Psychological and social interventions for survivors of torture
Citation: Patel N, Kellezi B, Williams ACDC. Psychological, social and welfare interventions for psychological health and well‐being of torture survivors. Cochrane Database of Systematic Reviews. 2014;(11):CD009317.
Language: Abstract available in EN, ES, FA, FR. Plain language summary available in EN, ES, FA, FR, HR, RU. Full text available in EN.
Free to view: Yes.
Funding sources: Medical Foundation (UK), Oak Foundation (UK).
What is this? Torture is widespread and can cause severe and lasting physical, psychological, social, and welfare challenges.
In this Cochrane review, the authors searched for controlled trials that assessed the impact of psychological, social, or welfare interventions for survivors of torture. They did not restrict their searches by date, publication type, publication status, or language. The authors searched in June 2014 and included nine trials (507 adult participants) from Burundi (1), Kenya (1), Mozambique (1), Germany (3), the Netherlands (1), Romania (1), and Sweden (1). They also identified one ongoing trial and six studies that were awaiting assessment. All studies were on psychological interventions: four trials used narrative exposure therapy (NET), one used cognitive-behavioural therapy (CBT), and the other four used mixed methods for trauma symptoms.
What works: At 6-month follow-up, one CBT and three NET studies showed moderate benefit compared to controls for reduction in symptoms of distress and post-traumatic stress disorder (PTSD). However, the evidence was of very low quality.
What doesn’t work: There were no immediate benefits from psychological therapy compared with controls for distress, PTSD, PTSD symptoms, or quality of life, though this was very low-quality evidence.
What is uncertain: At the time of this study, no trials of social or welfare interventions were found and therefore the impact of such interventions was unknown. None of the studies included children or adolescents, so the effect of psychological interventions on children or adolescents was unknown. It is uncertain whether the reported results can be generalised to torture survivors who did not score highly on PTSD symptom scales. The effects of time from torture to the start of treatment, treatment setting, group versus individual treatment formats, or the training of therapists were all unknown.
Implications: The authors of the review stated that the problems of torture survivors should be defined more broadly than by PTSD symptoms alone. Additional research is needed that assesses a range of interventions across cultures and languages.
Other considerations: The authors of the review discussed their findings in the context of ethnicity, culture, language, gender, religion, and education.
This summary was prepared by Catherine Haynes, checked by Sydney Johnson, and finalized by William Summerskill.