Psychosocial interventions to improve the mental health of survivors of human trafficking: a realist review.

ABSTRACT

More than 50 million people globally are subjected to modern slavery and human trafficking. Adverse mental health consequences of extreme exploitation are prevalent and often severe. We conducted a systematic and realist review on evaluations of psychosocial interventions for survivors of human trafficking. The review aimed to identify the influence of these interventions on the mental health and wellbeing of trafficked people and examine how they worked for which survivors in which contexts. We searched eight databases (MEDLINE, MEDLINE In-Process, Embase, PsycINFO, Global Health, CINAHL Plus, Web of Science, and Cochrane) for published evaluations of psychosocial interventions for survivors of human-trafficking. We followed a realist approach to analyse the data and report on the limitations of the studies identified. We identified four mechanisms of change as being triggered by the various intervention activities (1) awareness and understanding; (2) trust, safety, and security; (3) agency, autonomy, empowerment, and social connections; and (4) self-reflection, self-expression, and self-care. Improving mental health after traumatic events is an ongoing, nonlinear process. Intervention effectiveness and transferability would benefit from more transparent programme theories and well articulated assumptions that identify the pathways to change.