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The present systematic review examined post-migration variables impacting upon mental health outcomes among asylum-seeking and refugee populations in Europe. It focuses on the effects of post-settlement stressors (including length of asylum process and duration of stay, residency status and social integration) and their impact upon post-traumatic s...
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Abstract Background Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees livi...
Citations
... When considering stress and trauma in refugees, prior investigations have well-documented the importance of simultaneously accounting for the effects of post-migration living stressors. For instance, across refugee populations from a variety of backgrounds, studies have found that post-migration stressors, such as reduced social integration, time-consuming barriers to resettlement, weakened social networks, and loss of support systems within a shared culture, are linked to negative mental health outcomes [2,[20][21][22]. Notably, stronger intergenerational trauma associations have emerged in foreignborn refugee youth, as compared to U.S.-born children of refugee parents, indicating both the salience of resettlement stress and post-migratory lifestyle dynamics on child mental health [2]. ...
... The observed salience of PMLDs in regard to intergenerational trauma transmission is aligned with many studies indicating the role of PMLDs in refugee mental health [2,[20][21][22]; our findings extend upon this by clarifying the influence of post-migration stress in mediating maternal trauma exposure's impact on depression in refugee youth. Studies across populations have indicated the likelihood for trauma exposure to exacerbate the impact of later stressors-regarding both neurobiological and psychological mechanisms (e.g., altered stress reactivity; changes to stress coping) [48]. ...
... A worthy aim of future study may include further examining this pathway; for instance, perhaps dyregulated stress coping due to prior trauma impacts parenting style, parent availability, and/ or overall household stress-thereby contributing to child depressive symptoms. This specific significance of PMLDs also provides direction for future advocacy: while local public health interventions for refugee communities cannot limit or prevent trauma occurring prior to migration, understanding that PMLDs-such as lack of community supports, language barriers, and loss of social networks-following maternal trauma contribute to depression in youth could guide family-based support and advocacy efforts geared towards mitigating the impact of intergenerational trauma [20][21][22]. Further, such interventions may be most effective if targeted towards mothers, as culturally they are more involved in childrearing and statistically their experiences are associated with youth outcomes. Future studies may also compare these findings to pathways of symptom development in unaccompanied refugee youth, to gain insight into latent parental protective factors [49]. ...
Background
Trauma experienced by one generation has potential to impact those that follow. Refugee youth in particular are vulnerable to trauma and its intergenerational effects. By examining trauma subtypes, the impact of parental trauma, and post-/pre-migration stressors, this study investigated pathways linking parental trauma to psychological symptoms in Syrian and Iraqi refugee youth.
Methods
Participants included 165 minors from Syria and Iraq, and their 107 parents (56 mothers, 51 fathers), all of whom experienced forced migration due to war and resettled as refugees in southeast Michigan. Linear mixed-effects modeling and multi-level mediation analyses were employed to investigate pathways from parental trauma exposure to child symptoms (anxiety, depressive, and somatic), as well as possible explanatory mediators.
Results
Maternal cumulative trauma and death threat trauma were associated with child depressive symptoms (cumulative: b = 1.64, p =.007; death threat: b = 2.70, p =.020) and somatic burden (cumulative: b = 0.56, p =.032; death threat: b = 1.04, p =.041). Anxiety models also revealed an association between maternal cumulative trauma and child anxiety (b = 1.79, p =.034). Maternal post-migration living difficulties fully mediated the observed association between maternal cumulative trauma and child depression, though this effect was trending in sensitivity analyses. No paternal trauma variables were associated with child symptoms.
Conclusion
Findings indicate that maternal trauma exposure in particular—as well as elevated post-migration stressors for mothers—may contribute to mental health risk in refugee youth. These insights may be leveraged towards early identification of youth at high risk, and to direct focused intervention towards modifiable targets—including living difficulties (e.g., financial difficulties, access to health care and transportation) experienced by parents post-migration.
Clinical trial number
Not applicable.
... The majority of forcibly displaced children are hosted in low-and middle-income countries (LMICs) 2 ; only about 25% of displaced children resettle in well-resourced high-income countries (HICs) 5 (Box 1). Across LMICs and HICs, most displaced children experience substantial post-resettlement challenges 6,7 in addition to the long-term effects of exposure to conflict and displacement 8 . The experience of war or other crises, the loss of home, family and friends, and the enduring challenges of displacement and resettlement (such as socio-economic marginalization and limited access to school) puts displaced children at high risk for the development of mental health conditions [9][10][11] . ...
Close to 50 million children under 18 years of age are currently forcibly
displaced from their homes because of armed conflict and other
emergencies. Displaced children and adolescents are at increased risk
of developing poor mental health. However, knowledge about how best
to support their mental health and well-being is limited. In this Review,
we consolidate knowledge on the prevalence of mental disorders
in settings of forced displacement, discuss individual differences
in response to war and displacement, and review existing mental
health and psychosocial support approaches. Critical assessment of
this literature indicates a substantial mental health burden among
displaced children and supports a broad range of risk and resilience
mechanisms. Although some specific mental health and psychosocial
support interventions have positively influenced forcibly displaced
children’s mental health, there is a need for more culturally and
contextually relevant, accessible and evidence-based services that also
address family and community factors during displacement. We discuss
recommendations to ensure that these services are linked to strategies
that target adverse conditions and structural barriers and strengthen
the socio-ecological resources that contribute to children’s positive
development and well-being.
