A Full Systematic Review on the Effects of Cognitive Behavioural Therapy for Mental Health Symptoms in Child Refugees
Open accessAbstract
Global conflict in 2019 created record numbers of displaced children. These children have experienced multiple traumas and subsequently suffer high levels of mental health symptoms. Cognitive-behavioural therapy (CBT) is commonly used for post-traumatic stress disorder (PTSD), depression and anxiety, however the current evidence-base of CBT in child refugees is sparse, with mixed results. This study aimed to assess the effects of CBT on symptoms of PTSD, depression and anxiety in child refugees/AS. Ethics were reviewed and granted by the University of Manchester ethics committee. Medline, Embase, Cochrane, PsycINFO and CINAHL were systematically searched. Studies were included if CBT was delivered to refugee/AS children with pre and post-intervention measures of symptoms. Sixteen studies fulfilled criteria. In all studies, mental health symptom scores post-intervention had reduced, suggesting an improvement in mental health following CBT. This reduction was statistically significant in twelve studies (p < 0.001–0.5), clinically significant in eight studies and maintained at follow-up periods. No adverse effects of CBT were identified. This is the first systematic review to focus solely on CBT in child refugee populations, with unanimously positive results. Its use is cautiously recommended, however the need for more methodologically rigorous studies in this population is highlighted.
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Previous reviews merely aggregated qualitative findings related to acceptability of interventions.
“as previous reviews merely aggregated qualitative findings related to acceptability of interventions [45]”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [45]
The Methods (Criteria for Inclusion of Studies; page unavailable) identify changes in PTSD, anxiety, and depression measured with validated scales as the review’s primary outcome, with acceptability as a second objective. The Outcomes section also reports numerical satisfaction and completion rates. Thus, this review did not merely aggregate qualitative findings about acceptability. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAlthough the effectiveness of CBT interventions has been investigated, research has focused on the abatement of psychopathological symptoms rather than the improvement of quality of life in unaccompanied minors.
“although the effectiveness of CBT interventions has been investigated [45], research has focused on the abatement of psychopathological symptoms rather than the improvement of QoL in UM.”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [45]
The Methods (Criteria for Inclusion of Studies) define the review’s primary outcome as changes in PTSD, anxiety, or depression symptoms, not quality of life; the Outcomes table likewise reports symptom measures. The General Overview of Included Studies includes research on unaccompanied minors, but the review covers refugee and asylum-seeking children more broadly, so it does not establish that research specifically on unaccompanied minors has generally prioritized symptom reduction over quality of life. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe most common exclusion factor was unaccompanied minors with severe mental illness (i.e., psychosis or acute suicidality).
“Another concern was that the most common exclusion factor was UM with SMI (i.e., psychosis or acute suicidality; [45]).”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [45]
The Discussion (page unavailable) identifies severe mental illness as the most common exclusion factor in the included studies. The General Overview of Included Studies (page unavailable) specifies psychosis or suicidality, but describes the excluded participants as refugee children generally, not specifically unaccompanied minors, and does not qualify suicidality as acute. (LLM, conf=0.88)
Experimental — accuracy not yet measuredUnaccompanied minors should not be rejected due to language where possible.
“suggesting that UM should not be rejected due to language where possible [45].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [45]
The Introduction (Background; page unavailable) identifies linguistic barriers to refugee children’s access to mental health services, and the Discussion (page unavailable) describes translators as a way to improve the acceptability of therapy. These passages support addressing language barriers, but the review does not specifically say that unaccompanied minors should not be rejected because of language. (LLM, conf=0.75)
Experimental — accuracy not yet measuredStudies that used interpreters, cultural mediators, or bilingual therapists reported significant decreases in PTSD and depression symptoms in unaccompanied minors who did not speak the language of the host country.
“Studies that used interpreters, cultural mediators, or used bilingual therapists reported significant decreases in PTSD and depression symptoms in UM who did not speak the language of the host country, suggesting that UM should not be rejected due to language where possible [45].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [45]
The Discussion (page unavailable) says studies using interpreters and trained mental-health workers reported successful outcomes for children with language barriers, and it describes translators acting as cultural brokers. The General Overview of Included Studies (page unavailable) reports significant reductions in both PTSD and depression in some studies of unaccompanied minors. The review does not establish that those significant reductions occurred specifically among minors who could not speak the host-country language or in studies using bilingual therapists. (LLM, conf=0.87)
Experimental — accuracy not yet measured
This was the first review to use qualitative research synthesis to go beyond simple aggregation of findings.
“In contrast to previous studies [45], this was the first review to use QRS to go beyond simple aggregation of findings.”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [45]
The methodological drawbacks observed in this study have been reported in previous literature between 2018 and 2021.
“As the methodological drawbacks observed in this study have been reported in previous literature between 2018 and 2021 [45, 80, 84, 87] it is alarming that significant strides towards addressing these limitations have yet to be addressed.”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [45]
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What Is It Like to Be a Child Experiencing Ambiguous Loss During Russia’s War Against Ukraine?
Butsykin, Y., Palii, V., Solonskyi, A., & Дворник, М. С. (2026) · European Psychologist · doi:10.1027/1016-9040/a000600
Evans, K., & Mapp, S. C. (2026) · doi:10.1093/9780197757925.003.0006
- Authors
- Lawton, K., & Spencer, A.
- Affiliations
- Mersey and West Lancashire Teaching Hospitals NHS Trust (GB)
- University of Manchester (GB)
- Corresponding author
- Lawton, Katie
- Venue
- Journal of Immigrant and Minority Health
- Published
- 2021-02-15
- Volume
- 23
- Issue
- 3
- Pages
- 624-639
- ISSN
- 1557-1912 (ISSN-L)
- 1557-1920
- PMC
- PMC8068688
- OpenAlex
- W3130456941
- Cited by
- 39
- References
- 58
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 7 · 2023: 4 · 2022: 15 · 2021: 2
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Immigrant and Minority Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (ACF-2016-06-017)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- cognitive behavioral therapy, refugee children, asylum-seeking children, post-traumatic stress disorder, depression, anxiety, psychiatric symptoms, trauma, displaced children, treatment effects, adverse effects
- MeSH terms
- Child, Humans, Mental Health, Psychotherapy, Refugees, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy
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