Efficacy of integrated physical and psychological interventions on PTSD among forcibly displaced persons: a systematic review and meta-analysis.

Abstract

Forcibly displaced persons (FDPs) exposed to torture and trauma require multidisciplinary therapies to address their complex needs in mental and physical health. In this systematic review and meta-analysis, we explored the efficacy of models of care that integrated psychological and physical interventions for PTSD outcomes. We searched the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. We performed the meta-analysis on studies with randomized controlled trials and non-randomized controlled trial designs, followed by a subgroup analysis of moderators. In all meta-analyses, a random-effects model was used with standardized mean differences to accommodate for the heterogeneity of studies and outcome measures. In a meta-analysis of a between-group analysis of 11 studies comprising 610 participants, integrated intervention showed a moderate effect size (Hedges' g = -0.46 (95% CI -0.80 to -0.12) in reducing PTSD symptoms. The proportion of variation in observed effects reflects 82% of variation in true effects (I² = 82%). The efficacy of transdisciplinary interventions was higher compared to multidisciplinary models. Moderator analysis found that the type of PTSD measure, format of intervention, and type of personnel providing the intervention were significant predictors of efficacy. Integrated interventions are efficacious in reducing PTSD outcomes for people with FDPs and those exposed to war trauma. Factors such as the type of integration of interventions and service delivery need to be further studied with high-quality designs and larger numbers in future studies.