and contains the story told by an adolescent, while actors and musicians gather the information in order to play the story back to the teller and the group. The stories told can be transformed and replayed through alternative scenarios developed by the group of adolescents. Each week, team members introduce a topic through a brief personal experience. The students are then invited to express their experiences or concerns on the topic using fluid sculptures, rants, pairs and other reflective techniques, which have been refined by playback and Boal’s forum theater. -Sandplay (Preschoolers): The sandplay program consists of ten 60-min workshops, every second week over a period of four months, run by three art therapists of diverse cultural background with the help of the classroom teachers. Themes are related to the child’s everyday life, for example: family, siblings, transport to school, language, seasons.
Group-crisis intervention during ongoing conflict Thabet et al (2005)	This intervention was thought for children and adolescents with mild to severe symptoms of PTSD, living in the Gaza Strip. Crisis intervention groups were moderated by one lead clinician with two other clinicians (psychologist and social worker) acting as facilitators. The treatment protocol was adjusted to the nature of trauma, sociocultural circumstances, and children’s developmental ability, by using free drawing, talking about their traumatic experiences and feelings, writing about traumatic events, storytelling, games, and role-plays related to the conflict. There is guidance and facilitation by the group moderators, as well as some trauma-specific exercises, but there is no specific structure or order of group themes. Four training sessions with teachers are conducted on the meaning of trauma, consequences, and how to deal with such problems. Teachers subsequently provide information to children over four sessions on the impact of trauma on different areas of the child’s life, aiming to normalize children’s response.
The Happy Families Program (HFP) Annan et al (2016)	The HFP stems from the cultural adaptation of the already validated Strengthening Families Program (SFP), a family skills training program originally developed in the USA for substance abusing parents and their children. HFP consists of 14 weekly sessions in which caregivers learn parenting skills and children learn social skills in separate groups for the first hour and join together in the second hour for in vivo practice and feedback from facilitators, as well as positive family interaction through structured and unstructured play.
Child and Youth Learning Centers (CYLC) Metzler et al (2019)	The CYLCs consists of 6-8 temporary classroom structures, an office and storeroom, water tank, a kitchen, toilets and a playground with steel-structured play equipment. Both spaces emphasize functional literacy and numeracy skills (in Somali), facilitated by animators recruited from the camp and the local community (some with teaching experience) and trained and regularly supervised in the delivery of a specifically designed non-formal education curriculum. Psychosocial activities, such as cultural dance, drawing, recreational play, and singing, are included, but to a modest degree. Onsite counselling and a feeding program are also offered.

Most studies (10 out of 14) were randomized controlled trials, with one of them comparing three different arms. Half of the interventions were targeting children or adolescents directly, while the other half were involving families or mother-child dyads. The number of participants in each study ranged from 30 participants to broader trials with samples of 479 families. A brief description of the mentioned interventions and detailed results can be found in Table 2.

Table 2.

Overview of studies included in the review.

Interventions for the prevention of mental disorders and the promotion of mental health
Study (year), country	Sample size	Control group	Age range (Children 0–12/Adolescents 13–18)	Outcome measures
Barrett et al. (2003), Australia	320	Yes	Children/Adolescents	Self-esteem, internalizing (anxiety and trauma) symptoms, emotional resilience, future outlook
Ellis et al. (2013), USA	30	No	Adolescents	Trauma symptoms, PTSD and depression
Betancourt et al. (2020), USA	130	Yes	Children/Adolescents	Psychosocial functioning and family conflicts
Clauss et al. (2023), USA	31	No	Children	Anxiety and depressive symptoms, social difficulties and facial emotion labeling for the emotion recognition skills
El-Khani et al. (2021), Lebanon	119 + 1 caregiver each	Yes (3 arms)	Children	Child and caregiver mental health (symptoms of PTSD, depression, and anxiety); parenting skills confidence
Lebiger-Vogel et al. (2022), Germany	118 mother and child dyads	Yes	Children	Mother’s daily stressors and depressive symptoms; children cognitive and motor development, stress level, socio-emotional and language development, aggressiveness, hyperactivity, anxiety, social competence
Bacallao and Smokowski (2009), USA	81 families	Yes	Adolescents	Anxiety and depressive symptoms, parent-adolescent conflicts, behavioral problems
Rousseau et al. (2005), Canada	138	Yes	Children	Popularity, integration, externalizing and internalizing symptoms
Rousseau et al. (2007), Canada	136	Yes	Adolescents	Anxiety, conduct problems, peer relationships, impairment associated with symptoms, self-esteem
Rousseau et al. (2009), Canada	105	Yes	Children	Anxiety, conduct problems, peer relationships, impairment associated with symptoms
Sarkadi et al. (2018), Sweden	46	No	Adolescents	PTSD and depression symptoms
Thabet et al. (2005), Palestine	111	Yes	Children/Adolescents	PTSD and depressive symptoms
Annan et al. (2016), Thailand	479 families	Yes	Children/Adolescents	Children’s behavioral and emotional problems, psychosocial protective factors, internalizing and externalizing symptoms
Metzler et al. (2021), Ethiopia	825	No	Children/Adolescents	Children’s behavioral and emotional problems, psychosocial protective factors

Family-oriented interventions

Betancourt et al. (2020) investigated the effectiveness of the Family Strengthening Intervention (FSI-R), consisting of approximately ten 90-min weekly home-visit sessions by well-trained professionals from the refugee community, who were weekly supervised by licensed clinical social workers and every 2 months by a larger team including clinical supervisors and research staff (Betancourt et al., 2020). This RCT shows that children whose families received the intervention reported significant gains in mental health, as shown by a reduction in levels of traumatic stress reactions compared to children in the group receiving Treatment as Usual (TAU). Moreover, a reduced levels of depressive symptoms in the experimental treatment was also reported.

