The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers
- 4.9k Downloads
Refugees demonstrate high rates of post-traumatic stress disorder (PTSD) and other psychological disorders. The recent increase in forcible displacement internationally necessitates the understanding of factors associated with refugee mental health. While pre-migration trauma is recognized as a key predictor of mental health outcomes in refugees and asylum seekers, research has increasingly focused on the psychological effects of post-migration stressors in the settlement environment. This article reviews the research evidence linking post-migration factors and mental health outcomes in refugees and asylum seekers. Findings indicate that socioeconomic, social, and interpersonal factors, as well as factors relating to the asylum process and immigration policy affect the psychological functioning of refugees. Limitations of the existing literature and future directions for research are discussed, along with implications for treatment and policy.
KeywordsRefugee PTSD Mental health Post-migration stress
Compliance with Ethical Standards
Conflict of Interest
Susan S. Y. Li, Belinda J. Liddell, and Angela Nickerson declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.UNHCR. UNHCR mid-year trends 2015. UNHCR, Geneva. 2015. http://www.unhcr.org/56701b969.html. Accessed 4 April 2016.
- 6.Momartin S, Silove D, Manicavasagar V, Steel Z. Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. J Affect Disord. 2004;80(2–3):231–8. doi: 10.1016/S0165-0327(03)00131-9.CrossRefPubMedGoogle Scholar
- 8.•Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights. 2015;15:29. doi: 10.1186/s12914-015-0064-9. A systematic review of long-term mental health outcomes and correlates in war-affected refugees who have been settled for 5 years or longer.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49. doi: 10.1001/jama.2009.1132.CrossRefPubMedGoogle Scholar
- 13.•Nickerson A, Bryant RA, Schnyder U, Schick M, Mueller J, Morina N. Emotion dysregulation mediates the relationship between trauma exposure, post-migration living difficulties and psychological outcomes in traumatized refugees. J Affect Disord. 2015;173:185–92. doi: 10.1016/j.jad.2014.10.043. This cross-sectional study suggests that emotional dysregulation in refugees is an important psychological mechanism underlying the relationship between trauma and psychological symptoms, as well as the relationship between living difficulties and psychological symptoms.CrossRefPubMedGoogle Scholar
- 21.•Chu T, Keller AS, Rasmussen A. Effects of post-migration factors on PTSD outcomes among immigrant survivors of political violence. J Immigr Minor Health. 2013;15(5):890–7. doi: 10.1007/s10903-012-9696-1. A cross-sectional study conducted in the USA using a large clinical sample of survivors of political violence, examining the pre- and post-migration predictors of PTSD symptoms.CrossRefPubMedGoogle Scholar
- 34.Wilmsen B. Family separation and the impacts on refugee settlement in Australia. Aust J Soc Issues. 2013;48(2):241.Google Scholar
- 42.Silove D, Steel Z, McGorry P, Mohan P. Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants. Acta Psychiatr Scand. 1998;97(3):175–81. doi: 10.1111/j.1600-0447.1998.tb09984.x.CrossRefPubMedGoogle Scholar
- 44.Refugee Council of Australia. Fact sheet: detention. Refugee Council of Australia. 2014. http://www.refugeecouncil.org.au/fact-sheets/asylum-seeker-issues/mandatory-detention/. Accessed 28 April 2016.
- 53.Mansouri F, Leach M, Nethery A. Temporary protection and the refugee convention in Australia, Denmark, and Germany. Refuge: Canada’s Journal on Refugees. 2009;26(1):135–47.Google Scholar
- 54.Kaldor Centre. Factsheet: temporary protection visas. Andrew & Renata Kaldor Centre for International Refugee Law, UNSW. 2014. http://www.kaldorcentre.unsw.edu.au/sites/default/files/Temporary%20Protection%20Visas%20rev%2025.07.12014.pdf.
- 58.•Schick M, Zumwald A, Knöpfli B, Nickerson A, Bryant RA, Schnyder U et al. Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees. Eur J Psychotraumatol. 2016;7. doi: 10.3402/ejpt.v7.28057. This cross-sectional study of refugee victims of torture and war in Switzerland found that poorer social integration is associated with greater PTSD and depression symptoms, over and above trauma experiences.
- 59.•Sulaiman-Hill CMR, Thompson SC. Learning to fit in: an exploratory study of general perceived self efficacy in selected refugee groups. J Immigr Minor Health. 2013;15(1):125–31. doi: 10.1007/s10903-011-9547-5. A cross-sectional study of Afghan and Kurdish refugees settled in Australia examined the effect of general self-efficacy on psychological distress and subjective well-being.CrossRefPubMedGoogle Scholar
- 60.•Drozdek B, Kamperman AM, Tol WA, Knipscheer JW, Kleber RJ. Is legal status impacting outcomes of group therapy for posttraumatic stress disorder with male asylum seekers and refugees from Iran and Afghanistan? BMC Psychiatry. 2013;13:148. doi: 10.1186/1471-244X-13-148. This study of Iranian and Afghani refugees in the Netherlands examined post-settlement moderators of treatment outcomes for a trauma-focused group intervention for PTSD.CrossRefPubMedPubMedCentralGoogle Scholar
- 65.UNHCR. UNHCR global trends 2014: world at war. 2014. http://www.refworld.org/docid/558292924.html. Accessed 4 April 2016.
- 72.•Lambert JE, Alhassoon OM. Trauma-focused therapy for refugees: meta-analytic findings. J Couns Psychol. 2015;62(1):28–37. doi: 10.1037/cou0000048. A meta-analysis of RCTs of trauma-focused therapy for adult refugees, which supported the efficacy of trauma-focused treatments, although effect sizes were moderated by type of control condition (active vs passive).CrossRefPubMedGoogle Scholar