... The kind of postmigratory reception migrants receive in a host country is a key determinant of mental health. 5 Reception policies themselves are often reflective of the ambivalent or polarized views of refugees and asylum seekers in public discourse that vacillates between fear and resentment and humanitarian sentiments. During integration and resettlement, additional factors impacting mental health include racism, xenophobia, socioeconomic deprivation, low family cohesion and social isolation. ...
... Insecure status can also restrict employment opportunities, and therefore economic resources for housing and childcare. 5 Similar to the adult population, children and adolescents with an insecure status demonstrate higher rates of mental health problems as compared to those with a secure status. 19,20 Unaccompanied minors are migrants under the age of 18 years who have entered Canada unaccompanied by either a parent or a legal guardian. ...
... Bakker et al. (49) found an association between overcrowded institutional housing and poor mental health for people seeking asylum in the Netherlands. Gleeson et al. (50) and Lecerof et al. (51) found that people seeking asylum reporting housing problems had an increased risk of selfreported mental health symptoms. Leiler et al. (52) find that low quality of life in asylum housing was associated with "unpredictable conditions regarding housing location, clearly limited resources regarding healthcare, high levels of passivity and low levels of meaningful daily activities. ...
This paper presents the findings of a novel post-hoc analysis of data collected by Doctors of the World UK (DOTW UK) between 2020 and 2022 from people seeking asylum housed in repurposed hotels and barracks in England. We analyzed qualitative and quantitative data on individuals’ mental and physical health using a structural violence analytical framework. Institutional housing and associated poor living conditions were reported to contribute deteriorations in physical and mental health which collectively undermined wellbeing. Inactions around urgent and life-threatening health conditions were seen as placing individuals’ lives and long-term health at risk. Provision of housing does not currently meet people’s needs and actively undermines their mental and physical health. We conclude that approaches to accommodation provision need to be adapted to ensure individuals’ right to health is realized. We outline recommendations for policy and future research.
... A narrative systematic review of 22 studies examining the impact of post-migration variables on mental health showed that in 9 of them the length of the asylum process predicted psychiatric morbidity [8]. Other factors of relevance to migrants' mental health include a distressing family situation, poor social integration and weak social networks, financial difficulties, and housing and accommodation status, with less clear effects of unemployment, language proficiency, education, and gender. ...
Purpose:
To remedy the lack of a measure that jointly assesses the psychological status and impact of migration stressors among forced migrants, we developed and tested the Screening of Refugees Self-Report (ScoRE-SR) Questionnaire.
Method:
Four institutions with expertise on posttraumatic symptomatology and/or migration stressors developed the ScoRE-SR through an iterative process also involving consultation with migrants and experts. The measure consists of 54 items on functioning, migration stressors, and posttraumatic symptomatology. It was administered in English, Danish, Arabic, Farsi, Dari, and Tamil to migrants (N = 149) from different countries and residency types (citizen, permanent resident, holder of temporary protection visa, and Asylum Seeker) at refugee assistance institutions in Australia and Denmark.
Analyses:
The measure's internal psychometric properties were evaluated through confirmatory factor analyses and test-retest (at 2-3 months) intraclass correlations. Its convergent validity was evaluated through correlating the measure with questionnaires expected to relate to it.
Results:
The original 13 theoretical factors of the Score-SR showed adequate model-data fit, but CFAs indicated that a factor structure with 6 broader factors was more appropriate. These factors (emotional distress, anger, concerns about family/friends in other countries, concerns about family/friends in country of resettlement, adjustment/resettlement/practical difficulties, and impairment) were internally consistent, showed adequate temporal stability, and correlated as expected with measures of posttraumatic symptomatology and well-being.
Conclusions:
The ScoRE-SR is a valid measure of different types of migrants' distress and/or adjustment, filling a current gap and providing essential information for migrants' guidance and treatment.
... Whereas refugees have been legally recognised under the Refugee Convention and have been granted protection in their host country, asylum seekers' claims are still being assessed. Ongoing post-migration stressors for asylum seekers include fear of deportation, family separation, lack of employment, problems with the asylum-seeking process, and housing problems (Sinnerbrink et al., 1997;Bernardes et al., 2010;Gleeson et al., 2020). These stressors may increase asylum seekers' vulnerability to developing mental health difficulties. ...
... The ecological model of refugee distress suggests the sources of distress among ASRs are complex, multifaceted, and can stem from four ecological levels (individual, family, community, and society) before, during, and after their migration [3]. Indeed, one systematic review identified 11 predictors that affect ASRs' mental well-being [4], including the length of asylum process and duration of stay, residency status, poor social integration and weak social network, financial and employment problems, and premigration trauma. Together, these findings underscore the importance of considering both past exposures and ongoing environmental stressors when evaluating and addressing the mental health needs of ASRs. ...
