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The relationship of pre- and post-resettlement violence exposure to mental health among refugees: a multi-site panel survey of somalis in the US and Canada

Abstract

Background

A large body of research highlights the lasting impact of pre-resettlement violence on the mental health of refugees after resettlement. However, there is limited research on violence exposure after resettlement and its association with mental health. We examine the association of pre- and post-resettlement violence with post-resettlement mental health symptoms in a survey of Somali refugees in the US and Canada.

Methods and findings

We collected survey data from 383 Somalis across five cities in the US and Canada (Boston, MA; Minneapolis, MN; Lewiston, NC; Portland, ME; Toronto, Canada). Wave 1 data were collected between May 2013 and January 2014, while Wave 2 was collected between June 2014 and August 2015. Data from both waves were used to examine whether the association of past violence exposures persists across time and with more recent violence exposures. The War Trauma Screening Scale assessed exposure to any pre- and post-resettlement violence at Wave 1, while the My Exposure to Violence scale assessed any past-year violence exposure at Wave 2. Mental health outcomes included symptoms of depression and anxiety (Hopkins Symptom Checklist) and post-traumatic stress symptoms (Harvard Trauma Questionnaire). Separate linear regression models at Waves 1 and 2 examined the relationship of past violence exposure to standardized scores of mental health symptoms. Participants were 22 years of age, on average. Fifty-six percent of our sample had been exposed to violence after resettlement by Wave 2. At Wave 1, the associations of pre- and post-resettlement violence with mental health were comparable in magnitude across depression [β = 0.39, 95% CI (0.21 0.57) vs. β = 0.36, 95% CI (0.10 0.62)], anxiety [β = 0.33, 95% CI (0.12 0.55) vs. β = 0.38, 95% CI (0.01 0.75)], and PTSD [β = 0.55, 95% CI (0.37 0.72) vs. β = 0.47, 95% CI (0.21 0.74)]. At Wave 2, pre-resettlement violence was associated with depressive symptoms only [β = 0.23, 95% CI (0.06 0.40)], while past-year exposure to violence had the largest association with all mental health outcomes [depression: β = 0.39, 95% CI (0.17 0.62); anxiety: β = 0.46, 95% CI (0.01 0.75); PTSD: β = 0.67, 95% CI 0.46 0.88)].

Conclusions

Our study is the first to examine refugees’ exposure to post-resettlement violence across time, finding that Somali refugees’ exposure is both persistent and prevalent after resettlement. Post-resettlement violence had a larger association with mental health than pre-resettlement exposure by Wave 2. Our study highlights the urgent need to understand the role of post-resettlement violence exposure for refugees in the US and Canada.

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Data availability

Data from this manuscript are part of an ongoing, longitudinal study and are not publicly available.

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Acknowledgements

We thank Naima Agalab of the Refugee and Immigrant Assistance Center, who has been a partner in our work with the Somali community from the beginning and has provided leadership and training in their efforts to build community leadership teams in other cities. We thank Somali community advisors Farah Aw-Osman, Fatuma Hussein, Sharif Mohammed, and Rilwan Osman for their guidance and invaluable contribution to this project. We also thank Osob Issa for her efforts on recruitment and obtaining consent. And finally, we thank the community youth who took time to share their stories.

Funding

This research was supported by the National Institute on Minority Health and Health Disparities (R21 MD012405). The findings and conclusions expressed in this report are solely those of the authors and do not necessarily represent the official views of, the National Institute on Minority Health and Health Disparities.

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Correspondence to Carmel Salhi.

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The authors of this manuscript have no relevant conflicts of interest or competing interests to disclose.

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Salhi, C., Scoglio, A.A.J., Ellis, H. et al. The relationship of pre- and post-resettlement violence exposure to mental health among refugees: a multi-site panel survey of somalis in the US and Canada. Soc Psychiatry Psychiatr Epidemiol 56, 1015–1023 (2021). https://doi.org/10.1007/s00127-020-02010-8

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Keywords

  • Refugee
  • Mental health
  • Violence exposure
  • Resettlement