Review Article| Volume 8, ISSUE 6, P593-600, December 2022

Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons

  • Yuwen Cynthia Jou
    Harvard Extension School, Cambridge, Massachusetts, USA
    Search for articles by this author
  • Edward F. Pace-Schott
    Corresponding author: Edward F Pace-Schott, Harvard Medical School, Massachusetts General Hospital - East, CNY 149 13th St., Charlestown, MA 02129, USA. Tel.: 508-523-4288.
    Harvard Extension School, Cambridge, Massachusetts, USA

    Massachusetts General Hospital, Department of Psychiatry, Charlestown, Massachusetts, USA

    Harvard Medical School, Department of Psychiatry, Charlestown, Massachusetts, USA

    Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
    Search for articles by this author
Published:October 26, 2022DOI:


      Sleep difficulty is a recognized hallmark symptom of post-traumatic stress disorder (PTSD) yet often remains an enduring and neglected problem post-treatment. Around 4.4%- 88.0% of refugees, asylum seekers, and internally displaced persons report PTSD, of which 39%- 99% report sleep difficulties. These percentages substantially exceed those of the general population. Yet there has been a lack of research examining evidence-based stand-alone and add-on treatments for PTSD and related sleep disturbances among this population. Barriers to treatment encountered by this population often vary by their legal status or location, but generally include lack of access due to insufficient evidence-based treatments or mental health practitioner shortages, lack of psychoeducation on mental health, cultural stigma, language barriers, situational instability, and racial bias. The refugee population has been on the rise over the past 10 years, and the United Nations estimated the recent Ukraine-Russia conflict would lead to an additional 12 million people needing humanitarian assistance inside Ukraine and more than 6.9 million refugees fleeing to neighboring countries in the coming months. Given that refugees, asylum seekers, and internally displaced persons repeatedly encounter barriers to mental health care specific to their predicament, interventions designed to accommodate their situation are imperative for improving their sleep and mental health. We therefore call for there to be more research on integrative programs incorporating evidence-based treatments that allow for scalability, adaptability, and rapid dissemination to maximize impact in this population. Further, we encourage trainings among clinicians and researchers to increase knowledge and confidence in working with this population.


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