Promising results were also found with the Teaching Recovery Techniques (TRT) intervention, an evidence-based manualized intervention aiming at mitigating the psychological consequences of war and violence on mental health (El-Khani et al., 2021; Sarkadi et al., 2018). Both studies reported a positive effect of TRT in reducing both PTSD and depressive symptoms in adolescents (Sarkadi et al., 2018) and an improvement in behavioral and emotional difficulties in children (El-Khani et al., 2021). Moreover, a significant reduction in depressive, anxiety, and stress symptoms in caregivers were reported when TRT is associated to parenting skills training.

Lebiger-Vogel et al. (2022) assessed the impact of FIRST STEPS intervention, a psychoanalytically-oriented prevention program for immigrant families, aiming at improving child development and parenting skills in migrants. Despite not addressing directly children with mental health problems, the study of Lebiger-Vogel was retained in this review since it found that children with developmental delays are more likely to experience clinically significant behavioral and emotional problems compared to children with regular development (Caplan et al., 2015). Authors reported that the intervention was effective in preventing early developmental delays in immigrant children and improving school performance of participants (Lebiger-Vogel et al., 2020).

Bacallao and Smokowski (2009) assessed the efficacy of “Entre Dos Mundos (EDM)” intervention, an 8-week prevention program adopting a multifamily group format to discuss acculturation stressors and challenges (Bacallao & Smokowski, 2009). The provision of EDM was associated to lower rates of oppositional defiant behavior, anxious and depressive symptoms, and reduced parent-adolescent conflicts.

Annan et al. (2016) tested the efficacy of the “Happy Families Program” (HFP), a family skills training program originally developed in the USA for substance abusing parents and their children. Effectiveness was measured in terms of children’s behavioral and emotional problems and psychosocial protective factors. Treated children showed a significant reduction in externalizing problems and attention problems compared with controls. Moreover, a significant increase in psychosocial protective factors, such as sources of support, positive social skills, positive emotional outlook and self-esteem, was also found in treated children compared with controls (Annan et al., 2016). These findings show that an evidence-based parenting skills’ intervention adapted for displaced and migrant people facing high levels of adversities can have positive effects on children’s externalizing symptoms and protective psychosocial factor.

Child and/or adolescent-oriented interventions

Barrett et al. (2003) investigated the effects of the FRIENDS intervention, an internationally recognized early intervention program for children and adolescents delivered by trained bilingual mental health professionals to small groups (Barrett et al., 2003). Elementary school children who completed the intervention reported significant improvements in self-esteem, expectations for the future and a significant decrease in anxiety symptoms. High school students who participated in the program reported significantly reduced levels of anger, anxiety, depression, post-traumatic stress, and dissociative symptoms. Adolescents in the waiting list group reported an increase in anxiety symptoms from pre- to post assessment. Moreover, improvements in resilience were sustained in the long term. Thus, the FRIENDS program is effective in reducing anxiety and stress that accompany cross-cultural migration, promoting long-term self-esteem and a less pessimistic view of the future.

Ellis et al. (2013) tested the efficacy of the SHIFA (Supporting the Health of Immigrant Families and Adolescents) program on the reduction of trauma-related and depressive symptoms (Ellis et al., 2013). The program is divided into four different tiers; the first is the broadest level of service, which includes community engagement and parent outreach. Tier 2 consists of school-based groups open to all English language learner students in the participating school. Tiers 3 and 4 include direct mental health intervention for students with significant mental health needs. Results showed that students across all tiers of the program demonstrated improvements in both mental health and resources. Contrary to the authors’ expectations, improvements in mental health and resources were not different between those receiving the lower intensity Tier 2 level of services and those receiving Tiers 3 and 4.

Clauss et al. (2023) evaluated the effects of a resilience-focused group program. This intervention was piloted in three cohorts of adolescents (n = 11, 10, and 7, respectively) with subclinical psychiatric symptoms (i.e. emotional problems, conduct problems, hyperactivity, peer problems, and social behaviors) living in low-income, Latin immigrant communities. Results showed that the intervention is associated with reductions of transdiagnostic psychiatric symptoms (i.e. depressive and anxiety symptoms) and promoted social participation and emotional recognition (Clauss et al., 2023).

Art and expressive workshops taking place in school settings were proposed as preventive interventions in different studies (Rousseau et al., 2005, 2007, 2009). In the 2005 study, the authors assessed the efficacy of expressive workshops in terms of reduction of (internalizing and externalizing) symptoms and of popularity and integration. Children from the experimental group reported a significantly lower level of mental health symptoms than those in the control group, and higher levels of feelings of popularity and satisfaction (Rousseau et al., 2005). The results of this study show that a simple, school-based, low-cost intervention is effective in promoting mental health in young refugees. The second workshop (2007) was part of the regular school day. Although authors did not report improvement in self-esteem or emotional and behavioral symptoms, adolescents in the experimental group showed an increase in performance in mathematics and lower levels of impairment by symptoms than those in the control group (Rousseau et al., 2007). The third workshop, which was designed for preschoolers (2009), consisted of creative expressive workshops using sandplay. Children in the experimental group benefited moderately from the program, with a reduction of emotional symptoms. The intervention was also useful to prevent the increase in emotional and behavioral symptoms (Rousseau et al., 2009).

Thabet et al. (2005) tested the efficacy of a group-crisis intervention in a sample of children and adolescents with mild to severe symptoms of PTSD, living in the Gaza Strip. Authors did not report a significant impact of the intervention on children’s posttraumatic and depressive symptoms. These findings might be due to the continuing exposure to trauma and the non-active nature of the intervention (Thabet et al., 2005).

