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Comparative efficacy and acceptability of psychosocial
interventions for PTSD, depression, and anxiety in asylum
seekers, refugees, and other migrant populations: a systematic
review and network meta-analysis of randomised controlled
studies
Giulia Turrini,
a
,
∗
Marianna Purgato,
a
Camilla Cadorin,
a
Monica Bartucz,
a
,
b
Doriana Cristofalo,
a
Chiara Gastaldon,
a
Michela Nosè,
a
Giovanni Ostuzzi,
a
Davide Papola,
a
,
c
Eleonora Prina,
a
Federico Tedeschi,
a
Anke B. Witteveen,
d
Marit Sijbrandij,
d
and Corrado Barbui
a
a
WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience,
Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
b
Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
c
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
d
Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
Summary
Background Migrant populations are at increased risk of developing mental health problems. We aimed to compare
the efficacy and acceptability of psychosocial interventions in this population.
Methods We conducted a systematic review and network meta-analysis (NMA). Cochrane Central Register of
randomised trials (CENTRAL), MEDLINE, PTSDpubs, PsycINFO, PubMed, CINAHL, EMBASE, Web of Science,
Scopus, and ClinicalTrials.gov were searched from database inception to October 7, 2024, to identify randomized
clinical trials assessing the efficacy of psychosocial interventions for migrant populations in reducing symptoms of
post-traumatic stress disorder (PTSD), depression or anxiety. Studies with second-generation migrants were
excluded if they comprised over 20% of participants. Two independent researchers screened, reviewed, and
extracted data. The primary outcomes were the severity of PTSD, depression, and anxiety symptoms at post-
intervention. Secondary outcomes included acceptability. Standardised mean differences (SMDs) and risk ratios
(RRs) were pooled using pairwise and NMA. PROSPERO: CRD42023418817.
Findings Of the 103 studies with 19,230 participants included, 96 contributed to the meta-analyses for at least one
outcome, with women representing 64% of the participants. Narrative Exposure Therapy (NET), counselling, Eye
Movement Desensitization and Reprocessing (EMDR), and creative expressive interventions demonstrated greater
efficacy than treatment as usual (TAU) in reducing PTSD symptoms, with SMDs [95% Confidence Intervals (CIs)]
ranging from −0.69 [−1.14, −0.24] to −0.60 [−1.20, −0.01], albeit with low confidence in the evidence. For
depressive symptoms, Integrative therapy emerged as the top intervention compared to TAU, with moderate
confidence (SMD [95% CI] = −0.70 [−1.21, −0.20]). For anxiety symptoms, NET, Integrative therapy, and Problem
Management Plus (PM+)/Step-by-Step (SbS) were more effective than TAU, with SMDs [95% CIs] ranging
from −1.32 [−2.05, −0.59] to −0.35 [−0.65, −0.05]. Still, the confidence in the evidence was low. Overall, head-to-
head comparisons yielded inconclusive results, and the acceptability analysis revealed variations across
interventions. 16% of the studies (17 studies) were classified as “high risk”of bias, 68% (70) as having “some
concerns”, and 18% (19) as “low risk”. We identified considerable heterogeneity (I
2
of >70%).
Interpretation The analysis revealed no clear differences in the efficacy of psychosocial interventions compared to
TAU for reducing symptoms of PTSD, depression, and anxiety. While certain interventions showed potential ben-
efits, confidence in these findings was generally low, limiting the ability to draw definitive conclusions about their
comparative effectiveness.
*Corresponding author. Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Policlinico
GB Rossi, Piazzale Scuro 10, Verona 37134, Italy.
E-mail address: giulia.turrini@univr.it (G. Turrini).
The Lancet Regional
Health - Europe
2025;48: 101152
Published Online xxx
https://doi.org/10.
1016/j.lanepe.2024.
101152
www.thelancet.com Vol 48 January, 2025 1
Articles
Funding This research received no specific grant from any funding agency.
Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Psychosocial interventions; Mental health; Migrants; Refugees; Asylum seekers; Anxiety; Depression; Post-
traumatic stress
Introduction
Epidemiological data from the United Nations High
Commission for Refugees (UNHCR) showed that, in
2023, 110 million people worldwide were forcibly dis-
placed as a result of persecution, conflict, violence, hu-
man rights violations, or other threats that seriously
disrupted public order.
1
Of these, more than 40 million
fled their countries and became refugees or asylum
seekers in foreign nations. More than half of all refugees
and other persons in need of international protection
under UNHCR’s mandate come from just three coun-
tries, namely the Syrian Arab Republic, Afghanistan, and
Ukraine. In terms of countries of resettlement, the Is-
lamic Republic of Iran and Türkiye each host 3.4 million
refugees, the largest populations worldwide. Germany
ranks third with 2.5 million, followed by Colombia and
Pakistan with 2.4 and 2.1 million refugees, respectively.
1
Asylum seekers, refugees, and other migrant pop-
ulations are exposed to stressors that challenge their
subjective well-being, quality of life, and mental health.
This, in turn, increases the risk of developing mental
disorders. As a result, the frequency of psychological
distress and mental disorders is particularly high.
Among international migrants, including asylum
seekers and refugees, about one-third suffer from post-
traumatic stress disorder (PTSD), one-third from
depression, and one-quarter from anxiety.
2–6
To improve well-being, quality of life, and mental
health of asylum seekers, refugees, and other migrant
populations, numerous randomised clinical trials (RCTs),
systematic reviews and meta-analyses have been con-
ducted to test the efficacy of a variety of psychosocial in-
terventions, including Cognitive Behavioural Therapy
(CBT), Narrative Exposure Therapy (NET), Eye Movement
Research in context
Evidence before this study
Several randomised controlled clinical trials and systematic
reviews have been conducted to test the efficacy of various
psychosocial interventions on mental health outcomes in
asylum seekers, refugees, and other migrant populations. We
did a PubMed/MEDLINE search, with no language restrictions,
from database inception to January 1, 2023 (while planning
the current study), and updated on October 7, 2024, to
identify randomised controlled clinical trials on the efficacy of
psychosocial interventions for migrant populations on PTSD,
depression, and anxiety symptoms. We used the following
search terms and syntax: (“trial”OR “random*”OR “control*”)
AND (“migrant*”OR “immigrant*”OR “refugee*”OR “asylum
seeker*”OR “displaced”) AND (“psychotherapy”OR
“psychological”OR “psychosocial”OR “intervention”OR
“support”OR “program*”) AND (“mental”OR “disorder*”OR
“distress”OR “PTSD”OR “trauma*”OR “depress*”OR
“anxiety”OR “anxious”OR “post traumatic stress”OR mental
health OR dropouts). We found randomised controlled clinical
trials and pairwise meta-analyses that tested the efficacy of
various psychosocial interventions including Cognitive
Behavioural Therapy (CBT), Narrative Exposure Therapy
(NET), Eye Movement Desensitisation and Reprocessing
(EMDR), and a range of integrative and interpersonal
therapies. However, the available evidence was controversial
and fragmented, and the relative efficacy of each intervention
compared with the others was never assessed. Moreover,
although a previous network meta-analysis was conducted, it
was specifically focused on PTSD as a diagnostic category, and
exclusively on refugees and asylum seekers.
