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Numerous studies describe mental health effects of pre-migration trauma and post-resettlement stress among refugees, yet less research examines these associations with non-refugee immigrants. Additionally, few studies assess the prevalence and impact of traumatic experiences after settlement in a new country. Using a U.S.-based representative sample of Asian (n = 1637) and Latino (n = 1620) refugees and immigrants, we investigated how traumatic events prior to and after migration, and post-migration stressors, are associated with mental illness and distress. Pre-migration trauma posed risk across a broad range of psychological outcomes for Asian refugees and Latino immigrants. Deleterious effects of post-migration trauma were notable for both groups of refugees and immigrants. Discrimination, acculturative stress, and family conflict increased risk for disorder and distress across groups in complex ways. Findings highlight the importance of examining trauma and stress at pre- and post-migration phases across migrant populations, including those not labeled as refugees.
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Journal of Immigrant and Minority Health
Trauma, Post-Migration Stress, andMental Health: AComparative
Analysis ofRefugees andImmigrants intheUnited States
CindyC.Sangalang1· DavidBecerra2· FeliciaM.Mitchell2· StephanieLechuga‑Peña2· KristinaLopez2· IsokKim3
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Numerous studies describe mental health effects of pre-migration trauma and post-resettlement stress among refugees, yet
less research examines these associations with non-refugee immigrants. Additionally, few studies assess the prevalence
and impact of traumatic experiences after settlement in a new country. Using a U.S.-based representative sample of Asian
(n = 1637) and Latino (n = 1620) refugees and immigrants, we investigated how traumatic events prior to and after migration,
and post-migration stressors, are associated with mental illness and distress. Pre-migration trauma posed risk across a broad
range of psychological outcomes for Asian refugees and Latino immigrants. Deleterious effects of post-migration trauma
were notable for both groups of refugees and immigrants. Discrimination, acculturative stress, and family conflict increased
risk for disorder and distress across groups in complex ways. Findings highlight the importance of examining trauma and
stress at pre- and post-migration phases across migrant populations, including those not labeled as refugees.
Keywords Refugees· Immigrants· Trauma· Post-migration stressors· Mental health
Refugees experience multiple forms of trauma, including
persecution, physical and sexual violence, and life-threat-
ening situations, prior to and during the process of migra-
tion [1, 2]. These experiences can have severe and long-term
mental health consequences [3, 4]. In addition to trauma,
studies have called attention to the ways in which post-
migration stressors tied to resettlement in another country
pose significant risk for psychological problems and poor
mental health [57]. In contrast to refugees, less research
examines the mental health effects of trauma and stress at
pre- and post-migration phases for non-refugee immigrants
[8, 9]. These limitations can be attributed to the ways in
which studies classify foreign-born or migrant groups as
“immigrants” broadly, or examine disparities between immi-
grant and native-born populations without accounting for
important differences in subgroups of migrants [2, 10, 11].
Generally speaking, immigrants leave their countries of
origin by choice in search of social and economic opportu-
nity while refugees are forced to migrate in search of safety
from conflict and persecution. Yet, in the U.S. non-refugee
immigrants often survive conditions characterized by mass
violence and traumatic events prior to emigration but do
not qualify for legal status as a refugee [9, 12]. In the case
of immigrants who enter the U.S. without authorization,
many endure violence during the process of transit, includ-
ing detention, verbal and physical assaults, and other human
rights abuses [1315]. A number of non-refugee immigrants
may emigrate under circumstances related to family reunifi-
cation or other temporary statuses, but have also experienced
political violence and displacement [16]. Confounding the
issue, some individuals who have legal refugee status may
reject public recognition as a refugee due to the term’s asso-
ciation with stigma and past adversity [17].
Additionally, few studies examine the prevalence and
impact of trauma experiences after migration to the U.S.
According to the American Psychiatric Association [18],
trauma includes having direct exposure to or witnessing
* Cindy C. Sangalang
1 School ofSocial Work, California State University, Los
Angeles, 5151 State University Drive, ST 815, LosAngeles,
CA90032, USA
2 School ofSocial Work, Arizona State University, 411
N. Central Avenue, Suite 800, Phoenix, AZ85004, USA
3 School ofSocial Work, University ofBuffalo, The State
University ofNew York, 685 Baldy Hall, Buffalo, NY14260,
Journal of Immigrant and Minority Health
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an event that involves actual or threatened death or serious
injury and violence. The voluminous refugee mental health
literature often assesses trauma in one’s place of origin, in
the process of flight, and during temporary settlement (e.g.
refugee camps) though often without temporal delineations
in these events [12]. Prior research has recognized specific
forms of trauma, such as intimate partner violence, in immi-
grant populations [19], yet few studies look at trauma experi-
ences broadly after settlement in a new country. Researchers
have long conceptualized the migration process as having
multiple stages [1, 2], and described ways in which prior
trauma increases vulnerability to subsequent traumas and
stress [6]. Yet, the explicit study of trauma after resettlement
has not been applied broadly across refugee and non-refugee
immigrant populations.
To address existing gaps, we draw on a U.S.-based repre-
sentative sample of Asian and Latino refugees and non-ref-
ugee immigrants (hereafter, referred to as “immigrants”) to
address the following research questions: (1) How are trau-
matic events, prior to and after migration, associated with
mental health problems among refugees and immigrants?
(2) Accounting for trauma exposure, what post-migration
stressors are associated with mental health problems?
This study has a number of unique features. First, with
notable exceptions [10, 11], this paper is among the few to
use national data to compare a range of stressors and men-
tal health outcomes for refugees and immigrants of diverse
Asian and Latin American national origins. Our study builds
on prior findings by investigating the contribution of both
pre- and post-migration stress on outcomes that include
depressive disorders, anxiety disorders, and psychologi-
cal distress. Furthermore, we examine the timing of trauma
experiences in relation to resettlement in the U.S., as few
studies assess for post-migration trauma.
After accounting for trauma, our analyses also explore
mental health outcomes linked to post-migration stressors,
including acculturative stress, discrimination, neighborhood
factors, and family conflict. Challenges associated with soci-
ocultural adjustment in a new country resulting from disso-
nance between one’s culture of origin and the host culture
(acculturative stress) as well as experiences of racial/ethnic
discrimination are robust predictors of poor mental health
[20, 21]. Similarly, migrants are prone to neighborhood con-
texts affected by residential segregation and poverty, which
play important roles in shaping health behaviors and well-
being [22]. Finally, these adjustment stressors can adversely
affect family relationships and lead to family conflict, which
is strongly linked to psychological distress and mental health
in migrant populations [23].
In summary, the current study examines the mental
health effects of trauma and stress prior to and after migra-
tion among refugees and immigrants in the U.S. We hypoth-
esize that both pre-migration trauma and post-migration
trauma are associated with greater risk of mental illness
and increased psychological distress for immigrants as well
as refugees. Similarly, we hypothesize that post-migration
stressors will amplify risk for mental illness and elevate psy-
chological distress.