Child- and youth-friendly spaces are an important feature of emergency humanitarian provision. To provide educational services in Ethiopia’s Buramino camp, World Vision Ethiopia opened its first child and youth learning center (CYLC) in January 2012. This offered a location in which a range of activities were available for children aged from 6 to 17 years. The effects of these camps in terms of educational and psychosocial outcomes were investigated by Metzler et al. (2021). No structured intervention was available; the centers were considered to be short-term interventions while the camp was set up, in advance of the provision of formal education. Results from this study showed a general improvement in prosocial behavior and emotional and social adjustment, as well as in internal and external coping resources available in both camp-attending and non-attending children (Metzler et al., 2021). This was explained as a general adaptation to the harsh camp conditions. However, a particular reduction in psychosocial difficulties was found in children attending the CYLC.

Discussion

Interventions aiming to prevent and promote the mental health in high-risk populations, such as RAS children and adolescents, is crucial for reducing the risk of developing common mental disorders, promoting social inclusion and improving mental health and well-being (M. Fazel & Betancourt, 2018; Onoja et al., 2020; Pejušković & Vukčević-Marković, 2020; Peterson et al., 2020; Turrini et al., 2019). The majority of the interventions provided, although highly heterogeneous in format and content, have shown significant improvement in various psychopathological dimensions (trauma-related symptoms, psychological stress, anxiety, depression, cognitive symptoms and PTSD), also in the long term. However, several important outcomes, to which this population is considered to be at risk for, were not taken into account by any of the included studies (Hickie, 2022; Malla et al., 2022). In fact, none of the studies investigated if the interventions decreased the risk of developing antisocial behaviors, psychotic symptoms, or a full-blown psychiatric disorder in the long-term. One possible reason is that long-term follow-ups are often difficult in RAS people due to their frequent resettlements and displacements. Such outcomes should be the subject for future research (Patel et al., 2021; Robertshaw et al., 2017).

Furthermore, many interventions were directed not only to the child and or adolescent but involved relatives and caregivers too. Most interventions were also effective in improving parenting skills and promoting a healthy family environment, which are important protective factors for young and adult displaced people (Danese, 2022; Lång et al., 2022; McGorry et al., 2022; Stein et al., 2021).

Improvement of mental health is more effectively evaluated in studies with longer follow-ups, thus requiring longer periods for assessing the efficacy of mental health-oriented interventions. One additional limit might be due to the complex identification of RAS groups which aren’t experiencing severe stress or symptoms, making promotion strategies hard to implement (Mitschke et al., 2017; Priebe et al., 2016; Robertshaw et al., 2017; Sharan, 2022; Thompson et al., 2018).

The promotion of mental health in socially, economically, and culturally disadvantaged groups is one of the many challenges in the field of social psychiatry (Blackmore et al., 2020; Gnanapragasam et al., 2022), despite they represent the optimal target for such strategies, due to the numerous risk factors they are exposed to (Scharpf et al., 2021; Wilson et al., 2021). A full understanding of the importance of such interventions, together with increased appeal and availability are crucial to foster interest and participation from mental health professionals working with migrants and from RAS population. Besides, one consideration to be made when taking the RAS population into account relies on the transcultural nature of refugees and asylum seekers. Interventions need to be readapted not only from a linguistic viewpoint, but also from a cultural one for each specific RAS population, and then be administered to culturally homogeneous groups. As a matter of fact, many of the evaluated interventions were cultural readaptations of already existing evidence-based interventions.

Another relevant finding was that, despite the great feasibility of evidence-based, manualized and low-cost interventions, they are underutilized and poorly investigated, as reflected in the very small sample sizes of studies included in this systematic review. One possible explanation of this phenomenon might be due to the low availability of training and support for mental health professionals (Peñuela-O’Brien et al., 2023). In fact, several authors reported that lack of training greatly affects quality of health care provided to RAS population, which is often provided in settings different from generalistic mental health care settings (Peñuela-O’Brien et al., 2023). There is now enough evidence that psychological interventions for migrants can be adequately provided by trained and supervised persons who are not specialists in mental health (Kohrt et al., 2020; Nosè et al., 2017; Slobodin & de Jong, 2015; Turrini et al., 2021). Establishing competency-based training methodologies and competency assessment standards is one strategy to overcome this problem. With this purpose, the WHO has recently developed the Ensuring Quality in psychiatric Support (EQUIP) platform, to promote competency-based training in psychosocial support, psychiatric treatments, and basic helping skills (Watts et al., 2021). EQUIP is an online resource to evaluate training and to support trainees’ development which contains instructions on how to offer competency-based training programs as well as on how to use and modify psychological therapies. Common components of psychological care and general psychosocial support, such as communication skills, empathy, teamwork, and a helper-client link, are necessary for any intervention to be successful (Hettich et al., 2020). Training and support of non-specialized mental health care providers in the RAS population might be the topic of further investigation.

This review has several limitations. The decision to only include high-quality studies (randomized controlled trials and clinical trials) gave us the possibility to provide an overview on the efficacy of the different interventions, but it considerably reduced the sample of studies to be included. Moreover, the comparison of the different interventions was made more complicated due to the great heterogeneity of considered outcomes in the studies. Also, cultural background might influence how different populations react to different interventions, contributing to the difficulties in the comparison among the different studies (Bryant et al., 2021; Patton et al., 2021; Verkuyten, 2021) . The choice to extend the field of research to interventions that were conducted both in HIC and in LMIC gave a more global perspective, but it represented also a confounding factor when considering the different levels of available resources.