Added value of this study
We conducted a systematic review of 103 studies with almost
20,000 participants that assessed the comparative treatment
outcomes of different psychosocial interventions. Using
network meta-analytic techniques, we compared and ranked
all psychosocial interventions, providing a comprehensive
assessment of their relative efficacy, and overcoming the
limitations of standard pairwise meta-analyses.
Implications of all the available evidence
This network meta-analysis assesses the comparative efficacy
of psychosocial interventions for PTSD, depression, and
anxiety symptoms in asylum seekers, refugees, and other
migrant populations. Although some interventions showed
promising outcomes compared to treatment as usual (TAU),
the lack of clear differences in efficacy indicates that further
research is necessary to establish reliable evidence. This
analysis contributes to a growing understanding but also
emphasize the need for more high-quality studies to better
assess the comparative effectiveness of these interventions,
and highlights the importance of continued exploration of
their effectiveness across diverse contexts.
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Desensitisation and Reprocessing (EMDR) and a range of
different integrative and interpersonal therapies.
7,8
How-
ever, the available evidence is controversial and frag-
mented, with studies focusing on different subgroups of
migrant populations, interventions, outcomes, delivery
modalities, and settings. In particular, a significant
shortcoming of existing quantitative syntheses of evi-
dence on this topic is the use of standard pairwise meta-
analytic approaches, which do not allow each active
intervention to be compared with others, making it
impossible to evaluate the comparative efficacy of existing
psychosocial interventions.
Against this background, the present systematic re-
view applied the network meta-analytic technique to
compare the efficacy and acceptability of psychosocial
interventions in adult asylum seekers, refugees, and
other migrant populations in reducing symptoms of
post-traumatic stress disorder (PTSD), depression, and
anxiety. We aimed to estimate the probability of each
intervention being in each possible rank. Hierarchical
ranking of interventions is a straightforward and user-
friendly way to inform practitioners, policymakers, and
stakeholders on which interventions have the highest
probability of being in the top positions of the hierarchy
in terms of efficacy and acceptability.
Methods
This systematic review and network meta-analysis
(NMA) was conducted and reported according to the
Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guideline specific to network
meta-analyses (Supplementary—ANNEX A).
9,10
The
study protocol was registered in advance in the Inter-
national Prospective Register of Systematic Reviews
(PROSPERO), registration number: CRD42023418817.
Search strategy and selection criteria
Cochrane Central Register of randomised trials (CEN-
TRAL), MEDLINE, PTSDpubs, PsycINFO, PubMed,
CINAHL, EMBASE, Web of Science, Scopus and
ClinicalTrials.gov were searched from database incep-
tion to October 7, 2024, to identify RCTs assessing the
efficacy of any type of intervention with a main psy-
chosocial component compared with any other active or
inactive comparison, in migrant populations. This was
an enterprise that we named the meta-analytical
research domain (MARD) on migrants.
11–13
From such
a pool of RCTs, three investigators (CC, DC, GT) further
selected studies, according to the following criteria: (a)
including adult migrants (18 years or older) of any
ethnicity and religion; (b) assessing the efficacy of a
psychosocial intervention; (c) comparing psychosocial
interventions with treatment as usual (TAU), defined as
any intervention that reflects the usual care in a given
treatment setting, waiting list (WL) or any other psy-
chosocial interventions; (d) measuring as primary or
secondary outcome the effect of the interventions on at
least one of the following mental health outcomes:
symptoms of PTSD, depression, or anxiety. The Inter-
national Organization for Migration (IOM) definition of
migrants was followed, which includes a variety of
population groups such as asylum seekers, refugees,
internally displaced persons, economic migrants, and
other populations on the move.
14–17
Studies with second-
generation migrants were excluded unless they were
less than 20% of the randomized participants. Psycho-
social interventions were defined following IASC
Guidelines as ‘mental health and psychosocial support’
(MHPSS),
18,19
which is a composite term used to
describe “any type of local or outside support that aims
to protect or promote psychosocial well-being and/or
prevent or treat mental disorders”.
18
We included psy-
chosocial interventions delivered in any delivery format.
Two authors (GT, CC) independently assessed titles,
abstracts, and full texts of potentially relevant articles,
and extracted relevant data on study characteristics and
outcome measures. For continuous outcomes, we
extracted the mean scores and standard deviations at
post-intervention or, if it was neither available nor
inferable from the information available according to
validated methodology,
20
the mean change from base-
line, the standard deviation of these values, the confi-
dence intervals, and the number of participants
included in these analyses. For the dichotomous
outcome, we extracted the number of participants un-
dergoing the randomisation procedure, and the number
of participants leaving the study early for any reason. For
both screening and data extraction, disagreements were
resolved by discussion and arbitration by a senior author
(CB). For the full search strategy, see the Supplementary—
ANNEX B.Tworesearchers(GT,CC)independently
classified the interventions, and conflicts were resolved
through discussion with a senior author (MP). Definitions
of interventions and controls are given in the
Supplementary—ANNEX C.
Risk of bias and certainty of evidence
We assessed the risk of bias of the included studies for
primary outcomes, using version 2 of the Cochrane risk
of bias tool for randomised trials (RoB 2).
21
Three in-
vestigators (CC, EP, MB) independently used the RoB 2
signalling questions to form judgments on the five RoB
2 domains. Disagreements were resolved by discussion
and arbitration by senior review authors (MP, CB). De-
tails on the quality assessment are provided in the
Supplementary—ANNEXES G–I. For the primary out-
comes, we assessed the risk of bias due to missing ev-
idence for each of the possible pairwise comparisons
that can be made between the interventions in the
network, using the Risk Of Bias due to Missing Evi-
dence in Network meta-analysis tool (ROB-MEN).
22
All
eligible studies identified in the search, including those
not reporting the outcome, were included in the
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systematic review and in the analyses. Subsequently, the
certainty of the evidence was evaluated using the
CINeMA application (http://cinema.ispm.ch/), an
adaptation of the Grading of Recommendations
Assessment, Development and Evaluation (GRADE)
approach for NMAs.
23,24
We defined the equivalence
range for effect sizes as −0.5 to 0.5, where effect sizes
within this range are considered to reflect clinically
unimportant differences between interventions. The
ROB-MEN tool was incorporated in the reporting bias
domain of the CINeMA framework.
Outcome measures
The three primary outcomes were the severity of PTSD,
depression, and anxiety symptoms, measured on
continuous rating scales at post-intervention. For each
outcome, we selected rating scales based on a pre-
planned hierarchy (Supplementary—ANNEX D). To
complement clinical outcomes, we included interven-
tion acceptability as a secondary outcome, measured as
all-case study drop-out from measurement.