Data andSampling
Data from this study were drawn from the National Latino
and Asian American Study (NLAAS), an epidemiologi-
cal survey of mental illness and mental health service use
among Latinos and Asian Americans in U.S. The NLAAS
used a complex three-stage stratified sampling design that
has been described in detail elsewhere [24, 25]. Eligible
respondents were age 18years or older and were not in the
military or institutionalized. The NLAAS recruited a total
of 2554 Latino and 2095 Asian participants between 2002
and 2003.
Lay interviewers conducted interviews with participants
using computer-assisted survey instruments in the partici-
pants’ preferred language (English, Spanish, Mandarin, Can-
tonese, Tagalog, or Vietnamese). The final overall response
rate for Asians was 65.6% and the rate for Latinos was 75.5%
[25, 26]. We analyzed data on 3268 respondents born out-
side the U.S. (n = 1639 Asian; n = 1629 Latino). The use
and analysis of the NLAAS was approved by the Interuni-
versity Consortium for Political and Social Research and the
authors’ University Institutional Review Boards.
Depressive andAnxiety Disorders inthepast12 Months
Participants were classified with DSM-IV diagnoses in the
past year (0 = absent, 1 = present) using the World Health
Organization’s expanded version of the Composite Interna-
tional Diagnostic Interview [WHO-CIDI, 27]. Any depres-
sive disorder included at least one diagnosis of depressive
disorder or dysthymia in the last year. Any anxiety disorder
was based on diagnosis of at least one of the following dis-
orders in the past year: panic disorder, agoraphobia without
panic, social phobia, generalized anxiety disorder, or post-
traumatic stress disorder (PTSD).
Psychological Distress
The Kessler Psychological Distress scale assessed the fre-
quency of experiencing mental and emotional distress in the
past month [28]. Items included how often participants felt
depressed, hopeless, restless/fidgety, and tired for no good
Journal of Immigrant and Minority Health
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reason. Responses ranged from 1 (none of the time) to 5 (all
of the time). The index demonstrated high internal consist-
ency (α = 0.86 for Asians; α = 0.93 for Latinos).
Pre-migration andPost-migration Trauma Exposure
Twenty-six items captured whether participants experienced
a variety of traumatic events, with a subsequent follow-up
item for each regarding the age they first experienced the
aforementioned traumatic event. Taken from the WHO-
CIDI, these items were included in the NLAAS to assess
PTSD symptoms. Representative items included whether
participants were an unarmed civilian in a war zone, a civil-
ian exposed to ongoing war, saw injuries or dead bodies,
were mugged, or sexually assaulted (items previously pub-
lished [11]; see Appendix for most common items by group).
As was done in prior research [5, 10, 11], to determine the
timing of pre- and post-migration events, we subtracted
participants’ age of migration from the age they first expe-
rienced the traumatic events; negative values represented
traumatic events prior to migration to the U.S. and positive
values represented those after migration to the U.S. Affirma-
tive responses were summed for each period (range 0–14).
Participants reported the frequency of unfair treatment with
the 9-item Everyday Discrimination scale [29]. Representa-
tive items, ranging from 1 (never) to 6 (almost everyday),
asked how often participants were threatened/harassed,
called names/insulted, and treated with less respect than oth-
ers. Higher summed scores reflected more frequent experi-
ences of discrimination (α = 0.90 for Asians; α = 0.90 for
Acculturative Stress
A 10-item scale adapted from the Mexican American
Prevalence and Services Survey [30] assessed acculturative
stress. Items tapped into strains associated with adjustment
to a new country, including whether participants felt guilty
about leaving family/friends in their country of origin, felt
respected in the U.S. compared to their country of origin, had
difficulty finding work due to Latino/Asian descent, or were
questioned about their legal status. Dichotomous responses
(0 = no, 1 = yes) were summed, with higher summed scores
indicating greater acculturative stress (α = 0.57 for Asians;
α = 0.69 for Latinos).
Family Conflict
Five items drawn from the Hispanic Stress Inventory
assessed the relative frequency of perceived family
conflict due to incongruent cultural values [31]. Participants
responded on a scale of 1 (hardly ever or never) to 3 (often)
to statements including “Being too close to family interfered
with my goals” and “I argue with family over different cus-
toms” (α = 0.76 for Asians; α = 0.79 for Latinos).
Neighborhood Environment
A seven-item scale focused on respondents’ perceptions of
safety and social cohesion in their neighborhood [24, 32].
Representative items included whether people in the neigh-
borhood could be trusted, get along with each other, and help
in an emergency. Two items were reverse coded (“People get
mugged in the neighborhood” and “People sell/use drugs in
neighborhood”). Responses ranged from 1 (not at all true)
to 4 (very true), with summed scores ranging from 4 to 28
= 0.78 for Asians; α = 0.81 for Latinos).
We controlled for gender, age, ethnicity, education, mari-
tal status, duration in the U.S., work status, and social
desirability. To assess social desirability reporting bias, a
10-item measure assessed respondents’ agreement (0 = false,
1 = true) to statements such as “I never met a person I didn’t
like,” “I have never been bored,” and “I am not bothered
by someone taking advantage of me” [33]. Summed scores
ranged from 0 to 10 (α = 0.71 for Asians; α = 0.77 for
We conducted all analyses in Stata 15 and used the appropri-
ate sampling weights to account for the NLAAS multistage
survey design [34]. After describing and testing for group
differences across migrant status in the Latino and Asian
American samples, we examined associations between pre-
and post-migration stressors and mental health outcomes.
We employed logistic regression for binary outcomes
(depressive and anxiety disorders) and multivariable lin-
ear regression to model effects on psychological distress.
Because missing data was minimal we proceeded with com-
plete cases. Our analyses were stratified by migrant status
based on a single item that asked foreign-born participants
the following question: “Were you ever a refugee—that is,
did you ever flee from your home to a foreign country or
place to escape danger or persecution?” This item indicates
self-reported rather than legal status as a refugee (0 = immi-
grant, 1 = refugee) and has been used in prior research with
this data [5, 10, 11].
Journal of Immigrant and Minority Health
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Table1 presents characteristics of both Asian and Latino
samples, comparing immigrants and refugees, respec-
tively, within each sample. Among Asians, a significantly
greater proportion of refugees were older and of Vietnam-
ese heritage (57.93%), had lower levels of education and
English language proficiency, and a longer duration of
residence in the U.S. Furthermore, the proportion of Asian
refugees who were unemployed was double that of the
proportion of unemployed immigrants, though refugees
had comparatively lower levels of poverty. Asian refugees
had significantly higher levels of pre-migration trauma and
lower levels of perceived everyday discrimination com-
pared to immigrant counterparts. There were no significant
differences between refugees and immigrants in the rate of
12-month disorders or psychological distress.
Among Latinos, a greater proportion of refugees were
male, older, and of Cuban descent (49.65%) compared to
immigrants. Latino refugees had higher levels of educa-
tion, greater English language proficiency, higher levels
of poverty, and were less likely to be uninsured compared
to immigrants. Additionally, Latino refugees had signifi-
cantly higher levels of pre-migration and post-migration
trauma than their immigrant counterparts. Refugees and
immigrants did not differ in rates of 12-month disorders
or psychological distress.