In conclusion, available studies on interventions for the prevention of mental disorders and the promotion of mental health in RAS children and adolescents indicate that, despite their heterogeneity, available interventions yield a global improvement for participants. These results are of particular relevance since child and adolescent refugees and asylum seekers face limited or no access to healthcare services, are frequently marginalized in epidemiological investigations, and are frequently subjected to forced migrations (Carrasco-Sanz et al., 2018; ISSOP Migration Working Group (2018)).

However, these interventions remain underutilized, and a strategy for the implementation and promotion of psychological intervention in this at-risk population is needed. This will not only greatly improve mental and global health in the RAS population, decreasing the incidence of common psychiatric disorders in younger age, but it will also decrease the economic burden and workload on primary and secondary health care.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Bianca Della Rocca

Pasquale Pezzella

Gaia Sampogna

Lorenzo Tarsitani

References

Acarturk

Uygun

Ilkkursun

Carswell

Tedeschi

Batu

Eskici

Kurt

Anttila

Baumgartner

Churchill

Cuijpers

Becker

Koesters

Lantta

Nosè

Ostuzzi

Popa

M. . . .

Barbui

(2022). Effectiveness of a WHO self-help psychological intervention for preventing mental disorders among Syrian refugees in Turkey: A randomized controlled trial. World Psychiatry, 21(1), 88–95. https://doi.org/10.1002/WPS.20939

Almohamed

Vyas

(2016). Vulnerability of displacement: Challenges for integrating refugees and asylum seekers in host communities [Conference session]. Proceedings of the 28th Australian Computer-Human Interaction Conference, OzCHI 2016 (pp. 125–134). https://doi.org/10.1145/3010915.3010948

Annan

Sim

Puffer

E. S.

Salhi

Betancourt

T. S.

(2016). Improving Mental Health Outcomes of Burmese Migrant and Displaced Children in Thailand: a Community-Based Randomized Controlled Trial of a Parenting and Family Skills Intervention. https://doi.org/10.1007/s11121-016-0728-2

APA. (2023). APA Dictionary of Psychology. Retrieved October 13, 2023, from https://dictionary.apa.org/intervention

Arango

Dragioti

Solmi

Cortese

Domschke

Murray

R. M.

Jones

P. B.

Uher

Carvalho

A. F.

Reichenberg

Shin

J. I.

Andreassen

O. A.

Correll

C. U.

Fusar-Poli

(2021). Risk and protective factors for mental disorders beyond genetics: An evidence-based atlas. World Psychiatry, 20(3), 417–436. https://doi.org/10.1002/wps.20894

Asgary

Segar

(2011). Barriers to health care access among refugee asylum seekers. Journal of Health Care for the Poor and Underserved, 22(2), 506–522. https://doi.org/10.1353/hpu.2011.0047

Bacallao

M. L.

Smokowski

P. R.

(2009). Entre dos mundos/between two worlds: Bicultural development in context. The Journal of Primary Prevention, 30(3-4), 421–451. https://doi.org/10.1007/s10935-009-0176-x

Barrett

P. M.

Sonderegger

Xenos

(2003). Using FRIENDS to combat anxiety and adjustment problems among young migrants to australia: A national trial. Clinical Child Psychology and Psychiatry, 8(2), 241–260. https://doi.org/10.1177/1359104503008002008

Beine

Jeusette

(2021). A meta-analysis of the literature on climate change and migration. Journal of Demographic Economics, 87(3), 293–344. https://doi.org/10.1017/dem.2019.22

10.

Betancourt

T. S.

Berent

J. M.

Freeman

Frounfelker

R. L.

Brennan

R. T.

Abdi

Maalim

Abdi

Mishra

Gautam

Creswell

J. W.

Beardslee

W. R.

& Professor

(2020). Family-based mental health promotion for Somali Bantu and Bhutanese refugees: Feasibility and acceptability trial. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 66(3), 336–344. https://doi.org/10.1016/j.jadohealth.2019.08.023

11.

Beza

Mavrodi

A. G.

Kyratso

Aletras

V. H.

(2022). Health-related quality of life among refugees and asylum seekers in Northern Greece. Journal of Immigrant and Minority Health/Center for Minority Public Health, 24(2), 437–444. https://doi.org/10.1007/s10903-021-01199-3

12.

Blackmore

Boyle

J. A.

Fazel

Ranasinha

Gray

K. M.

Fitzgerald

Misso

Gibson-Helm

(2020). The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. Plos Medicine, 17(9), e1003337. https://doi.org/10.1371/journal.pmed.1003337

13.

Bloomfield

M. A. P.

Chang

Woodl

M. J.

Lyons

L. M.

Cheng

Bauer-Staeb

Hobbs

Bracke

Kennerley

Isham

Brewin

Billings

Greene

Lewis

(2021). Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: A systematic review and meta-analysis. World Psychiatry, 20(1), 107–123. https://doi.org/10.1002/wps.20841

14.

Braithwaite

Salehyan

Savun

(2019). Refugees, forced migration, and conflict: Introduction to the special issue. Journal of Peace Research, 56(1), 5–11. https://doi.org/10.1177/0022343318814128

15.

Bryant

R. A.

(2022). Post-traumatic stress disorder as moderator of other mental health conditions. World Psychiatry, 21(2), 310–311. https://doi.org/10.1002/wps.20975

16.

Bryant

R. A.

Bawaneh

Giardinelli

Awwad

Al-Hayek

Akhtar

(2021). A prevalence assessment of prolonged grief disorder in Syrian refugees. World Psychiatry, 20(2), 302–303. https://doi.org/10.1002/wps.20876

17.