Data analysis
We performed a standard pair-wise, random-effects
meta-analysis for every comparison, and, for each
outcome, a NMA with a random-effects model in a fre-
quentist framework, using: R (v 4.1.4),
25
RStudio,
26
and in
particular its meta
27
package, v 8.0-1, to obtain pairwise
meta-analyses estimates of observed comparisons, and its
netmeta
28
package, v 2.9-0, to produce the network meta-
regression estimates, the network plots, the forest plots,
to calculate the p-score and to perform the side-split test
and the netleague; Stata 18.0
29
and its mvmeta,
30
netfun-
nel
31
and ifplot
31
packages to perform, respectively,
network meta-regressions, funnel plots, and the test on
loop inconsistency. This allowed us to include multi-arm
trials in the analysis by considering the correlation be-
tween the effect sizes of each of their pairwise compari-
sons.
32
The between-study variance was assumed to be
constant across comparisons, while within-study corre-
lation was accounted for through reweighting.
33
For the dichotomous outcome, we pooled risk ratios
(RRs) with 95% confidence intervals (CIs). For contin-
uous outcomes, we pooled the standardised mean
differences (SMDs) between treatment arms at post-
intervention as the included studies measured the out-
comes using different rating scales. Intervention groups
that met the criteria for the same intervention classifi-
cation were combined into a single node following
standard approaches.
34,35
Moreover, studies that
compared two or more formats of similar psychosocial
interventions with an inactive treatment were included
in the meta-analysis by combining the respective group
arms into a single group.
20
For each outcome, we estimated the ranking proba-
bilities of each intervention being in each possible rank
for each intervention. We obtained a treatment
hierarchy using the p-scores, which is considered
equivalent to the surface under the cumulative ranking
curve (SUCRA). P-scores range from 0 to 1, with 0 or 1
being the theoretically worst or best treatment, respec-
tively.
36
When there was missing or unclear informa-
tion, we asked trial authors to supply data, by sending an
initial email, followed by three additional reminders in
case of no response. When standard deviations (SDs)
were not reported and not supplied by authors upon
request, we estimated them through single imputation,
by using the post-treatment means and SDs of each arm
of the RCTs in our dataset of observations. In particular,
a log-linear regression on the logarithm of the mean was
performed,
37
using weights proportional to the number
of observations used to measure the outcome. The
number of drop-outs at post-intervention was derived
through a single imputation of the logarithm of drop-out
rate, by using the logarithm of drop-out rate at follow-up
of the other two arms of the same study as observations.
For pairwise meta-analyses, we assessed heteroge-
neity using both the tau-squared and the I-squared sta-
tistics; for the former, we referred to findings from
Rhodes and colleagues
38
for mental health outcomes
(reporting a median value of 0.049, and a 95% range of
0.0007–4.70); for the latter, we followed the interpreta-
tion suggested by the Cochrane Handbook: 0%–40%:
might not be important; 30%–60%: may represent
moderate heterogeneity; 50%–90%: may represent sub-
stantial heterogeneity; 75%–100%: considerable hetero-
geneity.
20
For the NMA, common heterogeneity across
all comparisons was assumed and estimated in each
network.
39
To assess the transitivity assumption, we compared
the distribution of mean age, percentage of women,
baseline symptom severity (standardized with respect to
its range, with “0”corresponding to the minimum and
“100”to the maximum; Supplementary—ANNEX J),
individual interventions, participants with a formal
diagnosis, legal status (refugees, asylum seekers, dis-
placed people) and country income (low- and middle-
income countries) across study designs. Furthermore,
we performed network meta-regression analyses on the
same variables, through the Stata mvmeta command
29
(Supplementary—ANNEX J) to identify possible effect
modifiers. We considered differences in the distribution
of specific study characteristics between the different
comparisons to be relevant only if there were significant
imbalances according to the Kruskal–Wallis test and
meta-regression analyses showing an association with
treatment effect.
40–42
Coherence (also known as consistency in NMAs) in a
network of treatments refers to the agreement between
direct and indirect evidence on the same comparisons.
We evaluated the presence of incoherence by comparing
direct and indirect evidence within each closed loop of
nodes,
43,44
and comparing the goodness of fit for a NMA
model that assumes consistency with a model that
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allows for incoherence in a “design by treatment inter-
action model”framework,
45–47
using the Stata com-
mands mvmeta
48
and ifplot
49
in the Stata network suite.
We further investigated incoherence by first checking
for any erroneous data abstraction and second by using
a side-splitting approach between comparisons (i.e.,
splitting the total evidence into its direct and indirect
components and comparing them).
50
If more than ten studies were included in one of the
primary outcomes,
51
we assessed publication bias with
the ROB-MEN tool,
22
which involved a statistical test for
funnel plot asymmetry
22,51
and an investigation of
possible reasons for funnel plot asymmetry. We pro-
duced contour-enhanced funnel plots for pairwise
comparisons with more than ten studies to help
distinguish publication bias from other types of asym-
metry.
52
In addition, in case of evidence of small study
bias, we used Duval’s“Trim and Fill”procedure on both
sides for the primary outcomes to estimate the extent of
the possible small study effect.
53
A-priori subgroup analyses were conducted by pop-
ulation group (refugees and asylum seekers versus
others), level of the intervention (individual versus
group), clinical condition (diagnosis versus psychologi-
cal symptoms), and country income (high-income
countries [HICs] versus low- and middle-income coun-
tries [LMICs]). Sensitivity analyses excluding trials with
a high risk of bias and excluding studies evaluating
derivatives of CBT were carried out. In addition, we
conducted a post-hoc sensitivity analysis on studies
involving participants diagnosed with PTSD, focusing
exclusively on PTSD outcomes.
Role of the funding source
There was no funding source for this study.
Results
Characteristics of included studies
The electronic search yielded a total number of 9307 re-
cords (after removal of duplicates). After screening titles
and abstracts, 493 full-text papers were considered for in-
clusion, of which 103 studies with 19,230 participants met
the eligibility criteria and were included.
54–80,81–110,111–130,131–156
A total of 96 studies contributed to meta-analyses for at
least one outcome (Fig. 1). References to the studies
awaiting assessment as well as the excluded studies and
the reasons for exclusion are reported in the
Supplementary S2.
Forty-two studies employed a waitlist as control; 38
compared a psychosocial intervention with treatment as
usual; 11 compared a psychosocial intervention with a
psychological or attentional placebo condition; and 18
compared psychosocial interventions head-to-head.