Next, we present odd ratios and OLS regression coef-
ficients for the associations between pre- and post-migra-
tion stressors and mental health outcomes (any depres-
sive disorder, any anxiety disorder, and psychological
distress, respectively) for Asians and Latinos. Among
Asians (Table2), pre-migration trauma was associated
with greater odds of depressive disorder and psychologi-
cal distress for refugees; pre-migration trauma was associ-
ated with greater odds of anxiety disorders for immigrants.
Post-migration trauma was linked to depressive disorders
for both refugees and immigrants. For refugees, discrimi-
nation was associated with greater odds of anxiety disor-
ders. For immigrants, discrimination was associated with
greater odds of depressive and anxiety disorders as well
as psychological distress. Acculturative stress was linked
to lower odds of anxiety disorders and greater psychologi-
cal distress for refugees, but not linked to mental health
for immigrants. Across both refugees and immigrants,
family conflict increased odds of depressive and anxiety
disorders and psychological distress. Finally, there was
no association between one’s neighborhood context and
mental health outcomes.
Among Latinos (Table 3), pre-migration trauma
increased risk of psychological distress for refugees;
pre-migration trauma was associated with greater odds
of disorders and psychological distress for immigrants.
Post-migration trauma was linked to greater psychological
distress for refugees; post-migration trauma was associated
depressive disorders and psychological distress for immi-
grants. Discrimination was linked to poorer mental health
across all outcomes for immigrants, but not associated
with mental health outcomes for refugees. Acculturative
stress was linked to elevated odds of depressive disorder
for refugees; for immigrants acculturative stress was linked
to greater odds of depressive disorders and psychological
distress. Family conflict was associated with poorer mental
health across all outcomes for refugees, and with anxiety
disorders and psychological distress for immigrants. Simi-
lar to Asians, neighborhood context was not linked to men-
tal health outcomes for Latino refugees and immigrants.
This study compared effects of pre- and post-migration
trauma and stress on mental illness and distress across refu-
gees and immigrants in a representative U.S. sample with
Latino and Asian origins. In support of our primary hypoth-
eses, pre- and post-migration trauma was linked to mental
disorders and distress, with varied associations by racial/eth-
nic group and migrant status. For Asians, trauma exposure
prior to and after migration was similarly linked to poorer
mental health across refugee and immigrant groups. Among
Latinos, our results indicate both pre- and post-migration
trauma had deleterious effects across a broader range of
mental health problems for immigrants compared to their
refugee counterparts.
The findings regarding pre-migration trauma align with
prior research demonstrating the destructive, long-term
mental health consequences of war and political violence
migrants face in their countries of origin and in transit [8,
9, 12]. Our results are also consistent with the refugee men-
tal health literature indicating traumatic events are the most
common pre-migration factor associated with psychiatric
symptoms [35]. Numerous studies highlight pre-migration
trauma among Latino immigrants escaping individual, insti-
tutional, and state-based violence [8] as well as Asian immi-
grants escaping everyday violence tied to repressive regimes
in their home countries [12, 36]. In all, these data highlight
the importance of understanding effects of pre-migration
trauma broadly in migrant populations, including those not
labeled or seen as refugees.
A unique contribution of our study was the inclusion
of post-migration trauma as a risk for mental health. For
both Asian refugees and immigrants, post-migration trauma
heightened risk for depressive disorders, though the odds for
disorder were double for refugees. A history of severe war
trauma and barriers to appropriate mental health services
Journal of Immigrant and Minority Health
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Table 1 Weighted sample characteristics of refugees and immigrants: NLAAS (n = 3268)
Statistically significant differences relative to same-group refugees (Rao-Scott χ2 accounted for weighted survey proportions):
*p ≤ 0.05; **p ≤ 0 .01; ***p ≤ 0 .001
Asians (n = 354) Latinos (n = 1629)
Refugees (n = 354) Immigrants (n = 1285) Refugees (n = 306) Immigrants (n = 1323)
Mean (%) SE Mean (%) SE p Mean (%) SE Mean (%) SE p
Sociodemographic characteristics
Female 47.70% 0.04 54.32% 0.02 38.19% 0.05 49.09% 0.02 *
Age 45.68 1.58 41.67 0.65 * 42.96 1.64 38.29 0.54 **
Asian subgroup
Vietnamese 57.93% 0.05 8.83% 0.02 ***
Filipino 0.53% 0.01 23.05% 0.03
Chinese 16.51% 0.03 32.81% 0.03
Other Asian 25.02% 0.04 35.31% 0.03
Latino subgroup
Cuban 49.65% 0.06 3.59% 0.01 ***
Puerto Rican 1.16% 0.01 7.63% 0.01
Mexican 6.35% 0.04 58.73% 0.05
Other Hispanics 42.83% 0.05 30.04% 0.04
11years or less 29.51% 0.03 15.61% 0.01 *** 32.75% 0.05 56.19% 0.02 ***
12years 17.61% 0.03 16.14% 0.02 16.36% 0.04 20.10% 0.01
13–15years 19.89% 0.02 22.20% 0.02 28.97% 0.05 15.49% 0.01
16+ years 32.99% 0.04 46.04% 0.02 21.92% 0.04 8.21% 0.01
Marital status
Married/cohabiting 73.49% 0.04 73.91% 0.01 69.28% 0.05 70.13% 0.02
Divorced/separated/widowed 10.06% 0.03 7.17% 0.01 14.42% 0.03 13.92% 0.01
Never married 16.45% 0.03 18.92% 0.01 16.31% 0.05 15.95% 0.01
English language proficiency 6.70% 0.26 8.26% 0.13 *** 6.29% 0.35 5.43% 0.17 *
Social desirability bias 7.43 0.20 7.60 0.11 23.19 1.38 20.15 0.36 *
Duration of residence in the U.S
Less than 5years 5.41% 0.02 20.22% 0.02 *** 15.03% 0.04 16.97% 0.02
5–10years 16.53% 0.03 15.81% 0.01 14.55% 0.03 15.71% 0.01
11–20years 32.83% 0.03 34.47% 0.02 28.87% 0.05 31.41% 0.02
20+ years 45.23% 0.04 29.49% 0.02 41.55% 0.06 35.91% 0.02
Work status
Employed 61.24% 0.04 63.67% 0.02 * 66.55% 0.05 63.39% 0.03
Unemployed 11.42% 0.02 5.58% 0.01 4.13% 0.02 6.63% 0.01
Not in labor force 27.33% 0.03 30.76% 0.02 29.32% 0.05 29.98% 0.03
Income-to-poverty ratio 4.22 0.32 5.72% 0.18 *** 4.09% 0.53 2.67% 0.18 *
Uninsured 11.16% 0.02 14.61% 0.01 25.61% 0.05 43.83% 0.02 **
Pre-migration stress
Pre-migration traumas 1.88 0.12 0.84 0.04 *** 2.28 0.18 0.96 0.06 **
Post-migration stress
Post-migration traumas 0.6 0.06 0.56 0.04 1.45 0.11 0.98 0.06 *
Everyday discrimination 14.29 0.3 15.88 0.22 *** 16.21 0.37 14.84 0.29
Acculturative stress 2.1 0.15 1.73 0.08 * 2.34 0.14 2.5 0.08
Family conflict 6.74 0.12 6.49 0.08 6.13 0.09 6.23 0.07
Neighborhood context 22.06 0.37 21.49 0.25 21.01 0.38 20.21 0.2
Mental health outcomes
Any depressive disorder 6.9 0.03 4.09 0.01 7.91 0.02 7.44 0.01
Any anxiety disorder 5.14 0.02 5.58 0.01 13.91 0.04 8.54 0.01
Psychological distress 11.69 0.47 11.16 0.19 11.78 0.47 11.63 0.32
Journal of Immigrant and Minority Health
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among for Southeast Asian refugees has been well-docu-
mented [37, 38] and these factors combined with contem-
porary traumas may heighten trauma’s effects in the Asian
refugee sample [39]. In contrast, for Latinos, post-migration
trauma similarly increased risk for psychological distress
across refugees and immigrants but also increased risk for
depressive disorders among immigrants only. Though we did
not have data on visa type or authorized legal status, these
findings may partially reflect experiences of undocumented
Latino immigrants. Many endure perilous journeys to the
U.S. and, upon arrival, can encounter threats of deportation,
ineligibility for government services, and anti-immigrant
rhetoric [40], which can heighten effects of post-migration
trauma on mental health.