Cannon

Power

Cotter

Hill

(2022). Youth psychiatry: Time for a new sub-specialty within psychiatry. World Psychiatry, 21(1), 2–3. https://doi.org/10.1002/wps.20923

18.

Caplan

Neece

C. L.

Baker

B. L.

(2015). Developmental level and psychopathology: Comparing children with developmental delays to chronological and mental age matched controls. Research in Developmental Disabilities, 37, 143–151. https://doi.org/10.1016/j.ridd.2014.10.045

19.

Carrasco-Sanz

Leiva-Gea

Martin-Alvarez

Del Torso

van Esso

Hadjipanayis

Kadir

Ruiz-Canela

Perez-Gonzalez

Grossman

(2018). Migrant children’s health problems, care needs, and inequalities: European primary care paediatricians’ perspective. Child: Care, Health and Development, 44(2), 183–187. https://doi.org/10.1111/cch.12538

20.

Cattaneo

Beine

Fröhlich

C. J.

Kniveton

Martinez-Zarzoso

Mastrorillo

Millock

Piguet

Schraven

(2019). Human migration in the era of climate change. Review of Environmental Economics and Policy, 13(2), 189–206. https://doi.org/10.1093/reep/rez008

21.

Chen

E. Y. H.

Wong

S. M. Y.

(2022). Youth mental health care in a context of large-scale collective stress. World Psychiatry, 21(1), 85–86. https://doi.org/10.1002/wps.20932

22.

Chen

Caldeira

(2020). Climate change as an incentive for future human migration. Earth System Dynamics, 11(4), 875–883. https://doi.org/10.5194/esd-11-875-2020

23.

Clauss

J. A.

Bhiku

Burke

Pimentel-Diaz

DeTore

N. R.

Zapetis

Zvonar

Kritikos

Canenguez

K. M.

Cather

Holt

D. J.

(2023). Development of a transdiagnostic, resilience-focused intervention for at-risk adolescents. Journal of Mental Health, 32(3), 592–601. https://doi.org/10.1080/09638237.2022.2140790

24.

Cuijpers

Quero

Noma

Ciharova

Miguel

Karyotaki

Cipriani

Cristea

I. A.

Furukawa

T. A.

(2021). Psychotherapies for depression: A network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry, 20(2), 283–293. https://doi.org/10.1002/wps.20860

25.

Danese

(2022). Bridging between youth psychiatry and child and adolescent psychiatry. World Psychiatry, 21, 83–85. https://doi.org/10.1002/wps.20931

26.

El-Khani

Cartwright

Maalouf

Haar

Zehra

Çokamay-Yılmaz

Calam

(2021). Enhancing teaching recovery techniques (Trt) with parenting skills: Rct of trt + parenting with trauma-affected syrian refugees in lebanon utilising remote training with implications for insecure contexts and covid-19. International Journal of Environmental Research and Public Health, 18(16), 8652. https://doi.org/10.3390/ijerph18168652

27.

Ellis

B. H.

Miller

A. B.

Abdi

Barrett

Blood

E. A.

Betancourt

T. S.

(2013). Multi-tier mental health program for refugee youth. Journal of Consulting and Clinical Psychology, 81(1), 129–140. https://doi.org/10.1037/a0029844

28.

Fazel

Betancourt

T. S.

(2018). Preventive mental health interventions for refugee children and adolescents in high-income settings. The Lancet. Child and adolescent health, 2(2), 121–132. https://doi.org/10.1016/S2352-4642(17)30147-5

29.

Fazel

M. D.

Stein FRCPsych

Fazel

Reed

R. V.

Jones

Panter-Brick

Stein

(2012). Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Oxford Health NHS Foundation Trust, 379, 250–265. https://doi.org/10.1016/S0140

30.

Frounfelker

R. L.

Miconi

Farrar

Brooks

M. A.

Rousseau

Betancourt

T. S.

(2020). Mental health of refugee children and youth: Epidemiology, interventions, and future directions. Annual Review of Public Health, 41, 159–176. https://doi.org/10.1146/annurev-publhealth-040119-094230

31.

Fuentes

Vannelli

(2019). Human rights of children in the context of migration processes. Innovative efforts for integrating regional human rights standards in the Americas. Laws, 8(4), 31. https://doi.org/10.3390/laws8040031

32.

Fusar-Poli

Correll

C. U.

Arango

Berk

Patel

Ioannidis

J. P. A.

(2021). Preventive psychiatry: A blueprint for improving the mental health of young people. World Psychiatry, 20(2), 200–221. https://doi.org/10.1002/wps.20869

33.

Gao

Zhao

Wang

Yang

(2022). Migration modulates the prevalence of ASD and ADHD: A systematic review and meta-analysis. BMC Psychiatry, 22, 1–16. https://doi.org/10.1186/s12888-022-04037-4

34.

Gleeson

Frost

Sherwood

Shevlin

Hyland

Halpin

Murphy

Silove

(2020). Post-migration factors and mental health outcomes in asylum-seeking and refugee populations: A systematic review. Journal of Psychotraumatology, 11(1), 1793567. https://doi.org/10.1080/20008198.2020.1793567

35.

Gnanapragasam

S. N.

Pemberton

Bhugra

(2022). Social psychiatry, refugees, and asylum seekers. In Bhugra

Moussaoui

Craig

T. J.

(Eds.), Oxford textbook of social psychiatry: Oxford textbooks in psychiatry. Oxford Academic. https://doi.org/10.1093/med/9780198861478.003.0017

36.

Greenberg

Rafferty

(2021). Post-traumatic stress disorder in the aftermath of COVID-19 pandemic. World Psychiatry, 20(1), 53–54. https://doi.org/10.1002/wps.20838

37.

