Complex PTSD and Phased Treatment in Refugees: A Debate Piece

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Abstract

Asylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). The aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD. The first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees. Research shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high.

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Relevant Evidence Summaries

The evidence was reviewed and included in the following summaries: 

What works to improve mental health of refugee children and adults?

There is very strong evidence that numerous interventions are effective in improving the mental health of child and adult refugees. Specifically, cognitive behavioral therapy (CBT), trauma-focused interventions (TF), and psycho-education (PE) have been shown to improve symptoms related to anxiety, depression, post-traumatic stress disorder, and/or general distress in refugee populations. Furthermore, cultural adaptations of these […]

About this study

AGE: Adults

DIRECTION OF EVIDENCE: Inconclusive or mixed impact

DIRECTION OF EVIDENCE: Positive impact

FULL TEXT AVAILABILITY: Free

GENDER: All

HOST COUNTRY: Multiple countries

HOST COUNTRY INCOME: High Income

HOST COUNTRY INCOME: Upper Middle Income

INTERVENTION DURATION: Varies by study

INTERVENTION: Mental health and psychosocial support services

OUTCOME AREA: Post-traumatic Stress Disorder (PTSD) Reduction

REGION OF ORIGIN OF PARTICIPANT(S): Multiple Regions

STRENGTH OF EVIDENCE: Strong

TYPE OF STUDY: Systematic review

YEAR PUBLISHED: 2016

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