Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 7 appraisals
JMIR mental health
Efficacy of a World Health Organization-Guided Self-Help Intervention for Reducing Psychological Distress in Afghan Refugees: Randomized Controlled Trial
BACKGROUND: Common mental health disorders are highly prevalent among refugees. There is an urgent need to address the mental health burden in this population. OBJECTIVE: This study tested the efficacy of an individually supported self-help stress-management intervention developed by the World Health Organization-Doing What Matters in Times of Stress (DWM)-in reducing psychological distress and improving functioning among refugees in Indonesia, a major transit country in the Asia-Pacific region. METHODS: A single-blind randomized controlled trial with 303 Farsi-speaking refugees was conducted between June 2024 and June 2025. Participants with moderate to high psychological distress (Kessler Psychological Distress Scale [K10] score≥20) were randomly allocated to the facilitator-guided individual DWM condition (n=202) or a repeated assessment control condition (n=101). The primary outcome was psychological distress (K10 score) at the posttreatment assessment. Secondary outcomes were posttraumatic stress disorder symptoms, functional impairment, social functioning, and personally identified problems. RESULTS: Intent-to-treat analysis indicated that participants in the DWM condition showed greater reductions in K10 scores than those in the repeated assessment control condition (posttreatment: β=-.563, SE=0.124; P<.001; Cohen d=0.56; 1-month follow-up: β=-.447, SE=0.140; P=.002; Cohen d=0.45). Similarly, those participants in the DWM condition reported greater improvements in posttraumatic stress disorder symptoms, well-being, social functioning, functional impairment, and personally identified psychological problems. No serious adverse events were reported. CONCLUSIONS: The findings provide the first evidence for the effectiveness of DWM in reducing psychological distress and improving overall functioning among urban refugees living in a transit setting. Individually supported self-help interventions such as DWM mayoffer an effective, feasible, and scalable approach to improving mental health for refugees.
21 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Coverage and determinants of childhood immunization in Somalia: A systematic review and meta-analysis
Childhood immunization is a cost-effective public health intervention, yet coverage remains suboptimal in Somalia. This systematic review and meta-analysis aimed to pool childhood immunization coverage and its determinants in Somalia. The electronic database search strategy yielded 11 eligible cross-sectional studies conducted between 2010 and 2025. Using Comprehensive Meta-Analysis Version 5 (Biostat, Englewood, NJ, USA), the pooled coverage for receiving at least one vaccine was 57.9%, while completion of the four basic vaccines was 16.1%, Full immunization coverage was 42.2%. Children born in health facilities were more likely to be immunized than home births (AOR = 2.10; 95% CI: 1.87-2.35). Unexpectedly, mothers with ≥4 ANC visits had lower odds of child immunization (AOR = 0.27; 95% CI: 0.24-0.30). Maternal education increased immunization likelihood (AOR = 1.14; 95% CI: 1.09-1.20). Children in rural areas were likely to be immunized than urban counterparts (AOR = 1.55; 95% CI: 1.49-1.61). These findings highlight the urgent need to strengthen integrated maternal and child health services.
19 May 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
Vocal Biomarkers of Childhood Trauma: A Machine-Learning Approach to Speech Analysis
PURPOSE: Childhood trauma can disrupt communication, yet early signs often go unrecognized in regions affected by ongoing war, where immediate physical needs take precedence. Vocal biomarkers-acoustic features linked to emotional and motor regulation-offer a promising, noninvasive means of detecting trauma-linked speech disruptions. This study applied a hybrid framework to distinguish trauma exposure in Arabic-speaking children living amid active conflict. The aim was to support scalable, speech-based tools for early trauma identification in low-resource, humanitarian settings. METHOD: We analyzed 200 publicly available recordings of spontaneous speech from Arabic-speaking girls (ages 8-12 years): 100 trauma-exposed participants from Gaza (Palestinian) and 100 non-exposed controls from Jordan. Core acoustic features (fundamental frequency [F0], jitter, shimmer, harmonics-to-noise ratio [HNR], voice onset time [VOT], first formant, second formant) informed statistical testing and theory-driven composite indices. Exploratory features-including Mel-frequency cepstral coefficients and eGeMAPSv02 descriptors-were used to train binary classification models. Three classifiers (random forest, ridge regression, and logistic regression) were evaluated using nested cross-validation and bootstrap resampling. Composite indices were combined into a 0-10 Trauma Risk Score. Generalizability was assessed using an independent Lebanese cohort (n = 80), with the trained classifier applied using fixed exploratory features and preprocessing parameters. Core features were tested post hoc for cross-cohort stability. RESULTS: Trauma-exposed children showed reduced F0 and HNR, elevated shimmer and jitter, and prolonged VOT (Cohen's d > 1.2). Binary classification models achieved strong performance (area under the curve [AUC] = .89-.92); logistic regression reached AUC = .996 under cross-validation. Composite indices (AUCs > .90) stratified 68% into Moderate/High Trauma Risk. Lebanese validation confirmed generalizability, with theory-driven features showing stable predictive patterns. CONCLUSIONS: Vocal biomarkers reliably distinguished trauma exposure in Arabic-speaking children using a simple logistic regression model. This strong performance highlights the potential of speech-based tools as scalable, noninvasive methods for early trauma detection. Further validation is needed to support their use in diverse humanitarian and conflict-affected settings.