Seventy-six studies were conducted in HICs and 27 in
LMICs (Table 1). Most studies included refugees and
asylum seekers (68 studies, 66%); of these, 46 (45%)
included only refugees. In contrast, 28 studies (27%)
involved economic and other types of migrants, and 7
studies included internally displaced persons. Partici-
pants primarily came from Asia (27 studies, with 26%
including Chinese participants), the Middle East and
North Africa (25 studies, with 76% including Syrian
participants). Additionally, 24 studies included migrants
from multiple countries, while the remaining studies
involved participants from Sub-Saharan Africa, Latin
America, and Europe (Table 1). In 62 studies (60%)
most participants were women, and 23 studies with only
women. Two studies included only men. The average
age of participants was 37.6 years, ranging from 22.1 to
72.7 years (Supplementary—ANNEX E).
Thirty-four studies recruited participants with a
formal psychiatric diagnosis according to the Diag-
nostic and Statistical Manual of Mental Disorders
(DSM, or the International Classification of Diseases
(ICD), (PTSD: 23 studies, 68%; unipolar depression:
7 studies, 20%; common mental disorders (CMDs):
4 studies, 12%), and twenty-five studies recruited
participants with a probable psychiatric diagnosis,
according to clinician-led structured interviews or self-
report measures (probable PTSD: 15 studies; probable
unipolar depression: 4 studies; probable CMDs:
6 studies) (Supplementary—ANNEX E). The remain-
ing studies recruited participants with psychological
symptoms as ascertained after a clinical assessment,
without employing formal diagnostic criteria or vali-
dated rating scales (Supplementary—ANNEX E)
(Table 1). In terms of formal diagnoses, among the 23
studies involving participants diagnosed with PTSD, 19
contributed to the PTSD outcome, 16 to the depression
outcome and 10 to the anxiety outcome. In the 7
studies with participants diagnosed with depression, all
contributed to the depression outcome, 5 to the anxiety
outcome, while 2 contributed to the PTSD outcome.
Notably, no studies included participants diagnosed
solely with an anxiety disorder. Furthermore, 4 studies
involved participants diagnosed with CMDs (either
depression, or anxiety disorder, or both).
The included interventions were pooled together into
the following nodes: Cognitive Behavioural-based
Therapy (CBT) (24 studies); Supportive therapy (15
studies); Narrative Exposure Therapy (NET) (11 studies);
Counselling (11 studies); Problem Management Plus
(PM+) and Step-by-Step (SbS) (9 studies); Psycho-
education (7 studies); Family-Parenting Interventions
(FPI) (6 studies); Eye Movement Desensitisation
and Reprocessing (EMDR) and related protocols
(5 studies); Creative-Expressive Interventions
(5 studies); Self-Help Plus (SH+) and Doing What
Matters in Times of Stress (DWM) (4 studies);
Problem-Solving therapy (3 studies); Mindfulness (3
studies); Integrative therapy (2 studies); Interpersonal
therapy (1 study); Psychodynamic therapy (1 study).
Psychosocial interventions belonging to the same
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Records identified from:
Databases (n = 14,899)
Embase: 3,420
Web of Science: 2,968
PsychINFO: 1,780
ProQuest: 1,504
PubMed: 1,861
MEDLINE: 1,226
CENTRAL: 1,363
CINHAL: 752
Scopus: 25
Records removed before
screening:
Duplicate records removed
(n = 5,592)
Records screened
(n = 9,307)
Records excluded based on title
and abstract inspection
(n = 8,814)
Full-texts assessed for eligibility
(n = 493)
Full-texts excluded (n= 382):
Wrong study design (n = 96)
Wrong population (n = 87)
Wrong outcomes (n = 55)
Wrong intervention (n = 26)
Study stopped (n = 3)
Other reasons (n= 20)
Ongoing (n = 95)
Studies included:
n= 103
Identification of studies via databases and registers
noitacifitnedI
Screening
Included
Studies contributing to the NMA
for:
At least one outcome: n=96
At least one of the primary
outcomes: n= 89
Awaiting assessment (n=8)
Fig. 1: PRISMA flowchart.
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theoretical model were brought together into a
single node (Supplementary—ANNEX E). Sixty
studies included individual-level interventions, while
thirty-eight studies employed a group format. The
remaining studies included a mixed format. Most
interventions were brief, generally fewer than 12
sessions, with a small proportion of studies involving
longer interventions (Table 1). In forty-four studies,
the interventions were delivered by professionals;
another forty-four studies were conducted using the
task-sharing modality. Six studies used a mixed
approach, and nine studies did not specify this
information.
Overall, 17 studies (16%) were classified as having
a“high risk”of bias, mostly due to deviations from
the intended interventions (Domain 2). A total of 70
studies(68%)wereratedashaving“some concerns”,
mainly due to the use of self-reported questionnaires
and, in some cases, lack of masking of outcome as-
sessors (Domain 4). Meanwhile, 19 studies (18%)
were considered at low risk of bias. Most studies
adequately reported the randomisation process
(Domain 1), and showed a low risk of bias in the
domains of missing outcome data (Domain 3) and
selection of the reported result (Domain 5). Across all
studies, three resulted in different judgments with
different outcomes (Supplementary—ANNEXES G–I
and Supplementary S3).
Primary outcomes
Results for primary outcomes are shown in Figs. 2–4as
forest plots and network plots. For the three primary
outcomes, all standard pairwise meta-analyses, assess-
ments of heterogeneity and incoherence, net league ta-
bles, and quality of evidence are reported in the
Supplementary—ANNEXES L–N. A total of 62 studies
contributed to the analysis of PTSD outcomes, 79
studies to the analysis of depression outcomes, and 58
to the analysis of anxiety outcomes. We found no evi-
dence of violations of the transitivity assumption; as for
meta-regressions, statistical significance was met just in
one case, for baseline symptomatology, identified as a
possible source of heterogeneity for the anxiety outcome
(Supplementary—ANNEX J).