Table 2 Associations between pre- and post-migration stressors and mental health outcomes for asian refugees and immigrants: NLAAS
(n = 1637)
All analyses are weighted and control for the following: gender, age, ethnicity, duration of stay in the U.S., English language proficiency, marital
status, employment, health insurance, and social desirability bias
*p ≤ 0.05; **p ≤ 0 .01; ***p ≤ 0 .001
Refugees (n = 353) Immigrants (n = 1284)
Any depressive
Any anxiety
Any depressive
Any anxiety
Psychological distress
OR (95% CI) OR (95% CI) b (95% CI) OR (95% CI) OR (95% CI) b (95% CI)
Pre-migration stress
1.92 (1.39, 2.66)*** 1.07 (0.84, 1.37) 0.55 (0.16, 0.95)** 0.96 (0.73, 1.27) 1.17 (1.03, 1.34)* 0.18 (− 0.05, 0.42)
Post-migration stressors
2.51 (1.43, 4.41)** 1.30 (0.89, 1.90) 0.57, (− 0.40, 1.54) 1.26 (1.04, 1.55)* 1.22 (0.93, 1.59) 0.26 (− 0.06, 0.57)
Discrimination 1.07 (0.94, 1.20) 1.17 (1.04, 1.32)* 0.04 (− 0.06, 0.14) 1.11 (1.07, 1.14)*** 1.07 (1.03, 1.12)** 0.16 (0.09, 0.24)***
1.30 (0.85, 2.00) 0.40 (0.19, 0.87)* 0.43 (0.003, 0.86)* 1.10 (0.91, 1.34) 1.05 (0.92, 1.20) 0.02 (− 0.17, 0.21)
Family conflict 1.91 (1.29, 2.81)* 1.99 (1.25, 3.18)* 0.74 (0.25, 1.25)** 1.30 (1.13, 1.50)** 1.32 (1.15, 1.51)*** 0.73 (0.53, 0.93)***
1.18 (0.98, 1.42) 0.95 (0.84, 1.08) 0.05 (− 0.14, 0.23) 1.05 (0.98, 1.13) 0.97 (0.92, 1.02) − 0.01 (− 0.06, 0.04)
Table 3 Associations between pre- and post-migration stressors and mental health outcomes for latino refugees and immigrants: NLAAS
(n = 1620)
All analyses are weighted and control for the following: gender, age, ethnicity, duration of stay in the U.S., English language proficiency, marital
status, employment, health insurance, and social desirability bias
*p ≤ 0 .05; **p ≤ 0 .01; ***p ≤ 0 .001
Refugees (n = 304) Immigrants (n = 1316)
Any depressive
Any anxiety
Any depressive
Any anxiety
OR (95% CI) OR (95% CI) b (95% CI) OR (95% CI) OR (95% CI) b (95% CI)
Pre-migration stress
1.05 (0.86, 1.28) 0.95 (0.70, 1.30) 0.60 (0.39, 0.81)** 1.32 (1.15, 1.51)** 1.20 (1.04, 1.40)* 0.51 (0.31, 0.91)***
Post-migration stressors
1.10 (0.81, 1.52) 0.99 (0.74, 1.32) 0.50 (0.13, 0.87)* 1.34 (1.10, 1.63)*** 1.08 (0.94, 1.23) 0.46 (0.13, 0.79)**
Discrimination 0.93 (0.86, 1.01) 1.03 (0.96, 1.11) 0.03 (− .04, 0.09) 1.04 (1.01, 1.07)* 1.05 (1.02, 1.07)*** 0.14 (0.06, 0.22)**
1.35 (1.03, 1.77)* 1.06 (0.80, 1.42) 0.15 (− .50, 0.80) 1.19 (1.01, 1.41)* 1.17 (0.99, 1.39) 0.38 (0.11, 0.64)**
Family conflict 1.47 (1.10, 1.96)* 1.28 (1.01, 1.63)* 1.25 (0.60, 1.90)** 1.09 (0.98, 1.20) 1.15 (1.06, 1.25)** 0.70 (0.44, 0.95)***
1.10 (1.00, 1.22) 0.93 (0.81, 1.05) 0.05 (− .05, 0.15) 1.00 (0.95, 1.05) 0.99 (0.95, 1.03) 0.06 (− .006, 0.13)
Journal of Immigrant and Minority Health
1 3
Other post-migration stressors detracted from mental
health outcomes after accounting for trauma exposure,
aligned with a growing body of literature underscoring the
salience of the post-resettlement context on migrants’ health
[47]. Discrimination consistently predicted poorer mental
health for Asian and Latino immigrants. This finding echoes
the substantial literature illustrating the negative psychologi-
cal and health consequences of discrimination [41, 42]. Peo-
ple often migrate to the U.S. in search of increased freedoms
and economic opportunities in order to provide better lives
for themselves and their families, arriving with great opti-
mism and hope for their future [43]. However, immigrants
encounter discrimination due to racial/ethnic, religious, and
language biases in the U.S. as well as harmful social and
political discourse regarding immigrants from developing
countries. Although discrimination increased risk of anxiety
disorders among Asian refugees, discrimination largely did
not influence mental health outcomes for refugee groups.