12 May 2026
Read appraisal →JMIR formative research
Cultural Relevance and Acceptability of Cognitive Behavioral Therapy Techniques Adapted by AI or a Human Psychologist: Experimental Study
BACKGROUND: Evidence-based psychological interventions are usually not accessed by marginalized groups such as refugees. Culturally adapted psychological interventions have reported larger effect sizes than nonadapted psychological interventions. However, the cultural adaptation of interventions is a lengthy process, entailing a challenge. One potential solution to overcome this challenge is the use of artificial intelligence (AI). OBJECTIVE: The aim of this study was to investigate and compare the perceived cultural relevance and acceptability of 2 common cognitive behavioral therapy (CBT) techniques when translated and culturally adapted by AI versus a human psychologist. METHODS: In a 2×2 factorial design, the text generator type (AI vs human psychologist) and the CBT technique (cognitive restructuring vs behavior modification) were compared. CBT technique texts translated and culturally adapted either by AI or by a human psychologist were blindly rated using the Cultural Relevance Questionnaire and the Theoretical Framework of Acceptability. Raters were Arabic-speaking refugees and immigrants, aged between 18 and 69 years, residing in Sweden, Denmark, and Germany. Raters were randomly allocated to 1 of 4 conditions. Each condition consisted of 2 stimuli. Two-factor between-subject design analyses were used to analyze the data. RESULTS: A significant main effect of the text generator domain type (P=.02; η²=0.045) was found in the first rating, with texts adapted by the AI domain perceived as more culturally relevant than those adapted by the human domain. No significant main effect of the CBT technique was found in the first rating (P=.10; η²=0.022). There were no differences in the second rating. Regarding acceptability, no significant main effects of text generator domain type (P=.09; η²=0.024) or the CBT technique (P=.88; η²=0.001) were found in either of the ratings. CONCLUSIONS: CBT technique materials adapted by AI may be perceived as similarly culturally relevant as those adapted by a human psychologist. This finding implies the potential to accelerate the cultural adaptation of psychological interventions. However, AI still needs to be used with caution and in accordance with rigorous safety standards and robust frameworks.
11 May 2026
Read appraisal →PloS one
Protocol for a randomized pilot trial of COMPASS, an open‑source, culturally adapted cognitive behavioral therapy program for forcibly displaced Venezuelan adults in Peru
Task-sharing approaches have shown promise in low-resource settings, yet few culturally adapted interventions have been systematically evaluated for forcibly displaced populations. Since 2016, over 1.7 million Venezuelans have migrated to Peru, facing significant barriers to healthcare and elevated risks of anxiety, depression, and post-traumatic stress disorder (PTSD). This protocol describes COMPASS (Cognitive-behavioral Open-source Mental-health Program Adapted for migrants, Sustainably delivered by lay providers and Supported by evidence). COMPASS is a transdiagnostic, open-source cognitive behavioral therapy program co-designed with forcibly displaced populations. This protocol describes the procedures for an ongoing randomized pilot trial with n = 90 forcibly displaced Venezuelan people (Clinicaltrials.gov: NCT06635486). COMPASS guides, or lay providers, trained through an intensive apprenticeship model, will deliver 6-12 weekly remote sessions. Primary outcomes include changes in anxiety, depression, and PTSD symptoms, assessed with validated Spanish-language measures. Secondary outcomes include feasibility (recruitment, retention, fidelity) and acceptability (therapist and participant ratings). Exploratory outcomes will examine integration, migration experiences, and demographic moderators of intervention effectiveness. Analyses will follow the intention-to-treat principle, using descriptive statistics and regression models to evaluate symptom trajectories across baseline, post-intervention, and 3- and 6-month follow-ups. This study represents the first effectiveness evaluation of an open-source, lay-delivered CBT program tailored for forcibly displaced people in Peru. Findings will inform feasibility, acceptability, and preliminary effectiveness of COMPASS, with potential to expand scalable, culturally relevant mental health services for forcibly displaced populations in resource-constrained settings worldwide.