Griswold

K. S.

Vest

B. M.

Lynch-Jiles

Sawch

Kolesnikova

Byimana

Kefi

(2021). I just need to be with my family”: Resettlement experiences of asylum seeker and refugee survivors of torture. Globalization and Health, 17(1), 27–7. https://doi.org/10.1186/s12992-021-00681-9

38.

Hettich

Seidel

F. A.

Stuhrmann

L. Y.

(2020). Psychosocial interventions for newly arrived adolescent refugees: A systematic review. Adolescent Research Review, 5(2), 99–114. https://doi.org/10.1007/s40894-020-00134-1

39.

Hickie

I. B.

(2022). Implementing 21st century “end-to-end” and technology-enhanced care for young people. World Psychiatry, 21(1), 79–81. https://doi.org/10.1002/wps.20928

40.

Hollis

(2022). Youth mental health: Risks and opportunities in the digital world. World Psychiatry, 21(1), 81–82. https://doi.org/10.1002/wps.20929

41.

ISSOP Migration Working Group. (2018). ISSOP position statement on migrant child health. Child: Care, Health and Development, 44(1), 161–170. https://doi.org/10.1111/cch.12485

42.

Jannesari

Hatch

Prina

Oram

(2020). Correction to: Post-migration social-environmental factors associated with mental health problems among asylum seekers: A systematic review. Journal of Immigrant and Minority Health/Center for Minority Public Health, 22, 1065–1066. https://doi.org/10.1007/s10903-020-01036-z

43.

Kieling

Salum

G. A.

Pan

P. M.

Bressan

R. A.

(2022). Youth mental health services: The right time for a global reach. World Psychiatry, 21(1), 86–87. https://doi.org/10.1002/wps.20933

44.

Kien

Sommer

Faustmann

Gibson

Schneider

Krczal

Jank

Klerings

Szelag

Kerschner

Brattström

Gartlehner

(2019). Prevalence of mental disorders in young refugees and asylum seekers in European countries: A systematic review. European Child & Adolescent Psychiatry, 28, 1295–1310. https://doi.org/10.1007/s00787-018-1215-z

45.

Kiselev

Pfaltz

Schick

Bird

Hansen

Sijbrandij

De Graaff

A. M.

Schnyder

Morina

(2020). Problems faced by Syrian refugees and asylum seekers in Switzerland. Swiss Medical Weekly, 150(4344), w20381. https://doi.org/10.4414/smw.2020.20381.

46.

Kohrt

B. A.

Schafer

Willhoite

Van’t Hof

Pedersen

G. A.

Watts

Ottman

Carswell

van Ommeren

(2020). Ensuring quality in psychological support (WHO EQUIP): Developing a competent global workforce. World Psychiatry, 19(1), 115–116. https://doi.org/10.1002/wps.20704

47.

Lång

Ramsay

Yates

Veijola

Gyllenberg

Clarke

M. C.

Leacy

F. P.

Gissler

Kelleher

(2022). Potential for prediction of psychosis and bipolar disorder in child and adolescent mental health services: A longitudinal register study of all people born in Finland in 1987. World Psychiatry, 21(3), 436–443. https://doi.org/10.1002/wps.21009

48.

Lasrado

Ahankari

Kar

K. K.

(2021). Global Trends in Supercapacitors. In K. K. Kar, (Ed.), Handbook of nanocomposite supercapacitor materials III. Springer.

49.

Lebiger-Vogel

Rickmeyer

Fritzemeyer

Hettich

Leuzinger-Bohleber

Meurs

(2020). FIRST STEPS: Psychoanalytically based prevention projects for migrant and refugee families in Belgium and Germany. International Journal of Applied Psychoanalytic Studies, 17(1), 22–38. https://doi.org/10.1002/aps.1631

50.

Lebiger-Vogel

Rickmeyer

Leuzinger-Bohleber

Meurs

. (2022). Fostering emotional availability in mother-child-dyads with an immigrant background: A randomized-controlled-trial on the effects of the early prevention program first steps. Frontiers in Psychology, 13, 790244. https://doi.org/10.3389/fpsyg.2022.790244

51.

Leiler

Bjärtå

Ekdahl

Wasteson

(2019). Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden. Social Psychiatry and Psychiatric Epidemiology, 54(5), 543–551. https://doi.org/10.1007/s00127-018-1651-6

52.

S. S. Y.

Liddell

B. J.

Nickerson

(2016). The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports, 18, 82. https://doi.org/10.1007/s11920-016-0723-0

53.

L. Perch-Nielsen

B. Bättig

Imboden

. (2008). Exploring the link between climate change and migration. Climatic Change, 91, 375–393. https://doi.org/10.1007/s10584-008-9416-y

54.

Lustig

S. L.

Kia-Keating

Knight

W. G.

Geltman

Ellis

Kinzie

J. D.

Keane

Saxe

G. N.

(2004). Review of Child and Adolescent Refugee Mental Health. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 24–36. https://doi.org/10.1097/00004583-200401000-00012

55.

Malla

Boksa

Joober

(2022). Meeting the challenges of the new frontier of youth mental health care. World Psychiatry, 21(1), 78–79. https://doi.org/10.1002/wps.20927

56.

Mazhin

S. A.

Khankeh

Farrokhi

Aminizadeh

Poursadeqiyan

(2020). Migration health crisis associated with climate change: A systematic review. Journal of Education and Health Promotion, 9(1), 97. https://doi.org/10.4103/jehp.jehp_4_20

57.

McGorry

P. D.

Mei

Chanen

Hodges

Alvarez-Jimenez

Killackey

(2022). Designing and scaling up integrated youth mental health care. World Psychiatry, 21(1), 61–76. https://doi.org/10.1002/wps.20938

58.