A few interventions demonstrated better efficacy in
reducing PTSD symptoms when compared to TAU,
specifically creative expressive interventions, counsel-
ling, EMDR and NET, all of which had overlapping
confidence intervals (Fig. 2). Creative expressive in-
terventions and counselling targeted participants with
mixed diagnoses and symptoms, while NET and
EMDR were studied mainly in participants with a
PTSD diagnosis. Confidence in the evidence was
moderate for creative expressive interventions, with a
relatively precise effect estimate that was, however,
close to the threshold of non-significance. In contrast,
confidence in the evidence was rated as very low for
Study characteristic
Number of studies contributing to at least one
outcome
96
Number of participants included 16.867
Women % 64.16 (0–100)
Mean age, years (range) 37.28 (22.1–72.7)
Population N %
Refugees/asylum seekers/internally displaced 69 71.9
Other migrant populations 27 28.1
Recruiting country
High-income country 71 74.0
Middle/Upper middle-income country 18 18.7
Low/Lower middle-income country 7 7.3
Country of origin
Mixed 25 26.0
East/Central/South Asia 25 26.0
Middle East/North Africa 23 24.0
Sub-Saharian Africa 8 8.3
Latin America 6 6.3
Europe 4 4.2
Not specified 5 5.2
Psychosocial interventions
Counselling 12 12.5
Creative expressive interventions 5 5.2
Cognitive- Behavioural Therapy 25 26.0
Eye Movement Desensitization and Reprocessing 5 5.2
Family parenting interventions 6 6.2
Interpersonal therapy 1 1.0
Integrative therapy 2 2.1
Mindfulness 3 3.1
Narrative Exposure Therapy 11 11.4
Problem Management Plus/Step-by-Step 9 9.4
Problem-solving therapy 3 3.1
Psychodynamic therapy 1 1.0
Psychoeducation 7 7.3
Self-Help Plus/Doing What Matters in Times of
Stress
4 4.2
Supportive therapy 15 15.6
Number of sessions
1–4 11 11.5
5–8 40 41.6
9–12 26 27.1
13–30 13 13.5
31–45 2 2.1
NA 4 4.2
Mental health condition
Diagnosis of mental disorder 56 58.3
Psychological symptoms/exposure to social
adversity
40 41.7
Number of studies contributing to each outcome
PTSD symptoms 62 64.6
Depressive symptoms 79 82.3
Anxiety symptoms 58 60.4
Drop-out by any cause 91 94.8
NA: not assessed; PTSD: post-traumatic stress disorder.
Table 1: Characteristics of randomized controlled trials included in the
network meta-analysis.
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NET, counselling, and EMDR. While these in-
terventions showed point estimates above the clinically
significant cut-off, suggesting a moderate effect size,
their confidence intervals indicate the possibility of
smaller effect sizes. The prediction intervals for all
interventions were not significant. When compared to
the waiting list, all interventions except for mindful-
ness, psychoeducation, problem-solving therapy, and
attentional/psychological placebo, showed better effi-
cacy in reducing PTSD symptoms, with SMDs ranging
from −1.45 (IPT) to −0.46 (TAU). However, the confi-
dence in the evidence was rated as very low. In terms of
p-scores, Interpersonal therapy and NET were identi-
fied as the top-ranking interventions. Nevertheless, the
effect estimate for Interpersonal therapy was highly
imprecise and non-significant, while NET was also
associated with a greater reduction in PTSD symptoms
compared to CBT, psychoeducation, and problem-
solving therapy, albeit with very low confidence in the
evidence. No significant differences were observed for
other interventions (Supplementary—ANNEX L). The
overall network heterogeneity was moderate to sub-
stantial (estimated between-studies standard deviation
[SD]: tau = 0.444; I
2
= 80%). Intra-loop incoherence
emerged for three loops: EMDR, supportive therapy,
and waitlist; counselling, NET and TAU; CBT, coun-
selling and TAU. There was no inconsistency between
direct and indirect estimates, except for the compari-
sons of counselling versus TAU and EMDR versus
waitlist. However, according to the design-by-treatment
interaction test, there was no evidence of global
inconsistency (p-value = 0.311) (Supplementary—
ANNEX L).
A few interventions demonstrated greater efficacy in
reducing depressive symptoms than TAU, specifically
PM+/SbS, CBT, Integrative therapy, and NET (Fig. 3),
although the prediction intervals for all interventions
were not significant. PM+/SbS was studied in partici-
pants with probable PTSD, CMDs, and psychological
symptoms; CBT targeted participants with mixed di-
agnoses and symptoms; Integrative therapy targeted
participants with diagnoses of depression and CMDs;
and NET was primarily focused on participants with
PTSD diagnoses. Confidence in the evidence was rated
moderate for Integrative therapy, which showed point
estimates above the clinically significant cut-off, indi-
cating a moderate effect size, and was identified as the
top-ranking intervention. At the same time, it was low
for NET and CBT, and very low for PM+/SbS, with NET
showing point estimates above the clinically significant
cut-off. In contrast, CBT and PM+/SbS fell within the
range of clinically unimportant differences. CBT, Inte-
grative therapy, and NET outperformed attentional/
psychological placebo, although the confidence in the
evidence was low. When compared to the waiting list, all
interventions were associated with a greater reduction in
depressive symptoms, with SMDs ranging from −1.39
(IPT) to −0.58 (FPI). In head-to-head comparisons,
Integrative therapy was associated with a greater
reduction in depressive symptoms than family
parenting interventions, mindfulness, problem-solving
therapy, and psychoeducation, with confidence in the
evidence rated as low. Similarly, NET was superior to
family parenting interventions and psychoeducation,
with a low confidence in the evidence (Supplementary—
ANNEX M). A moderate heterogeneity was found
Fig. 2: Forest plot comparing each intervention with TAU for PTSD symptoms. Network plot of evidence: the thickness of edges is proportional
to the number of studies comparing the two interventions, and the size of nodes is proportional to the number of studies including that
intervention. SMD—standardized mean difference; CI—confidence interval; PIs: Prediction intervals; APP—attentional/psychological placebo;
CBT—cognitive behavioural therapy; CE—creative expressive interventions; COU—counselling; EMDR—eye movement desensitization and
reprocessing; INTEGT—integrative therapy; IPT—interpersonal therapy; MIN—mindfulness; NET–narrative exposure therapy; PMpSbS—Problem
Management Plus/Step by Step; PO—problem-solving therapy; PSE—psychoeducation; SHpDWM—self-help plus/doing what matters in times of
stress; ST—supportive therapy; TAU—treatment as usual.
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8 www.thelancet.com Vol 48 January, 2025
(estimated between studies SD: tau = 0.328; I
2
= 70%).
Intra-loop incoherence emerged for four loops: atten-
tional/psychological placebo, counselling, and family
parenting interventions; problem-solving therapy, psy-
choeducation, and waitlist; creative expression, SH+/
DWM, TAU, and waitlist; attentional/psychological
placebo, creative expressive interventions, family-
parenting interventions, and waiting list. There was no
inconsistency between direct and indirect estimates,
except for comparing counselling and family parenting
interventions. However, there was no evidence of global
inconsistency according to the design-by-treatment
interaction test (p-value = 0.584) (Supplementary—
ANNEX M).
Fig. 3: Forest plot comparing each intervention with TAU for depressive symptoms. Network plot of evidence: the thickness of edges is
proportional to the number of studies comparing the two interventions and the size of nodes is proportional to the number of studies including
that intervention. SMD—standardized mean difference; CI—confidence interval; PIs: Prediction intervals; APP—attentional/psychological pla-
cebo; CBT—cognitive behavioural therapy; CE—creative expressive interventions; COU—counselling; EMDR—eye movement desensitization and
reprocessing; FPI—family parenting intervention; INTEGT—integrative therapy; IPT—interpersonal therapy; MIN—mindfulness; NET–narrative
exposure therapy; PDT—psychodynamic therapy; PMpSbS—Problem Management Plus/Step by Step; PO—problem solving therapy; PSE—
psychoeducation; SHpDWM—self-help plus/doing what matters in times of stress; ST—supportive therapy; TAU—treatment as usual.