27 Apr 2026
Read appraisal →Global public health
Seroprevalence of hepatitis C virus among refugees, asylum seekers, and internally displaced populations within Africa: A systematic review and meta-analysis
Hepatitis C virus (HCV), an often overlooked public health concern, is highly prevalent among marginalized groups. Refugees, asylum seekers, and internally displaced people (RASIDP) constitute an underserved population in healthcare. Given that displacement rates are increasing and that HCV is endemic to many African countries, we aimed to determine the prevalence of HCV among RASIDP communities in Africa. Studies investigating HCV prevalence within RASIDP communities across Africa were identified via the following database searches: Ovid MEDLINE, EMBASE, Web of Science, APA PsycINFO, and the WHO Africa Index Medicus. Seroprevalence estimates were meta-analysed using a random-effects model, with data stratified by participant region, age, and gender. Across 9 studies, we estimated a pooled HCV seroprevalence of 3.63% (95% CI: 0.54, 9.16) among RASIDP in Africa. Seroprevalence varied by region of origin and age, with those from Northern Africa and those aged > 40 years having the highest seroprevalence, at 10.03% (95% CI:9.03, 11.13) and 5.70% (95% CI: 0.81, 14.21), respectively. RASIDP communities represent a marginalised and vulnerable population that often faces significant barriers to accessing healthcare. Our findings show that HCV seroprevalence within these communities varies by region and age, thus suggesting a need for targeted screening approaches.
12 Apr 2026
Read appraisal →European journal of psychotraumatology
Emotion regulation skills training as an adjunctive treatment to narrative exposure therapy for posttraumatic stress disorder (PTSD) in refugees: a pilot randomized controlled trial
Background: Responses to evidence-based interventions for posttraumatic stress disorder (PTSD) in refugees vary considerably. Emotion regulation difficulties are associated with greater PTSD severity in refugees and thus represent a potential treatment target.Objective: This study aimed to test the efficacy of Skills Training in Affective and Interpersonal Regulation for Refugees (STAIR-R) and Narrative Exposure Therapy (NET) or Supportive Problem-Solving (SPS) and NET. An exploratory aim was to examine relative efficacy in refugees with high and low levels of visa and family insecurity.Methods: Seventy-one participants were randomly assigned to STAIR-R (6 sessions) + NET (7 sessions) or SPS (6 sessions) +NET (7 sessions). Assessments occurred at baseline, post-treatment, and 3-month follow-up, with additional self-report at mid-treatment. The primary outcome was clinician-assessed PTSD symptom severity (CAPS-5) and secondary outcomes included self-reported PTSD symptoms, depression symptoms, emotion regulation difficulties, difficulties in relationships and environmental quality of life.Results: Intent-to-treat linear mixed models showed no significant between-group differences at mid-treatment, post-treatment, or follow-up. Both groups demonstrated significant improvements at 3-month follow-up in clinician-assessed (STAIR-R + NET, g = -1.41; SPS + NET, g = -1.54, p < .001) and self-reported (STAIR-R + NET, g = -0.49; SPS + NET, g = -0.44, p = .006) PTSD symptoms. Moderatorg analyses revealed that those with high insecurity (n = 16) obtained greater benefits in STAIR-R + NET from pre-treatment to follow-up on self-reported PTSD (g = 1.35), depression (g = 1.11), emotion regulation difficulties (g = 1.24), relationship difficulties (g = 1.12) and quality of life (g = -1.05).Conclusions: While there were no overall between group-differences, refugees in both conditions showed reduced PTSD symptoms. There is preliminary evidence that those with high insecurity showed a better response to STAIR-R + NET than SPS + NET across several clinical outcomes, although the small sample size necessitates replication of these. These findings highlight the potential importance of tailored intervention approaches for refugees living in different environmental circumstances. Emotion regulation difficulties represent a promising treatment target for refugees with PTSD.A randomized controlled trial comparing Skills Training in Affective and Interpersonal Regulation for Refugees + Narrative Exposure Therapy (STAIR-R + NET) to Supportive Problem Solving Training + Narrative Exposure Therapy (SPS + NET) revealed no significant differences at 3-month follow-up, with both groups improving on PTSD symptoms.Moderator analyses provided preliminary evidence that refugees living with high insecurity (i.e. insecure visa or separated from all family) showed greater improvements following STAIR-R + NET than SPS + NET.
9 Apr 2026
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