Metzler

Jonfa

Savage

Ager

(2021). Educational, psychosocial, and protection outcomes of child- and youth-focused programming with Somali refugees in Dollo Ado, Ethiopia. Disasters, 45(1), 67–85. https://doi.org/10.1111/disa.12392

59.

Miller

K. E.

Rasmussen

(2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine (1967), 70(1), 7–16. https://doi.org/10.1016/j.socscimed.2009.09.029

60.

Mitschke

D. B.

Praetorius

R. T.

Kelly

D. R.

Small

Kim

Y. K.

(2017). Listening to refugees: How traditional mental health interventions may miss the mark. International Social Work, 60(3), 588–600. https://doi.org/10.1177/0020872816648256

61.

Morina

Akhtar

Barth

Schnyder

(2018). Psychiatric disorders in refugees and internally displaced persons after forced displacement: A systematic review. Frontiers in Psychiatry, 9(SEP), 433. https://doi.org/10.3389/fpsyt.2018.00433

62.

Murray

R. M.

Cannon

(2021). Public health psychiatry: An idea whose time has come. World Psychiatry, 20(2), 222–223. https://doi.org/10.1002/wps.20868

63.

Nickerson

Bryant

R. A.

Silove

Steel

(2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review, 31, 399–417. https://doi.org/10.1016/j.cpr.2010.10.004

64.

Nordentoft

Jeppesen

Thorup

A. A. E.

(2021). Prevention in the mental health field should be implemented synergically at different levels. World Psychiatry, 20(2), 230–231. https://doi.org/10.1002/wps.20856

65.

Nosè

Ballette

Bighelli

Turrini

Purgato

Tol

Priebe

Barbui

(2017). Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis. Plos One, 12(2), e0171030. https://doi.org/10.1371/journal.pone.0171030

66.

Ohtani

Suzuki

Takeuchi

Uchida

(2015). Language barriers and access to psychiatric care: A systematic review. Psychiatric Services, 66(8), 798–805. https://doi.org/10.1176/appi.ps.201400351

67.

Onoja

Sanni

Shaibu

Onoja

Oguche

Adamu

Abiodun

(2020). Baseline and postintervention assessment of sexual violence and condom use among female Sex workers in a Semiurban African Community. Social Health and Behavior, 3, 124. https://doi.org/10.4103/shb.shb_29_20

68.

Patel

Bernays

Dolan

Muscat

D. M.

Trevena

Mwanri

Gesesew

Fauk

N. K.

Mude

(2021). Communication experiences in primary healthcare with refugees and asylum seekers: A literature review and narrative synthesis. International Journal of Environmental Research and Public Health, 18(4), 1469. https://doi.org/10.3390/ijerph18041469

69.

Patton

G. C.

Raniti

Reavley

(2021). Rediscovering the mental health of populations. World Psychiatry, 20(2), 151–152. https://doi.org/10.1002/wps.20842

70.

Pejušković

Vukčević-Marković

(2020). Mental health of refugees, asylum seekers and migrants: An overview of challenges and good practice examples. Psihijatrija Danas, 52(1-2), 73–87. https://doi.org/10.5937/psihdan2001073p

71.

Peñuela-O’Brien

Wan

M. W.

Edge

Berry

(2023). Health professionals’ experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review. Transcultural Psychiatry, 60(1), 176–198. https://doi.org/10.1177/13634615211067360

72.

Peterson

Poudel-Tandukar

Sanger

Jacelon

C. S.

(2020). Improving Mental Health in refugee populations: A Review of Intervention Studies conducted in the United States. Issues in Mental Health Nursing, 41(4), 271–282. https://doi.org/10.1080/01612840.2019.1669748

73.

Pezzella

Giordano

G. M.

Galderisi

. (2022). Neglected vulnerabilities in mental health: Where do we need to do more? In: Colizzi

Ruggeri

(Eds.), Prevention in mental health. Springer. https://doi.org/10.1007/978-3-030-97906-5_18

74.

Priebe

Giacco

El-Nagib

(2016). Public health aspects of mental health among migrants and refugees: a review of the evidence on mental health care for refugees, asylum seekers and irregular migrants in the WHO European Region HEALTH EVIDENCE NETWORK SYNTHESIS REPORT 47.

75.

Robertshaw

Dhesi

Jones

L. L.

(2017). Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: A systematic review and thematic synthesis of qualitative research. BMJ Open, 7(8), e015981–NaN18. https://doi.org/10.1136/bmjopen-2017-015981

76.

Rosen

Salvador-Carulla

(2022). No service is an island: Towards an ecosystem approach to mental health service evaluation. World Psychiatry, 21(2), 237–238. https://doi.org/10.1002/wps.20963

77.

Rousseau

Benoit

Gauthier

M. F.

Lacroix

Alain

Rojas

M. V.

Moran

Bourassa

(2007). Classroom drama therapy program for immigrant and refugee adolescents: A pilot study. Clinical Child Psychology and Psychiatry, 12(3), 451–465. https://doi.org/10.1177/1359104507078477

78.

Rousseau

Benoit

Lacroix

Gauthier

(2009). Evaluation of a sandplay program for preschoolers in a multiethnic neighborhood. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 50, 743–750. https://doi.org/10.1111/j.1469-7610.2008.02003.x

79.

Rousseau

Drapeau

Lacroix

Bagilishya

Heusch

(2005). Evaluation of a classroom program of creative expression workshops for refugee and immigrant children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 46(2), 180–185. https://doi.org/10.1111/j.1469-7610.2004.00344.x

80.

