The effect of flexible cognitive-behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial
Open accessAbstract
BACKGROUND: Little evidence exists on the treatment of traumatised refugees. AIMS: To estimate treatment effects of flexible cognitive-behavioural therapy (CBT) and antidepressants (sertraline and mianserin) in traumatised refugees. METHOD: Randomised controlled clinical trial with 2 × 2 factorial design (registered with Clinicaltrials.gov, NCT00917397, EUDRACT no. 2008-006714-15). Participants were refugees with war-related traumatic experiences, post-traumatic stress disorder (PTSD) and without psychotic disorder. Treatment was weekly sessions with a physician and/or psychologist over 6 months. RESULTS: A total of 217 of 280 patients completed treatment (78%). There was no effect on PTSD symptoms, no effect of psychotherapy and no interaction between psychotherapy and medicine. A small but significant effect of treatment with antidepressants was found on depression. CONCLUSIONS: In a pragmatic clinical setting, there was no effect of flexible CBT and antidepressants on PTSD, and there was a small-to-moderate effect of antidepressants and psychoeducation on depression in traumatised refugees.
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Throughout the studies the treatment has shown limited but similar effectiveness.
“Throughout the studies the treatment has shown limited but similar effectiveness.”
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 Buhmann et al., 2016
The Discussion reports limited effects in this trial: no improvement in PTSD and a small improvement in observer-rated depression with medication. It does not support similar effectiveness throughout studies; the authors explicitly contrast their findings with other refugee studies and say their depression effect was smaller than in other antidepressant trials. (LLM, conf=0.87)
Experimental — accuracy not yet measuredA previous study conducted at CTP found a small but significant effect of sertraline on depression compared to waitlist controls.
“However, a previous study conducted at CTP found a small but significant effect of sertraline on depression compared to waitlist controls, and it therefore seems likely that at least part of the change is due to the pharmacological treatment in the present study too [14].”
From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [14]
The Outcomes section reports a significant improvement in observer-rated depression with antidepressant treatment and psychoeducation, and the Discussion describes the improvement as small in a trial that included a waiting-list control. But the Discussion explicitly says the effects of sertraline, mianserin and psychoeducation cannot be separated, so the paper does not establish an effect of sertraline alone compared with waitlist controls. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIt seems likely that at least part of the change in the present study is due to the pharmacological treatment.
“and it therefore seems likely that at least part of the change is due to the pharmacological treatment in the present study too [14].”
From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [14]
The majority of the study participants would be out of job.
“Based on our experience with the patient group, we estimated that the majority of the study participants would be out of job [14].”
From Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study (2016) · cites this paper as [14]
The study-population section describes participants’ demographics and clinical conditions, but the passages available from our copy do not state whether most were out of work. Searches for employment, unemployment, and occupational status did not establish the cited estimate; the citing authors also frame it as based on their own experience. (LLM, conf=0.72)
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References 44 · Cited by 92
Research works printed but not linked: 2
- Mollica RF, Wyshak G, de Marneffe D, Tu B, Yang T, Khuon F, et al. Hopkins Symptom Checklist 25. Manual Cambodian, Laotian and Vietnamese versions. Torture 2000; 1: 36-42.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). APA, 2000.
- Authors
- Buhmann, C. B., Nordentoft, M., Ekstroem, M., Carlsson, J., & Mortensen, E. L.
- Affiliations
- University of Copenhagen (DK)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2016-03
- Volume
- 208
- Issue
- 3
- Pages
- 252-259
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2232977717
- Cited by
- 92
- References
- 44
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 11 · 2020: 17 · 2019: 11 · 2018: 11 · 2017: 12 · 2016: 3
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Update notices
- correction (2018-01-02)
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Funders
- British Heart Foundation
- Lundbeckfonden (R155-2014-1724)
- TrygFonden
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- post-traumatic stress disorder, depression, antidepressants, sertraline, mianserin, psychoeducation, war trauma, psychotherapy
- MeSH terms
- Adult, Antidepressive Agents, Combined Modality Therapy, Denmark, Depressive Disorder, Female, Humans, Male, Mianserin, Middle Aged, Patient Education as Topic, Psychiatric Status Rating Scales, Quality of Life, Refugees, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome, Sertraline
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