Fig. 4: Forest plot comparing each intervention with TAU for anxiety symptoms. Network plot of evidence: the thickness of edges is pro-
portional to the number of studies comparing the two interventions, and the size of nodes is proportional to the number of studies including
that intervention. SMD—standardized mean difference; CI—confidence interval; PIs: Prediction intervals; APP—attentional/psychological pla-
cebo; CBT—cognitive behavioural therapy; CE—creative expressive interventions; COU—counselling; EMDR—eye movement desensitization and
reprocessing; FPI—family parenting intervention; INTEGT—integrative therapy; MIN—mindfulness; NET–narrative exposure therapy; PDT—
psychodynamic therapy; PMpSbS—Problem Management Plus/Step by Step; PO—problem solving therapy; PSE—psychoeducation; SHpDWM—
self-help plus/doing what matters in times of stress; ST—supportive therapy; TAU—treatment as usual.
Articles
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In terms of anxiety symptoms, Integrative therapy,
NET, and PM+/SbS were found to be significantly
more effective compared to TAU, with creative
expressive interventions touching the line of non-
significance (Fig. 4). NET and Integrative therapy
were identified as the top-ranking interventions based
on p-scores, showing significant prediction intervals
and point estimates above the clinically significant cut-
off. Notably, Integrative therapy was studied in par-
ticipants with diagnoses of depression and CMDs, and
NET was primarily focused on participants with PTSD
diagnoses. However, despite both interventions
showed moderate effect estimates, they demonstrated
very low and low confidence in the evidence, respec-
tively. Similarly, although PM+/SbS had a precise ef-
fect estimate, its confidence in the evidence was low
and its point estimates fell within the range of clini-
cally unimportant differences. When compared with
the waiting list, all interventions showed to be effec-
tive in reducing anxiety symptoms except for family
parenting interventions, mindfulness, problem-solving
therapy, and SH+/DWM (Fig. 4), with SMDs ranging
from −1.92 (NET) to −0.48 (PSE). In terms of head-to-
head comparisons, Integrative therapy was more
effective than several interventions, including CBT,
problem-solving therapy, and psychoeducation, with a
moderate confidence in the evidence, and mindful-
ness, SH+/DWM, attentional/psychological placebo,
and supportive therapy, with a low confidence in the
evidence. Among these, CBT showed superiority over
problem-solving therapy only, with a very low confi-
dence in the evidence. NET showed a greater reduc-
tion in anxiety symptoms compared with CBT,
EMDR, counselling, family parenting interventions,
PM+/SbS, problem-solving therapy, psychoeducation,
SH+/DWM, attentional/psychological placebo, and
supportive therapy. However, confidence in the evi-
dence was very low. Creative expressive interventions
were more effective than family parenting in-
terventions and psychoeducation, with low confidence
in the evidence, and problem-solving therapy, with
moderate confidence in the evidence. Likewise, coun-
selling outperformed family parenting interventions
and problem-solving therapy, with a low confidence in
the evidence. Finally, both psychodynamic therapy and
PM+/SbS were superior to problem-solving therapy,
with very low and low confidence in the evidence,
respectively. The overall network heterogeneity was
moderate (estimated between studies SD: tau = 0.369;
I
2
= 72%). Intra-loop incoherence emerged for three
loops: CBT, Integrative therapy, and TAU; NET, psy-
choeducation, and waitlist; CBT, creative expressive
interventions, supportive therapy, TAU, and waitlist.
There was no inconsistency between direct and indi-
rect estimates, except for NET versus psychoeducation
and NET versus waitlist comparisons. However, there
was no evidence of global inconsistency according to
the design-by-treatment interaction test (p-value = 0.139)
(Supplementary—ANNEX N).
For the comparison with at least ten studies (waiting
list versus CBT) the ROB-MEN tool showed evidence of
small study effects for PTSD and depression, but not for
anxiety. However, the trim and fill method did not
suggest presence of missing studies (Supplementary—
ANNEXES L–N).
In the subgroup analyses for PTSD outcome, no
statistically significant differences were found between
psychosocial interventions and TAU for subgroups
involving participants with a formal diagnosis, studies
conducted in HICs, or those who were not refugees,
asylum seekers, or internally displaced, due to wide
confidence intervals. Consistent with the main analysis,
NET and counselling demonstrated moderate effect
estimates when compared to TAU in studies conducted
in LMICs and among refugees and asylum seekers,
though counselling was close to the threshold of non-
significance in this population. EMDR also showed
effectiveness in this population. Within the individual
interventions’subgroup, NET and EMDR approached
statistical significance, while counselling proved effec-
tive in group interventions. Creative expressive in-
terventions, which were marginally non-significant in
the main analysis but had moderate confidence in the
evidence, demonstrated increased effectiveness in group
interventions and among participants without formal
PTSD diagnosis.
For the depression outcome, no significant differ-
ences were noted in the migrant subgroup, or partici-
pants with a formal diagnosis. However, PM+/SbS
showed borderline significance in the subgroup of in-
dividual interventions and participants without a formal
diagnosis. Consistently with the results of the primary
analyses, among refugees and asylum seekers, NET,
Integrative therapy, CBT, and PM+/SbS were more
effective than TAU, with EMDR also gaining signifi-
cance. Only Integrative therapy was significant in HICs,
while NET and PM+/SbS remained significant in
LMICs, with EMDR also gaining borderline signifi-
cance. As for PTSD, in group interventions, creative
expressive interventions showed moderate efficacy,
while CBT remained barely significant, and supportive
therapy achieved statistical significance.
For anxiety outcome, Integrative therapy, NET, and
PM+/SbS remained significant in the subgroup of ref-
ugees, asylum seekers and internally displaced persons,
as well as in LMICs, where counselling and psycho-
education also gained significance. In HICs and indi-
vidual interventions, both NET and Integrative therapy
showed significance, though with less precise confi-
dence intervals. Creative expressive interventions
showed moderate efficacy for group interventions, and
both supportive therapy and psychodynamic therapy
became significant. Among participants without a
formal diagnosis, creative expressive interventions,
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10 www.thelancet.com Vol 48 January, 2025
counselling, and PM+/SbS were effective, while no
significant differences were noted in participants with a
formal diagnosis.
The test for overall network heterogeneity was sig-
nificant across all subgroups.