One explanation is that due to refugees’ experiences with
trauma and severe violence in their home countries, they
may minimize everyday discrimination in the U.S. Fur-
thermore, despite their potentially greater need for material
and social support upon arrival, refugees are provided with
some financial and housing support from refugee resettle-
ment agencies to ease the transition to a new country; it may
be that the need to maintain relative safety supersedes refu-
gees’ concerns with everyday negative treatment. In contrast,
immigrants who leave their homelands with expectations for
a better life in the U.S. may be especially vulnerable to the
effects of discrimination.
We found acculturative stress increased risk of depressive
disorders for Latino refugees and immigrants and contrib-
uted to greater psychological distress for Asian refugees and
Latino immigrants. These results are consistent with prior
literature describing the negative influence of acculturative
stress on the psychological adjustment of Latino and Asian
immigrants [44, 45]. However, the finding that acculturative
stress was associated with lower risk of anxiety disorders
among Asian refugees was unexpected. Anxiety is character-
ized by excessive fear and worry about the future [46]. Asian
refugees in our sample who escaped war-torn pasts might
view stressors tied to the cultural adjustment process as a
type of “immigrant tax” [47] paid in exchange for resettle-
ment in the U.S., which nonetheless frames the future with
optimism rather than fear. Research has shown that coping
in the form of forbearance, or emotional restraint in light of
challenges, has buffered the stress of discrimination among
Southeast Asian (Chinese, Vietnamese, and Lao) refugees
in Canada [48]. More research is needed to investigate vari-
ables omitted in our analysis that may capture mechanisms
underlying this anomalous finding.
The most consistent predictor of negative mental health
across all refugee and immigrant groups was family conflict.
Our data parallel the vast literature indicating that family
conflict rooted in value differences and acculturation gaps
predicts poorer mental health [49, 50]. Though value clashes
in families are normative, migration-related stressors and
experiences of displacement may uniquely shape problems
in migrant family relationships and functioning [51], which
in turn detract from mental health. Thus, interventions that
address family-based conflict may hold significant promise
in reducing risk of mental health problems for individuals
in migrant families.
Finally, we did not find a link between neighborhood con-
text and mental health. Many refugees and immigrants in
urban areas live in ethnic minority-concentrated neighbor-
hoods characterized by residential segregation and economic
disadvantage [52]. However, prior analyses with this data
have found that co-ethnic neighborhood density can con-
fer social and cultural resources that benefit health [32]. It
may be that the inclusion of trauma exposure in our analy-
ses captures some the environmental variability tied to risk
for disorder and distress. While not the focus of this study,
additional research is needed to further examine if trauma
exposure mediates the relationship between neighborhood
context and mental health in migrant populations.
We acknowledge a number of study limitations. First, our
analyses are based on self-reported refugee status, and the
extent that self-reported status aligns with legal distinctions
of migrant status in the data is unknown. This measure is an
improvement upon prior studies that may assume refugee
status based on country of origin [8, 53]. Still, the lack of
reliable data on legal refugee status is pervasive in large,
non-clinical studies of immigrants and refugees and should
be addressed in future research [54]. Second, the measures
of traumatic events were based on retrospective accounts
and are subject to recall bias. Due to the sensitive nature
of trauma, participants could have repressed or forgotten
such experiences, or chose to not disclose this information
to interviewers. Relatedly, higher scores on these measures
assessed exposure to a greater variety of traumatic events
rather than a higher frequency of trauma exposure (i.e.
individuals may have seen a dead body on multiple occa-
sions, yet this was counted as one traumatic event). These
concerns, and the relatively low prevalence rates of trauma
in our study, may reflect an underestimation in the meas-
urement of lifetime exposure to trauma. Furthermore, with
cross-sectional data we caution against causal statements
among variables in our study, particularly with regards to
post-migration stressors and mental health outcomes. The
reverse relationship is possible, such that refugees and immi-
grants with psychiatric problems may be vulnerable to the
impact of subsequent traumatic and stressful events once
they are exposed. Longitudinal research is needed to confirm
directionality in these relationships. It is also important to
note that most migrants in our sample had lived in the U.S.
Journal of Immigrant and Minority Health
1 3
for more than 10years and that we do not measure life-
time mental health symptoms; thus our data cannot speak
to reactions to and processes of adaptation following trauma
that can change over time. Finally, we did not have data on
refugees and immigrants from parts of the world outside
Asia and Latin America, including the Middle East and
Africa. Because a significant proportion of migrants have
origins in these regions, future research must include these
Taken together, our study findings highlight the impor-
tance of understanding pre- and post-migration experiences
as they relate to mental health for refugees and immigrants.
Notably, it is critical for research to examine trauma’s effects
on mental health for migrant populations, regardless of sta-
tus as a refugee or immigrant. As our results suggests, trau-
matic experiences tied to the migration process are perhaps
more common among immigrants than is widely recognized.
Furthermore, our results underscore how attention to racial,
ethnic, and cultural factors that shape the experiences of
refugee and immigrant populations continues to be impera-
tive for understanding disparities in risk and resilience for
psychiatric illness and distress.
Trauma-informed, culturally grounded interventions, as
well as humane immigration policies, are needed to reduce
the risk of psychiatric illness and distress for refugees and
immigrants alike.
In sum, the U.S. is one of the leading recipients of
the global share of immigrants and refugees, with over
43million foreign-born individuals [55], and various fac-
tors influence negative mental health outcomes for these
populations. Community organizations, social service
agencies, and mental health service providers are well-
poised to address the needs of these populations but may
need appropriate training to identify mental health issues
rooted in trauma before, during, and after migration to
the U.S. World events will continue to create new immi-
grants and refugees, and it is therefore vital that their
mental health needs are better understood, assessed, and
Author Contributions C. C. Sangalang led the study conceptualization,
data analysis and interpretation, and writing. D. Becerra contributed to
the writing and interpretation of data. F. M. Mitchell, S. Lechuga-Pena,
and K. Lopez contributed to the writing and theoretical content. I. Kim
contributed to the study concept and interpretation of data.
Compliance with Ethical Standards
Conflict of interest All listed authors have reviewed and approved this
manuscript, report no conflicts of interest, and will accept responsibil-
ity for its content.
See Tables4 and 5.
