Predicting post-traumatic stress disorder treatment response in refugees: multilevel analysis
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OBJECTIVES: Given the recent peak in refugee numbers and refugees' high odds of developing post-traumatic stress disorder (PTSD), finding ways to alleviate PTSD in refugees is of vital importance. However, there are major differences in PTSD treatment response between refugees, the determinants of which are largely unknown. This study aimed at improving PTSD treatment for adult refugees by identifying PTSD treatment response predictors. DESIGN: A prospective longitudinal multilevel modelling design was used to predict PTSD severity scores over time. We analysed data from a randomized controlled trial with pre-, post-, and follow-up measurements of the safety and efficacy of eye movement desensitization and reprocessing and stabilization in asylum seekers and refugees suffering from PTSD. METHODS: Lack of refugee status, comorbid depression, demographic, trauma-related and treatment-related variables were analysed as potential predictors of PTSD treatment outcome. Treatment outcome data from 72 participants were used. RESULTS: The presence (B = 6.5, p = .03) and severity (B = 6.3, p < .01) of a pre-treatment depressive disorder predicted poor treatment response and explained 39% of the variance between individuals. CONCLUSIONS: Refugee patients who suffer from PTSD and severe comorbid depression benefit less from treatment aimed at alleviating PTSD. Results highlight the need for treatment adaptations for PTSD and comorbid severe depression in traumatized refugees, including testing whether initial targeting of severe depressive symptoms increases PTSD treatment effectiveness. PRACTITIONER POINTS: There are differences in post-traumatic stress disorder (PTSD) treatment response between traumatized refugees. Comorbid depressive disorder and depression severity predict poor PTSD response. Refugees with PTSD and severe depression may not benefit from PTSD treatment. Targeting comorbid severe depression before PTSD treatment is warranted. This study did not correct for multiple hypothesis testing. Comorbid depression may differentially impact alternative PTSD treatments.
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Heterogeneity in the existing literature indicates difficulties in identifying specific stressors predicting treatment outcome.
“Overall, heterogeneity in the existing literature indicates difficulties in identifying specific stressors predicting treatment outcome(Sonne et al., 2016; Haagen et al., 2017).”
From Refugees versus persons family reunified to a refugee: A comparison of sociodemographic factors, trauma history, baseline psychopathology and treatment effectiveness (2023) · cites this paper as Haagen et al., 2017
The paper says in its background discussion (page unavailable) that few studies have directly examined predictors of PTSD treatment response in refugees. Its Baseline model with predictors (page unavailable) found that the number and nature of traumatic events were not significant predictors. These passages support difficulty identifying specific stressors, but the paper does not say that heterogeneity in the existing literature is the reason. (LLM, conf=0.79)
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- Authors
- Haagen, J. F. G., ter Heide, F. J. J., Mooren, T. M., Knipscheer, J. W., & Kleber, R. J.
- Affiliations
- Utrecht University (NL)
- Foundation Centrum ′45 Oegstgeest The Netherlands
- Department of Clinical Psychology Utrecht University The Netherlands
- Corresponding author
- Haagen, Joris F. G.
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2016-11-30
- Volume
- 56
- Issue
- 1
- Pages
- 69-83
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2558703230
- Cited by
- 81
- References
- 51
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 11 · 2021: 14 · 2020: 12 · 2019: 11 · 2018: 4 · 2017: 4
- FWCI
- 8.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, refugees, asylum seekers, treatment response prediction, comorbid depression, depressive symptoms, EMDR, stabilization, trauma treatment, predictors of treatment outcome
- MeSH terms
- Adult, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Prospective Studies, Refugees, Severity of Illness Index, Stress Disorders, Post-Traumatic, Stress, Psychological, Treatment Outcome
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