The sensitivity analyses were generally consistent
with the primary analyses. Specifically, the analysis
excluding studies evaluating derivatives of CBT yielded
results consistent with the main outcomes. However,
the sensitivity analysis excluding trials at high risk of
bias led to a minor shift in the p-score ranking for
PTSD, with EMDR emerging as the top intervention. In
this context, EMDR showed a moderate and precise ef-
fect estimate. Finally, when considering only studies
involving participants with a formal PTSD diagnosis,
there was no statistically significant evidence supporting
the benefit of any psychosocial interventions compared
to TAU. However, CBT, counselling, EMDR, and NET
were found to be significantly more effective than WL,
with NET and EMDR identified as the top-ranking in-
terventions based on p-scores. Notably, while the con-
fidence in the evidence was not reassessed during this
sensitivity analysis, it ranged from low to very low in the
primary analyses, with very few comparisons rated as
moderate (Supplementary—ANNEXES Q–S).
Secondary outcome
Attentional and psychological placebo, along with CBT,
PM+/SbS, and problem-solving therapy were less
acceptable compared to treatment as usual. Family
parenting interventions were more acceptable than
attentional and psychological placebo, CBT, counselling,
and waitlist. Problem-solving therapy was less accept-
able than NET, creative expressive interventions, and
supportive therapy. Intra-loop incoherence emerged for
three loops involving attentional/psychological placebo,
creative expressive interventions, and TAU; and creative
expressive interventions, waitlist, and TAU respectively
with NET and CBT. However, there was no evidence of
inconsistency between direct and indirect estimates.
Moreover, the network did not show significant overall
incoherence (design-by-treatment test, p-value = 0.32)
nor heterogeneity (estimated between-studies SD:
tau = 0; I
2
= 0%; p-value = 0.811) (Supplementary—
ANNEX P).
Discussion
The current NMA included almost a hundred studies
and almost 20,000 participants to assess the comparative
treatment outcomes of different psychosocial in-
terventions delivered to asylum seekers, refugees, and
other migrant populations.
The results revealed that several interventions,
including NET, counselling, EMDR, and creative
expressive intervention, were more effective than TAU
for PTSD symptoms, though all exhibited overlapping
confidence intervals. Creative expressive interventions
had moderate confidence in the evidence, but the effect
estimate was close to the threshold of non-significance.
Confidence in the evidence for NET, counselling, and
EMDR was rated as very low, although they showed
point estimates above the clinically significant cut-off.
For depressive symptoms, interventions like Integra-
tive therapy, NET, PM+/SbS, and CBT demonstrated
greater efficacy than TAU. Integrative therapy showed a
moderate effect size and was identified as the top-
ranked intervention with moderate confidence in the
evidence. However, this conclusion is based on a very
limited number of studies. For anxiety symptoms, NET,
Integrative therapy, and PM+/SbS were significantly
more effective than TAU, but they resulted in a low
confidence in the evidence, despite moderate effect es-
timates, especially for NET whose confidence interval
lies above the clinically significant cut-off. Head-to-head
comparisons remain largely inconclusive due to the low
confidence in the evidence. For PTSD symptoms, NET
showed greater efficacy compared to CBT, psycho-
education, and problem-solving therapy, although with
very low confidence in the evidence. For depressive
symptoms, Integrative therapy outperformed family
parenting interventions, mindfulness, problem-solving
therapy, and psychoeducation, but with a low confi-
dence in the evidence. Similarly, NET was superior to
family parenting interventions and psychoeducation,
with low confidence in the evidence. For anxiety symp-
toms, Integrative therapy and NET appeared more
effective than a range of interventions, but confidence in
the evidence varied from moderate to very low. While
certain interventions seem to perform better, the overall
reliability of these results is weakened by the low con-
fidence, making them indicative but not definitive. Also,
subgroup analyses suggest that, while certain in-
terventions show promise, further research is needed to
strengthen the evidence base and determine their
generalizability across different settings and pop-
ulations. Finally, in terms of acceptability, individual
preference has proven to be an important factor to
consider when selecting interventions, as it can signifi-
cantly influence engagement, adherence, and overall
treatment outcomes.
Previous meta-analyses have shown the benefitof
certain interventions like NET, EMDR, and CBT, but no
definitive differences between them have emerged. Our
findings align with Kip and colleagues,
157
who found
NET to have a medium to large effect on PTSD and
depression symptoms compared to control conditions at
follow-up. However, the study highlighted considerable
heterogeneity, suggesting that efficacy can vary. Simi-
larly, Molendijk and colleagues
158
supported the efficacy
of EMDR in forced migrants. However, Wright and
colleagues
159
found no significant differences between
EMDR and other psychological treatments in their in-
dividual participant meta-analysis, although not
Articles
www.thelancet.com Vol 48 January, 2025 11
specifically focused on migrants, which echoes our
finding of very low confidence in the evidence for
EMDR. Our results also align with studies like Sam-
bucini and colleagues,
160
which supported the efficacy of
interventions based on CBT techniques for depressive
symptoms, but Daniel and colleagues
161
reported low-
quality evidence for CBT-based interventions in forc-
ibly displaced persons, similar to our findings. This
contrasts with Turrini and colleagues’network meta-
analysis,
162
which found CBT more effective than TAU
for PTSD. Additionally, our findings are also consistent
with a recent systematic review
163
that showed that
PM + and SbS, two World Health Organization (WHO)
low-intensity psychosocial interventions, are effective in
reducing distress indicators like anxiety, depressive or
post-traumatic stress disorder symptoms and promoting
positive mental health in populations exposed to adver-
sities. Despite the potential of these interventions, our
findings and previous studies stress the recurring theme
of low confidence in evidence across interventions due
to heterogeneity and variability in study quality. This
highlights the ongoing need for more high-quality
research to better assess the comparative effectiveness
of psychosocial interventions across different settings
and populations.