Table 4 Top five pre-migration traumatic events for refugees and immigrants
Ranked by weighted %
Asians (n = 1639)
Refugees (n = 353) Immigrants (n = 1285)
Weighted % n Traumatic event Weighted % n Traumatic Event
28.78 110 Witness death or saw dead body 13.59 206 Witness death or saw dead body
27.92 126 Civilian in war zone 10.83 141 Unexpected death of someone close
20.26 72 Civilian in terror zone 9.61 137 Natural disaster
18.03 46 Unexpected death of someone close 7.02 90 Civilian in terror zone
12.11 45 Kidnapped or held in captivity 4.82 73 Civilian in war zone
Latinos (n = 1629)
Refugees (n = 306) Immigrants (n = 1323)
Weighted % n Traumatic event Weighted % n Traumatic event
29.93 102 Civilian in terror zone 13.05 187 Natural disaster
29.19 48 Witness death or saw dead body 12.09 162 Unexpected death of someone close
29.13 63 Civilian in war zone 12.09 153 Witness death or saw dead body
19.76 60 Unexpected death of someone close 7.13 78 Beaten up by parents
14.21 42 Natural disaster 7.00 85 Mugged/held up/threatened with weapon
Journal of Immigrant and Minority Health
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Table 5 Top five post-migration traumatic events for refugees and immigrants
Ranked by weighted %
Asians (n = 1639)
Refugees (n = 353) Immigrants (n = 1285)
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someone close
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with weapon
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ing illness or injury
3.98 43 Witness death or saw dead
Latinos (n = 1629)
Refugees (n = 306) Immigrants (n = 1323)
Weighted % n Traumatic event Weighted % n Traumatic event
23.40 50 Mugged/held up/threat-
ened with weapon
15.10 233 Unexpected death of some-
one close
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18.18 51 Unexpected death of
someone close
11.76 157 Mugged/held up/threatened
with weapon
15.91 40 Life-threatening auto
6.05 114 Natural disaster
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dead body
4.77 74 Child had life-threatening
illness or injury
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... Compared to nonimmigrants, recent immigrant families in Canada are more likely to live below the poverty line, have lower mean levels of household income, and live in neighbourhoods characterized by greater socio-economic disadvantage -all established risk factors for poor child mental health outcomes [4][5][6]. Immigrant families, including those who resettled as refugees fleeing persecution or armed conflict in their home countries, are also likely to experience adverse life events (e.g., trauma, discrimination) and acculturative stressors (e.g., language barriers) that can have direct and indirect effects on children's mental health via impaired family processes [7]. ...
... Given significant heterogeneity in exposures to mental health stressors among immigrant and refugee groups, adverse migration experiences may be a more sensitive risk factor for poor outcomes than broad categorisations of immigrant versus refugee status. Notably, a representative survey with adult refugees and immigrants in the United States found that pre-and post-migration trauma was associated with mental distress and illness across both groups irrespective of immigrant class [7]. ...
Full-text available
Background Immigrant children exhibit significant variation in their mental health outcomes despite disproportionate exposure to socio-economic adversity compared to their non-immigrant peers. Identifying aspects of neighbourhood and family contexts that are most salient for immigrant children’s mental health can help to inform and target interventions to prevent mental disorder and promote mental well-being among this population. Methods The study analyzed multi-informant data from 943 first- and second-generation immigrant caregiver and child dyads from the Hamilton Youth Study, a representative sample of immigrant and non-immigrant families in Hamilton, Ontario. Multivariate multilevel regression models examined associations between neighbourhood and family characteristics and processes, and parent and child self reports of internalizing and externalizing problems. Results Positive and negative parenting behaviours were significantly associated with internalizing and externalizing problems, with negative parenting demonstrating associations with externalizing problems across both parent and child reports ( b = 0.26–1.27). Neighbourhood social disorder and parental trauma exposure were associated with greater internalizing and externalizing problems, and neighbourhood immigrant concentration was associated with fewer externalizing problems for parent reports only. Adding parental distress and parenting behaviour to the models reduced the coefficients for parental trauma exposure by 37.2% for internalizing problems and 32.5% for externalizing problems and rendered the association with neighbourhood social disorder non-significant. Besides the parenting variables, there were no other significant correlates of child-reported internalizing and externalizing problems. Conclusions Results highlight the importance of parenting behaviour and parental experiences of trauma and distress for immigrant children’s mental health. While not unique to immigrants, the primacy of these processes for immigrant children and families warrants particular attention given the heightened risk of exposure to migration-related adverse experiences that threaten parental and family well-being. To prevent or mitigate downstream effects on child mental health, it is imperative to invest in developing and testing trauma-informed and culturally responsive mental health and parenting interventions for immigrant families.
... Saefudin and Setiawan proved that a good parenting style was conducive to cultivating college students' self-confidence [14]. Therefore, the study of family influence is the main way to analyze individual mental health [15]. Although many researchers worldwide have studied college students' mental health, there is little research on parenting style and college students' mental health. ...
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At present, the mental health of college students in China is relatively poor. This work is aimed at analyzing the correlation between family parenting style and college students’ mental health and providing a realistic basis for improving the mental health level of college students. Firstly, this work detailed the family parenting style, the influencing factors of family parenting style, and the theoretical basis of personality traits. Then, 300 college students in Anhui Province were selected as the research objects who answered the questionnaire on parenting style and the Revised Eysenck Personality Questionnaire Short for Chinese. Finally, statistical software was used to visually analyze the personality characteristics of college students, the overall situation of mental health, the impact of parents’ education on college students’ mental health, and the family parenting style of college students. According to the score of anxiety, the top 27% of the research objects are classified as the high-anxiety group, while the bottom 27% are classified as the low-anxiety group. The results show significant gender differences in the psychoticism and neuroticism dimensions of personality traits (P
... Many residents feel as though their existences have been hollowed out by the protracted process of arrival. Extensive psychological studies into the links between post-migration stress and psychological disorders demonstrate the diverse aspects of the migration process that adversely impact mental health beyond the asylum process itself (Carswell et al., 2011;Li et al., 2016;Sangalang et al., 2019). These include separation, social isolation, discrimination, financial and housing security, and the stress of acculturation. ...
During the so-called ‘refugee crisis’ of 2015 German chancellor Angela Merkel made the historic decision to welcome over one million refugees into the country. Throughout Germany municipal governments created a diverse range of temporary accommodations to house the arrivals, most notably in cities due to a lack of affordable housing. At the end of 2019 in Berlin, over 20,000 refugees were still living in institutional refugee shelter. These structures have come to be key mediators of the ways in which these newcomers have arrived in the city. Refugee shelters have primarily been understood in the context of the rich literature that has developed in recent decades around the ‘camp’ as a complex socio-spatial and political phenomenon. Yet the proliferation of different forms of refugee shelters especially in urban areas requires new theoretical lenses to shed new light on these structures. This thesis focuses on an alternative body of literature that considers the way urban infrastructures shape migration. It considers Berlin’s institutional shelters as part of infrastructural complexes to reveal how infrastructures shape the nature of refugee arrival in the city. It engages with emerging theoretical work on infrastructure and migration as well as presents empirical data obtained through eight months of on-site research that focuses on the quotidian experiences of refugees from their perspectives. It consists of three parts which examine the directional, contradictory, and entangled nature of infrastructure through its construction, calibration, operation, and location in relation to refugee arrival. The first part deepens understandings on the diverse ways that infrastructures sort and channel arrival trajectories to undermine the autonomy of refugee newcomers. The second part analyses the internal spatial dynamics of the shelters to explore the ways their contradictory functions as infrastructure blur the conceptual boundaries between camps, shelter, and housing and limit possibilities to inhabit domestic spaces. The third part explores the ways the urban locations of infrastructure shape everyday encounters and the development of relationships between newcomers and the city. While infrastructures can provide the potential to find stability within the city for refugees to move on from becoming forcibly displaced, the thesis argues that Berlin’s institutional shelters operate as infrastructures which undermine this process and exacerbate the uncanny and unsettling nature of arrival. Instead, refugees find the greatest scope for autonomy in their arrival through existing infrastructures of the city, especially the more informal ‘bottom up’ forms created and operated by existing migrant communities.
