Mental health support in the community for refugee children and adolescents in high-income countries

Refugee children and adolescents who have settled in high-income countries are at risk of mental health problems due to the many challenges they face before, during, and after migration.

Key message

The evidence to date is not of sufficient quantity or quality to recommend what interventions should be implemented in practice. It is necessary for existing mental health support programmes and interventions for child refugees and asylum seekers to be evaluated so that they can add to the evidence on what works to support mental health in this population.

What did we want to find out?

We aimed to assess the evidence for mental health promotion, prevention, and treatment taking place in the community for refugee children and adolescents living in high-income countries. Some programmes or interventions may focus on mental health promotion (to improve mental health) through community-building and social support, while others may focus on the treatment of mental health problems with individualised specialist care.

What did we do?

We searched for studies in online databases and registries on 23 February 2021. 

Studies of any design were eligible as long as they included child or adolescent refugees aged 18 years or younger and evaluated a community-based mental health intervention in a high-income country. 

What did we find?

We included 38 studies with a wide range of study designs, participant characteristics, and interventions. Three studies used a randomised controlled trial design where the treatments people received were decided at random; these usually give the most reliable evidence about treatment effects. We used these studies to assess the effectiveness of interventions and the acceptability as indicated by the occurrence of adverse events. 

What were the limitations of the evidence?

There were important limitations relating to the quality of the included trials. There was no evidence on the acceptability of interventions. Data on effectiveness, relating to symptoms of mental health problems, psychological distress, and behaviour, showed no evidence of a difference in effectiveness between the intervention group and the waiting list control group (where the intervention was not delivered until after participants in the intervention group had completed the treatment) for any of the three studies.

Authors' conclusions: 

There is insufficient evidence to determine the efficacy and acceptability of community-based mental health interventions for refugee children and adolescents. 

Read the full abstract...

An unprecedented number of people around the world are experiencing forced displacement due to natural or man-made events. More than 50% of refugees worldwide are children or adolescents. In addition to the challenges of settling in a new country, many have witnessed or experienced traumatic events. Therefore, refugee children and adolescents are at risk of developing mental health problems such as post-traumatic stress disorder, and require appropriate and effective support within communities.


To assess the effectiveness and acceptability of community-based interventions (RCTs only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post-traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high-income countries.

Search strategy: 

Databases searches included the Cochrane Common Mental Disorders Controlled Trials Register (all available years), CENTRAL/CDSR (2021, Issue 2), Ovid MEDLINE, Embase, six other databases, and two trials registries to 21 February 2021. We checked reference lists of included study reports. 

Selection criteria: 

Studies of any design were eligible as long as they included child or adolescent refugees and evaluated a community-based mental health intervention in a high-income country. At a second stage, we selected randomised controlled trials.

Data collection and analysis: 

For randomised controlled trials, we extracted data relating to the study and participant characteristics, and outcome data relating to the results of the trial. For studies using other evaluation methods, we extracted data relating to the study and participant characteristics. W derived evidence on the efficacy and availability of interventions from the randomised controlled trials only. Data were synthesised narratively.

Main results: 

We screened 5005 records and sought full-text manuscripts of 62 relevant records. Three randomised controlled trials were included in this review. Key concerns in the risk of bias assessments included a lack of clarity about the randomisation process, potential for bias is outcome measurement, and risk of bias in the selection of results.

Primary outcomes

There was no evidence of an effect of community-based interventions when compared with a waiting list for symptoms of post-traumatic stress (mean difference (MD) −1.46, 95% confidence interval (CI) −6.78 to 3.86: 1 study; low-certainty evidence), symptoms of depression (MD 0.26, 95% CI −2.15 to 2.67: 1 study; low-certainty evidence), and psychological distress (MD −10.5, 95% CI −47.94 to 26.94; 1 study; very low-certainty evidence). 

There were no data on adverse events.

Secondary outcomes

Three trials reported on short-term changes in child behaviour, using different measures, and found no evidence of an effect of the intervention versus a waiting list (low to very low certainty).

None of the trials reported on quality of life or well-being, participation and functioning, or participant satisfaction.