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Refugees in the United States report high rates of trauma and poor mental and physical health (Blackmore et al., 2020). Sleep can be a modifiable behavior that can improve physical and mental health (Scott et al., 2021). Studies investigating sleep among refugee populations reveal high rates of suboptimal sleep, insomnia, nightmares, and sleep disturbances (Baskaran et al., 2023). Research indicates that sleep disorders might impact as much as 99% of the refugee population (Richter et al., 2020). While research has demonstrated poor sleep in this population and its potential negative impact on mental and physical health outcomes, there is limited research investigating ways to improve sleep health among refugees.
To address this dearth in the literature, we conducted a systematic review of interventions to address sleep health among refugees. We further investigated the impact of these interventions and assessed cultural adaptation.
Methods: A systematic literature search was conducted in February 2024 using the databases Academic Search Complete, PsycInfo, Global Health, Health Source, MEDLINE, Psychology and Behavioral Sciences Collection, and Social Work Abstracts. Search terms included identifiers for refugee populations (“refugee”; “forced migrant”; “asylee”), sleep health (“sleep”; “insomnia”; nightmares”), and intervention studies (“intervention”; “therapy”; “treatment”). An initial search identified 592 articles, with 74 duplicates being removed, leaving 518 articles that underwent title and abstract review by two independent reviewers. Subsequently, 42 articles were identified and underwent a full-text review by two independent reviewers. A total of 13 articles were identified as meeting the inclusion criteria for the study.
Results: Among the 13 identified articles, intervention modality varied and included music therapy, group and individual psychotherapy, medication treatment, physical therapy, psychoeducation, dietary changes, and guided imagery. Many studies used a combination of interventions. Results showed strong potential for using behavioral interventions to improve the sleep outcomes of refugees. Several studies additionally examined PTSD and other mental health outcomes and found improvement. Limited cultural adaptation was employed in interventions, with modifications such as interpretation, involvement of community members in intervention delivery, and simplification of intervention/language utilized in studies.
Conclusions and Implications: Considering the suboptimal state of sleep among refugees and the importance of sleep for overall well-being, there is a considerable lack of research on interventions to promote sleep health interventions among refugees. Among the interventions, we found potential opportunities for continued research as well as potential intervention techniques for social workers and interdisciplinary teams to advance the health of this marginalized population.