... The first theme relates to the premigration period. The pertinent studies focus on the effect of the premigration conditions and socio-psychological characteristics of immigrants formed in the premigration period on the emigration motivation and adjustment in the new country (Hynie, 2018;Sangalang et al., 2019). The second theme concerns the immigrants' acculturation, that is, the immigrants' relationships with the receiving society versus their relationships with the country of origin and the immigrant group (Berry et al., 2021;Verkuyten et al., 2019). ...
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... Post-migration experiences comprise ongoing challenges and stressors during and upon resettlement in the host country including culture shock and acculturative stress, language barriers, as well as unemployment or underemployment (Bemak & Chung, 2017). Other experiences are financial challenges, incidences of racism and discrimination, isolation, hopelessness, and helplessness that may result from uncertainties related to immigration and legal statuses (Sangalang et al., 2019). ...
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With over 80 million persons around the world forcibly displaced from their homes, 26.3 of whom are refugees, recent estimates indicate that the number of forced migrants has reached an all-time high (UNHCR, 2020). Already at a disadvantage, the closures of schools and key community resources aimed at combating the spread of the virus during the early stages of the pandemic contributed to further distress on the well-being of refugees. Recognizing that forced migrants are a vulnerable and underserved population and that the COVID-19 virus and the lockdowns put in place to reduce its spread severely worsened their multidimensional stressors, the authors used a qualitative narrative review with attention to the thematic analysis model to explore the impact of lockdowns on refugees’ mental health by reviewing publications from April 2020 through May 2021. The review findings are categorized under three themes: (a) negative impact on mental health, (b) suggested intervention approaches/strategies, and (c) recommendations. Implications for counseling and research are discussed.
Families and youth from the Northern Triangle of Central America seeking asylum in the United States report substantial trauma exposure and post-traumatic stress symptoms. Sexual and gender minorities of this population especially present unique circumstances and thus challenges and needs. However, with immigration along the southern U.S. border at a 21-year high, health and social resources for refugees and asylum seekers are being strained. Accordingly, the primary aim of this review is to raise awareness about migration-related trauma and the mental health needs among Central American and LGBTQ+ refugees and asylum seekers in the U.S.-Mexico border. The authors also discuss practical, clinical, and advocacy implications to improve the mental health of refugees and asylum seekers entering the United States.
Family connections are crucial for trauma-affected refugees from collectivistic cultures. Evidence-based family interventions are consistently promoted to support a host of mental and relational health needs of families exposed to traumatic stressors; however, there is still limited research focused on cultural adaptation and the testing of the effectiveness of these interventions on some of the most disenfranchised populations in the aftermath of forced displacement. This systematic review was conducted to examine the reach of existing evidence-based family interventions implemented with newly resettled refugees globally. Studies included in this review include those testing the effectiveness of a systemic treatment with pre and post intervention evaluation, studies with or without control groups, and studies that include at least one family member in addition to the target participants. Twelve studies met the inclusion criteria. Barriers to conducting randomized control trials with displaced refugee populations are discussed. Recommendations are made for future studies to include a focus on scientifically rigorous multi-method designs, specific cultural adaptation frameworks, and the integration of relational aspects rather than focusing only on individual adjustment. Global displacement continues to rise; therefore, it is imperative that the mental health and wellbeing of displaced populations be treated with a comprehensive, multi-level framework.
Thwarted expectations regarding one's post-settlement life may challenge the mental health of refugees. The present study aimed to investigate the relationship between pre-arrival expectations and the course of psychological symptoms across time. A secondary analysis of 1,496 principal visa applicants across five waves of the Building a New Life in Australia (BNLA) study was conducted. The cross-sectional associations between expectations on the one hand, and post-traumatic stress (PTSD-8) symptoms and psychological distress (Kessler-6; K6) on the other, were assessed using multiple regression. Latent class growth analysis (LCGA) was used to identify discrete symptom trajectories of psychological symptoms across five years following settlement, and multinomial regressions were used to determine if violated expectations predicted membership of identified PTSD-8 and K6 class trajectories. LCGA supported a four-class solution for the PTSD-8 “Resilient Post Traumatic Stress (PTS)” (54.1%), “Improving PTS” (15.0%), “Deteriorating PTS” (17.3%), and “Persistently High PTS” (13.6%). For the K6, three classes were identified: “Persistently Mild K6” (60.4%), “Resilient K6” (9.4%), and “Persistently High K6” (30.2%). Thwarted expectations were found to significantly predict membership of less favourable symptom trajectories classes in the context of other established predictors. Post-settlement expectations may thus have weak but unique predictive value for the course of psychological symptoms alongside other factors such as older age and financial stress. Implications of these findings for service provision and policy are discussed.
The Multicultural and Social Justice Counseling Competencies (MSJCCs) illustrate the need for counselors to act as social justice advocates. The significant influx of refugees in the United States and the sociopolitical nature of their resettlement necessitate practical multicultural and social justice counseling competencies. Using two case studies, the authors apply the four levels and four competencies of the MSJCCs and provide multicultural and social justice interventions on three levels: interpersonal, community, and public policy. Las Competencias en Consejería Multicultural y de Justicia Social (MSJCCs, por sus siglas en inglés) ilustran la necesidad de que los profesionales en consejería actúen como defensores de la justicia social. El flujo considerable de refugiados hacia los Estados Unidos y la naturaleza sociopolítica de su reasentamiento requieren competencias prácticas en consejería multicultural y de justicia social. Utilizando dos estudios de caso, las autoras aplican los cuatro niveles y las cuatro competencias de las MSJCC y también proporcionan intervenciones multiculturales y de justicia social en tres niveles: interpersonal, comunitario y de política pública.
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To explore the overlooked role of political violence in global " populism, " the essay explores the rise of Rodrigo Duterte from long-serving mayor of a provincial city to an exceptionally powerful Philippine president. Using an analytical frame that juxtaposes localized violence with international influence, the essay examines not only the political dynamics that elevated Duterte to power but the tensions that are already circumscribing his authority after only a year in office. Application of this model to comparable cases could both highlight the parallel role of political violence in contemporary populism and indicate the forces likely to lead to its decline.
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This paper examines how recent immigration policies and immigration enforcement strategies have impacted Latino immigrants in Arizona. Data were drawn from a sample of adult Latino immigrants (n = 213) living in Arizona. Analyses examined the relationship between fear of deportation and the impact of immigration policies on various aspects of daily life of Latino immigrants as a result of US immigration policies. Results indicate that participants who reported a greater fear of deportation were also significantly more likely to report: (1) trouble keeping a job; (2) trouble finding a job; (3) having been asked for immigration documents; (3) that friends have suffered; (4) that their family has suffered; (5) lower confidence that police will treat Latino immigrants fairly; (6) lower confidence that the courts will treat Latino immigrants fairly; and (7) lower confidence that they will have a better future. Implications for social work practice, advocacy, and research are discussed.
