A systematic review of MHPSS interventions targeting non-clinical Arabic-speaking refugees and/or displaced populations in the MENA region

Clinical Snapshot

Key Findings

• P Value: Not reported at review level; individual study-level statistics not synthesised

• Effect Size: No pooled effect size reported; narrative synthesis indicates that culturally adapted interventions promoting complex thinking, relational healing, and community participation were associated with more favourable mental health outcomes, including reduced harsh parenting behaviours and improved reflective capacity

• Primary Outcome: Identification, appraisal, and synthesis of 38 eligible MHPSS interventions for non-clinical Arabic-speaking adult refugees/displaced persons in MENA (2011–2022); assessment of IC-ADAPT framework alignment in a subset of ten top-rated interventions

• Nnt Or Sensitivity: Not calculable from available data; no NNT, sensitivity/specificity, or hazard ratio reported. Most studies prioritised feasibility and effectiveness outcomes rather than efficacy endpoints, precluding NNT estimation

• Confidence Interval: Not reported (no meta-analysis conducted)

Clinical Application

Interventions identified were predominantly group-based, delivered by trained non-specialist facilitators in community settings, suggesting scalability in resource-limited humanitarian contexts. The non-specialist delivery model is consistent with WHO task-sharing frameworks (e.g., Problem Management Plus, Group Interpersonal Therapy) and is feasible in settings with limited mental health workforce capacity. Australia hosts a significant Arabic-speaking refugee population, including communities from Syria, Iraq, and Sudan. The RACGP and Australian Centre for Posttraumatic Mental Health (ACPMH) recognise the importance of culturally adapted MHPSS for refugee populations. Findings support the value of community-based, culturally grounded programmes delivered through settlement services and community health centres, consistent with the Australian Government's Humanitarian Settlement Program framework. No specific PBS-listed pharmacological interventions are evaluated in this review. TGA considerations are not applicable. The review's emphasis on non-clinical, task-shared delivery aligns with Australian primary care models for refugee mental health, including the Refugee Health Practice resource endorsed by RACGP. Australian practitioners should note that the evidence base is derived from MENA contexts and requires careful cultural adaptation before application to Arabic-speaking diaspora communities in Australia. Non-clinical Arabic-speaking adult refugees and displaced persons in MENA countries, particularly those in Lebanon and Jordan. Findings may have directional relevance for Arabic-speaking refugee populations in other host countries, including Australia, though direct transferability requires contextual adaptation.

Abstract

BACKGROUND: Arabic-speaking refugees and displaced populations in the Middle East and North Africa (MENA) face ongoing adversity that negatively impacts their mental health. Despite increasing mental health needs, there is no published systematic review evaluating non-clinical mental health and psychosocial support (MHPSS) interventions in the MENA region for this population, particularly through a culturally grounded framework. METHODS: We conducted a systematic review of MHPSS interventions published from 2011 to 2022 targeting non-clinical Arabic-speaking adult refugees and/or displaced persons in MENA countries. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and PROSPERO registration (CRD42023421057), we searched ten databases and grey literature sources. Objectives were to identify, appraise and synthesise eligible MHPSS interventions and assess their alignment with the Integrative Complexity (IC)-Adaptation and Development After Persecution and Trauma (ADAPT) framework. Studies were appraised using four validated quality assessment tools and a novel tool assessing links to the IC-ADAPT framework, which integrates an eco-psycho-social model (ADAPT) and a cognitive-interactionist model (IC). A subset of ten top-rated interventions was synthesised for IC-ADAPT alignment. RESULTS: Thirty-eight studies met the inclusion criteria. Most interventions were conducted in Lebanon or Jordan, group-based and delivered by non-specialist facilitators in community settings. Parenting, resilience-building and trauma-focused therapies were the most common modalities. Most studies prioritised feasibility and effectiveness over efficacy. While none explicitly applied IC-ADAPT, several implicitly aligned with its eco-psychosocial systems (eg, bonds/networks, safety/security and roles/identities) and IC (eg, increased 'differentiation'), reporting reduced harsh parenting and improved reflective capacity. Culturally adapted interventions that promoted complex thinking, relational healing and community participation were linked with more favourable outcomes. CONCLUSION: This review highlights the value of culturally sensitive, non-clinical MHPSS interventions in enhancing mental health outcomes for Arabic-speaking refugee populations in MENA. Programmes grounded in eco-psychosocial and cognitive complexity frameworks-such as IC-ADAPT-offer effective, scalable strategies for addressing refugee mental health. Future work should embed these models explicitly to optimise intervention design, relevance and impact. PROSPERO REGISTRATION NUMBER: CRD42023421057.

References

1. 1.Bashmi, L., Silove, D., Brayne, C., Kuhn, I., & Boyd, E. (2026). A systematic review of MHPSS interventions targeting non-clinical Arabic-speaking refugees and/or displaced populations in the MENA region. BMJ Global Health. https://doi.org/10.1136/bmjgh-2025-021128