Sarkadi

Ådahl

Stenvall

Ssegonja

Batti

Gavra

Fängström

Salari

(2018). Teaching Recovery Techniques: Evaluation of a group intervention for unaccompanied refugee minors with symptoms of PTSD in Sweden. European Child & Adolescent Psychiatry, 27, 467–479. https://doi.org/10.1007/s00787-017-1093-9

81.

Satinsky

Fuhr

D. C.

Woodward

Sondorp

Roberts

(2019). Mental health care utilisation and access among refugees and asylum seekers in Europe: A systematic review. Health Policy, 123, 851–863. https://doi.org/10.1016/j.healthpol.2019.02.007

82.

Scharpf

Kaltenbach

Nickerson

Hecker

(2021). A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clinical Psychology Review, 83, 101930. https://doi.org/10.1016/j.cpr.2020.101930

83.

Sharan

(2022). Implementation strategies for the new World Mental Health Report in low-resource settings. World Psychiatry, 21(3), 466–467. https://doi.org/10.1002/wps.21032

84.

Silove

(2021). Challenges to mental health services for refugees: A global perspective. World Psychiatry, 20(1), 131–132. https://doi.org/10.1002/wps.20818

85.

Silove

Ventevogel

(2022). Living through interminable adversity: The mental health of the Afghan people. World Psychiatry, 21(1), 55–56. https://doi.org/10.1002/wps.20955

86.

Singh

Kumar

Gupta

(2022). Mental health prevention and promotion-a narrative review. Frontiers in Psychiatry, 13, 898009. https://doi.org/10.3389/fpsyt.2022.898009

87.

Slobodin

de Jong

J. T.

(2015). Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy? International Journal of Social Psychiatry, 61(1), 17–26. https://doi.org/10.1177/0020764014535752

88.

Stein

D. J.

Craske

M. G.

Rothbaum

B. O.

Chamberlain

S. R.

Fineberg

N. A.

Choi

K. W.

de Jonge

Baldwin

D. S.

Maj

(2021). The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management. World Psychiatry, 20(3), 336–356. https://doi.org/10.1002/wps.20919

89.

Tarsitani

Della Rocca

Pancheri

Biondi

Pasquini

Ferracuti

Ventriglio

Mandarelli

(2022). Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study. International Journal of Social Psychiatry, 68(2), 429–434. https://doi.org/10.1177/00207640211001903

90.

Tarsitani

Todini

Roselli

Serra

Magliocchetti

D’Amore

Della Rocca

Pasquini

Massetti

Biondi

(2020). Somatization and traumatic events in asylum seekers and refugees resettled in Italy. Journal of Psychopathology, 26(1), 41–45. https://doi.org/10.36148/2284-0249-374

91.

Thabet

A. A.

Vostanis

Karim

(2005). Group crisis intervention for children during ongoing war conflict. European Child & Adolescent Psychiatry, 14(5), 262–269. https://doi.org/10.1007/S00787-005-0466-7/METRICS

92.

Thompson

C. T.

Vidgen

Roberts

N. P.

(2018). Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: A systematic review and meta-analysis. https://doi.org/10.1016/j.cpr.2018.06.006

93.

Turrini

Purgato

Acarturk

Anttila

Ballette

Bird

Carswell

Churchill

Cuijpers

Hall

Hansen

L. J.

Kösters

Lantta

Nosè

Ostuzzi

Sijbrandij

Tedeschi

Valimaki

M. . . .

Barbui

(2019). Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis. Epidemiology and Psychiatric Sciences, 28, 376–388. https://doi.org/10.1017/s2045796019000027

94.

Turrini

Tedeschi

Cuijpers

Del Giovane

Kip

Morina

Nosè

Ostuzzi

Purgato

Ricciardi

Sijbrandij

Tol

Barbui

(2021). A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD. BMJ Global Health, 6(6), 5029. https://doi.org/10.1136/bmjgh-2021-005029

95.

Uphoff

Robertson

Cabieses

Villalón

F. J.

Purgato

Churchill

Barbui

(2020). An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons. Cochrane Database of Systematic Reviews, 9(9), CD013458. https://doi.org/10.1002/14651858.CD013458.pub2

96.

Verkuyten

(2021). Public attitudes towards migrants: understanding cross-national and individual differences. World Psychiatry, 20(1), 132–133. https://doi.org/10.1002/wps.20819

97.

Vossoughi

Jackson

Gusler

Stone

(2018). Mental health outcomes for youth living in refugee camps: A review. Trauma, Violence & Abuse, 19(5), 528–542. https://doi.org/10.1177/1524838016673602

98.

Walther

Fuchs

L. M.

Schupp

von Scheve

(2020). Living conditions and the mental health and well-being of refugees: Evidence from a large-scale German survey. Journal of Immigrant and Minority Health/Center for Minority Public Health, 22, 903–913. https://doi.org/10.1007/s10903-019-00968-5

99.

Watts

Hall

Pedersen

G. A.

Ottman

Carswell

Van’t Hof

Kohrt

B. A.

Schafer

(2021). The WHO EQUIP Foundational Helping Skills Trainer’s curriculum. World Psychiatry, 20(3), 449–450. https://doi.org/10.1002/wps.20880

100.

WHO. (2022). Mental health. Retrieved August 9, 2023, from https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

101.

Williams

D. R.

Etkins

O. S.

(2021). Racism and mental health. World Psychiatry, 20(2), 194–195. https://doi.org/10.1002/wps.20845

102.

Wilson

Turner-Halliday

Minnis

(2021). Escaping the inescapable: Risk of mental health disorder, somatic symptoms and resilience in Palestinian refugee children. Transcultural Psychiatry, 58(2), 307–320. https://doi.org/10.1177/1363461520987070