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There are several million war-refugees worldwide, majority of whom stay in the recipient countries for years. However, little is known about their long-term mental health. This review aimed to assess prevalence of mental disorders and to identify their correlates among long-settled war-refugees. We conducted a systematic review of studies that assessed current prevalence and/or factors associated with depression and anxiety disorders in adult war-refugees 5 years or longer after displacement. We searched Medline, Embase, CINAHL, PsycINFO, and PILOTS from their inception to October 2014, searched reference lists, and contacted experts. Because of a high heterogeneity between studies, overall estimates of mental disorders were not discussed. Instead, prevalence rates were reviewed narratively and possible sources of heterogeneity between studies were investigated both by subgroup analysis and narratively. A descriptive analysis examined pre-migration and post-migration factors associated with mental disorders in this population. The review identified 29 studies on long-term mental health with a total of 16,010 war-affected refugees. There was significant between-study heterogeneity in prevalence rates of depression (range 2.3–80 %), PTSD (4.4–86 %), and unspecified anxiety disorder (20.3–88 %), although prevalence estimates were typically in the range of 20 % and above. Both clinical and methodological factors contributed substantially to the observed heterogeneity. Studies of higher methodological quality generally reported lower prevalence rates. Prevalence rates were also related to both which country the refugees came from and in which country they resettled. Refugees from former Yugoslavia and Cambodia tended to report the highest rates of mental disorders, as well as refugees residing in the USA. Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression. There is a need for more methodologically consistent and rigorous research on the mental health of long-settled war refugees. Existing evidence suggests that mental disorders tend to be highly prevalent in war refugees many years after resettlement. This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.
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Drawing on the stress proliferation theory, this study examined whether pre-migration trauma exposure is associated with post-migration acculturative stressors among Asian and Latino immigrants in the US. Based on the nationally representative data from the National Latino and Asian American Study, logistic regression models were estimated to assess how the pre-migration trauma exposure predicts multiple forms of the acculturative stress: guilt of leaving family/friends behind, social isolation, communication difficulty, employment difficulty, legal status stress, race- and language-based discrimination. Findings suggested that pre-migration trauma exposure is positively associated with social isolation, communication difficulty, legal status stress, and race-based discrimination for both the Asian and Latino immigrants. Pre-migration trauma exposure predicts higher risks of feeling guilty, employment difficulty, and language-based discrimination only for Asian immigrants. The study informs the public health intervention by highlighting distal risk factors in the pre-migration context as well as its proliferated stressors in the post-migration context. It also provides a basis for understanding the complexities of addressing the global burden of trauma.
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War-related traumas impact refugees' mental health. Recent literature suggests that structural and sociocultural factors related to the resettlement also become critical in shaping refugees' mental health. So far, there is limited empirical evidence to support this claim among resettled refugees. Resettlement contextual factors that influence mental health outcomes were examined using Latino and Asian refugees (n = 656) from a nationally representative survey. Linear and logistic regressions predicted factors associated with the study's outcomes (self-reported mental health, mood disorders, and anxiety disorders). Post-resettlement traumas were significantly associated with mental health outcomes, but pre-resettlement traumas were not. Unemployment, everyday discrimination, and limited English were significantly associated with mental health outcomes among both Latino and Asian refugees. The outcomes indicate that resettlement contextual factors have a significant association with refugees' mental health. Therefore, future studies with refugees must pay closer attention to structural and sociocultural factors after resettlement.
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Immigrants report more psychotic symptoms than native-born populations. This study used data from the U.S.-based, nationally representative and culturally validated National Latino and Asian American Study to investigate whether refugees are at higher risk of psychotic symptoms than voluntary migrants. In this study, refugee status predicted more psychotic symptoms. Effects remained significant in most models after controlling for demographic covariates and traumatic experiences, however the direction of the effect differed for pre- versus post-migration periods. The study concludes that refugees are at higher risk for developing psychotic symptoms, which arise among refugees more often in the pre-migration period and less often post-migration.
Background: The psychological effects of trauma are well-documented among refugee adults and children alone, yet less research has attended to the intergenerational transmission of trauma within refugee families. Additionally, there is considerable diversity between refugee populations as well as within-group variation in the experiences and effects of refugee trauma. Objective: The current study examines the longitudinal effects of maternal traumatic distress on family functioning and child mental health outcomes among Southeast Asian refugee women and their adolescent children. Given the potential for variation in these effects, we also explore group differences in these relationships by ethnicity and child nativity. Methods: Longitudinal data were collected from a random sample of 327 Southeast Asian refugee mothers and their children in the United States. We employed structural equation modeling to examine associations between latent variables representing maternal traumatic distress, family functioning, and child mental health outcomes (i.e., depressive symptoms, antisocial and delinquent behavior, and school problems). We then tested for group differences in these associations by ethnicity (Cambodian and Vietnamese subgroups) and child nativity (U.S.-born and foreign-born children). Results: We found maternal traumatic distress was indirectly linked to child mental health outcomes, and that child nativity was associated with these paths while ethnicity was not. For foreign-born children, maternal traumatic distress was associated with diminished family functioning a year later, which was associated with increased school problems at the two-year mark. Maternal traumatic distress was indirectly associated with depressive symptoms and antisocial and delinquent behavior, respectively, after accounting for family functioning. For all children, weaker family functioning was significantly associated with poorer mental health. Conclusions: Findings suggest that refugee parents' trauma can adversely affect family relationships and the mental health of children. Interventions that address parental trauma and support intergenerational relationships may enhance mental health within refugee communities for future generations.
Objectives: To evaluate publicly available data sets to determine their utility for studying refugee health. Methods: We searched for keywords describing refugees in data sets within the Society of General Internal Medicine Dataset Compendium and the Inter-University Consortium for Political and Social Research database. We included in our analysis US-based data sets with publicly available documentation and a self-defined, health-related focus that allowed for an examination of patient-level factors. Results: Of the 68 data sets that met the study criteria, 37 (54%) registered keyword matches related to refugees, but only 2 uniquely identified refugees. Conclusions: Few health data sets identify refugee status among participants, presenting barriers to understanding refugees' health and health care needs. Public Health Implications. Information about refugee status in national health surveys should include expanded demographic questions and focus on mental health and chronic disease. (Am J Public Health. Published online ahead of print May 19, 2016: e1-e2. doi:10.2105/AJPH.2016.303201).
Using a stress-coping framework, the authors examined indirect and direct coping strategies as potential mediators in the relationship between intergenerational family conflict and psychological distress in Asian American, Hispanic, and European American college students. Asian American college students reported the highest likelihood of family conflict. Students from all cultural groups also used direct coping slightly more often than they did indirect coping. Only indirect coping mediated the effect of family conflict on distress for Asian Americans and European Americans, but it did so in the opposite direction than hypothesized. For these two cultural groups, indirect coping fully accounted for the variance shared between family conflict and psychological distress. For Hispanics, indirect coping partially mediated the effect of family conflict on psychological distress.