The present review has some limitations. First, most
studies included refugees and asylum-seekers, while
economic migrants and other migrant groups were less
commonly studied. This would suggest an over-
representation of refugee studies compared to epide-
miological figures on different types of migrants, which
show a predominance of economic migrants,
164
thus
reducing the applicability of the findings to the real
world. A second limitation is that the included studies
differed concerning the background origins of the
included populations, the reason for migration, time
since resettlement, country of origin and resettlement,
the type of outcome measures, the content and modal-
ities of delivering psychosocial interventions, and the
modalities of questionnaire administration. All these
differences are likely to have contributed to the high
level of statistical heterogeneity that was detected, and
that was not fully explained by subgroup and sensitivity
analyses. Furthermore, while meta-regression results
suggested that baseline severity might be an effect
modifier for anxiety outcome, it is important to
acknowledge that the presence of other sources of het-
erogeneity cannot be ruled out. To further explore het-
erogeneity, we could have conducted additional
subgroup analyses, such as grouping interventions into
face-to-face versus digital, or those with a specific focus
on trauma versus others, or task-shifting versus non-
task-shifting. However, we anticipated that this would
have increased the chances of finding statistical associ-
ations by chance, and therefore only the a priori planned
subgroup analyses were conducted and reported. The
heterogeneity and poor methodological quality of the
primary studies may have affected the accuracy and
reliability of the results, although no evidence of
inconsistency was found. Third, small study bias was
identified for PTSD and depression, specifically in the
CBT-WL comparison, making it not possible to
completely rule out an overall risk of bias. In addition,
while ClinicalTrials.gov and CENTRAL were searched,
other clinical trial registries were not, raising the pos-
sibility that some unpublished studies may have been
overlooked. Fourth, the limited number of direct com-
parisons may have affected the robustness of our re-
sults, which should be interpreted with caution. For
example, in certain subgroup analyses, the limited
number of studies available for each comparison made
it difficult to distinguish between heterogeneity and
inconsistency. This limitation is likely tied to the
inherent challenges of conducting research with
migrant populations. Factors such as cultural differ-
ences between migrants and host countries, lack of
cultural mediators, and the added complexity of accul-
turation stress often hinder the feasibility and quality of
studies in these groups. These challenges may
contribute to the scarcity of research, which may also
have impacted the certainty of evidence. Future research
should address these gaps in the evidence base to pro-
vide a more comprehensive understanding of the in-
terventions and strengthen the conclusions. Fifth, we
made the a priori decision to only analyse data at post-
intervention, as we anticipated that a relevant number
of studies lacked long-term data and networks may have
been poorly connected, leaving uncertainty about the
long-term effects of psychosocial interventions. Addi-
tionally, since the migrant population is inherently in
transition and demands urgent assessment, this
approach aligns with the needs of humanitarian and
emergency interventions, which often require early in-
terventions and rapid evaluations. Another limitation is
that local and cultural adaptation of psychosocial in-
terventions was poorly reported, which may weaken the
accuracy of the conclusions of the studies. Moreover,
only PTSD, depression, and anxiety outcomes were
considered. We made this choice because these are the
best-studied mental health outcomes in this population,
while data for other mental health conditions are still too
limited to be re-analysed to produce meaningful pooled
estimates. Future research should consider discussing
the potential availability of other symptom domains,
such as psychotic symptoms and substance use, in the
studies included. Finally, as many studies contributing
to the outcomes of depression and anxiety involved
participants with a primary diagnosis of PTSD or vary-
ing degrees of psychological distress, most of whom did
not meet the diagnostic criteria for a depressive or an
anxiety disorder, there is a need for future research to
focus on interventions targeting specific diagnoses. As a
result, the improvements in depression and anxiety
symptoms observed in these studies may reflect the
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12 www.thelancet.com Vol 48 January, 2025
alleviation of comorbid symptoms within the context of
PTSD treatment, rather than the direct treatment of
depression or anxiety as distinct clinical entities. This
would allow for a more accurate evaluation of the effi-
cacy of these interventions in treating depression and
anxiety as separate clinical conditions.
Despite these limitations, the evidence summarised
here has important research implications. While certain
interventions show potential, they are limited by the low
or very low confidence in the evidence. Future research
should, therefore, prioritize high methodological rigour
to yield more definitive conclusions. Secondly, the
considerable heterogeneity across studies highlights the
need for more tailored research that should be expanded
beyond refugees and asylum seekers to include eco-
nomic and other types of migrant populations to better
understand the generalizability of the interventions and
to better reflect the epidemiology of migration on a
global scale. The lack of clear differences between in-
terventions in head-to-head comparisons indicates the
need for more studies directly comparing multiple in-
terventions. This will help to determine whether specific
therapies are more effective for certain mental health
outcomes or populations. Exploring the effectiveness of
interventions targeting specific diagnostic categories is
essential, as psychological interventions for different
conditions target distinct mechanisms. Understanding
these differences is critical for accurately tailoring in-
terventions and ensuring that therapeutic approaches
address the underlying mechanisms specifictoeach
disorder. Thirdly, studies with long-term assessments of
intervention efficacy are needed to consolidate findings
and assess whether the benefits of psychosocial in-
terventions are maintained over time. Also, future
research should explore the effectiveness of interventions
that aim to promote positive mental health by strength-
ening psychological well-being, resilience, coping, and
prosocial behaviour, among others.
165,166
Finally, there is a
need to test and develop selective and indicated preven-
tion interventions focused on preventing the onset of
disorders in populations not screened for diagnoses or
without any symptoms, but exposed to risk factors.
8,167
By
addressing these gaps, future research could provide
more robust evidence on the comparative effectiveness of
psychosocial interventions, thereby informing clinical
guidelines and improving mental health outcomes for
migrant populations.
In addition to research implications, the evidence
has significant policy implications. First and foremost,
the considerable heterogeneity in intervention outcomes
indicates a need for strategic resource allocation towards
high-quality research that addresses existing evidence
gaps regarding the effectiveness of psychosocial in-
terventions. Policymakers should prioritize rigorous
studies that assess both short- and long-term impacts,
ensuring mental health services are guided by reliable
data and ultimately leading to improved health
outcomes. Moreover, the observed low confidence in the
effectiveness of various psychosocial interventions un-
derscores the necessity for evidence-based guidelines
tailored to the specific needs of different migrant
groups. Policies should also focus on programs that
enhance coping mechanisms and promote positive
mental health among migrants, thereby mitigating
mental health issues before they escalate into more se-
vere conditions. Also, engaging with communities to
understand their unique mental health needs and
preferences is crucial for ensuring that the interventions
provided are relevant and acceptable. Finally, since some
interventions are less effective than others, there is a
critical need for training healthcare providers in
evidence-based practices that have shown better out-
comes in various populations. This will help ensure that
interventions are not only implemented but are done so
in a manner that maximizes their efficacy.
By addressing these considerations, policymakers
could enhance the quality and impact of mental health
interventions for migrant populations, fostering better
mental health outcomes and overall well-being.
Contributors
GT and CB conceptualized the network meta-analysis and wrote the
protocol. GT and CC screened titles and abstracts for inclusion and
inspected the full texts for inclusion. GT and CC performed data
extraction and CC, EP, MB performed the quality assessment. GT, MP,
DC and MN took part in collecting data. Analysis was performed by FT,
GO, and DP. CG and GT applied the ROB-MEN tool. GT wrote the first
manuscript draft. CB and MP reviewed it. Successive versions have been
written with feedback from all authors. All authors reviewed and edited
the manuscript and had final responsibility for the decision to submit
for publication. All authors had full access to all data.
Data sharing statement
All data relevant to the study are included in the article or uploaded as
Supplementary information.
Declaration of interests
None declared.
Acknowledgements
This research received no specific grant from any funding agency. DP was
funded by the European Union’s Horizon-MSCA-2021-PF-01 research
program under grant agreement N 101061648. The funder had no role in
the design and conduct of the study; collection, management, analysis,
and interpretation of the data; preparation, review, or approval of the
manuscript; and decision to submit the manuscript for publication.
Appendix A. Supplementary data
Supplementary data related to this article can be found at https://doi.
org/10.1016/j.lanepe.2024.101152.
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