... Trauma exposure also significantly heightened the risks of screening positive for PTSD/CPTSD. The present findings highlight the importance of considering both pre-migration traumatic experiences and post-migration environmental stressors when assessing the current mental health well-being of ASRs residing in Hong Kong [4]. For example, the substantiation rate for ASRs in Hong Kong (< 1%) has persistently remained significantly lower compared to some European societies that have a substantiation rate exceeding 50%. ...
The mental health of asylum seekers and refugees (ASRs) is a pressing global concern, with complex trauma histories and environmental stressors contributing to heightened vulnerability. This study investigates the mental health and service utilization patterns of ASRs in Hong Kong, where unique policy landscapes pose additional challenges to this population. A cross-sectional survey was conducted with 100 ASRs in Hong Kong. Participants completed measures assessing displacement-related stressors, trauma exposure, mental health symptoms (depression, anxiety, stress, PTSD/CPTSD), and mental health service utilization. Participants reported high levels of displacement-related stressors and trauma exposure. The majority exhibited symptoms of depression, anxiety, and stress, with a significant proportion screening positive for PTSD/CPTSD. Despite high mental health needs, their service utilization rates were low. Trauma exposure and displacement-related stressors were significantly associated with poorer mental health outcomes, but not with service utilization. ASRs in Hong Kong face significant mental health challenges, influenced by both pre- and post-migration factors. Findings underscore higher rates of mental distress in the present sample compared to prior studies in ASRs and other local surveys. While trauma-informed care is crucial, efforts to improve mental health service access and reduce systemic barriers are needed with targeted strategies and policy changes.
... It can be hard to concentrate on learning Danish in the presence of a constant fear of deportation (Vitus 2011). It is well-documented that the uncertainty and temporality of the asylum procedure is harmful to the mental health of asylum seekers (Gleeson et al. 2020, Hvidtfeldt 2018, Boettcher and Neuner 2022. The mental load of waiting-living in uncertainty and powerlessly awaiting the decision of the immigration authorities-has a widespread negative effect of life in asylum centres with serious negative consequences for health and the ability to uphold caregiver responsibilities (Dansk Flygtningehjaelp 2018). ...
Denmark’s migration and integration policies have become increasingly restrictive, reaching their peak in 2019 with a “paradigm shift” that moved the focus away from integration toward deterrence and repatriation. This volume explores the consequences of these new paradigms, particularly since 2015 and 2019: What impact has the shift had on asylum seekers and affected residents? Has the restrictive approach led to a reduction in asylum applications and an increase in repatriations? And has it weakened the radical right? A close examination suggests that the new paradigms have led to many negative outcomes, but hardly any measurable success.
... Lastly, the 'post-migration' period refers to the acculturation experiences and processes when resettlement takes place (Pieloch et al., 2016). This may include difficulties with social integration, relationships, cultural tensions, poor living conditions and being away from significant others (Gleeson et al., 2020). ...
... Considering the multiple changes/losses refugees face in foreign countries, the large proportion of asylum claims and the resettlement challenges within the host countries themselves, it is pertinent to better understand the psychological consequences of the post-migration period (Gleeson et al., 2020). An extensive exploration of qualitative studies on this topic could inform the improvement of resettlement processes. ...
Background: Many refugees face post-migration stressors during resettlement in
host countries including forced separation from loved ones. This qualitative study
aimed to examine the impact of family separation on refugee men living in the UK
and their understanding of meaningful support.
Methodology: In-depth interviews were completed with nine individuals with
experiences of family separation. Interviews were analysed following the
Interpretative Phenomenological Analysis framework.
Results: Five Group Experiential Themes with subthemes were identified.
Altogether, the themes described the emotional burden of family separation, men’s
perceived responsibility to support their families, experiences of powerlessness,
discrimination, and acculturation. Men made sense of their experiences in relation to
time and context, and their stories were embedded in their intersectional identities of
masculinity, race, sexuality, religion, and migration status. Men highlighted the
critical role of family reunification and helpful outlets for integrated support.
Discussion: Clinicians need to be aware of the unique challenges male refugees
separated from their families face in the UK and tailor their practice accordingly.
The findings highlighted the appreciation of integrative and culturally sensitive
approaches to assessment, formulation, and intervention. Recommendations are
given for policymakers to implement consequential changes in the family
reunification policy and simplify the process.
... Further, stress symptoms were predictive of CVD symptoms (AUROC 0.813). Several other studies have documented the negative health effects of migration-associated stress, including work, housing and language barriers [18][19][20][21][22] . Multiple studies have identified the profound detrimental effects specifically of deportation stress (also known as deportation worry, threat of deportation, legal status fears and fear of punitive immigration policies) [23][24][25][26][27][28][29][30] ; notably, these effects were found to be independent of all other migration stressors. ...
