The Global Mental Health Program at Columbia is happy to introduce a new literature review initiative. Each month, the GMHP will compile a list of the latest research on specific topics dealing with mental health for those interested in diving more deeply into the vast literature in the field.
April 2017: The Psychosocial Impact of Displacement
The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers
Current Psychiatry Reports
Li, S. S. Y., Liddell, B. J., & Nickerson, A. (2016). The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers. Current Psychiatry Reports, 18(9). https://doi.org/10.1007/s11920-016-0723-0
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.
Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect of post-migration stressors
Chen, W., Hall, B. J., Ling, L., & Renzaho, A. M. (2017). Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect of post-migration stressors: findings from the first wave data of the BNLA cohort study. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(17)30032-9
Background: The process of becoming a humanitarian migrant is potentially damaging to mental health. We examined the association between pre-migration and post-migration potentially traumatic events and stressors and mental health, and assessed the moderating effect of post-migration stressors in humanitarian migrants in Australia.
Methods: In this study, we used the first wave of data between 2013 and 2014 from the Building a New Life in Australia survey. The survey included 2399 migrants who had arrived in Australia holding a permanent humanitarian visa 3–6 months preceding the survey, with 77% and 23% of participants being granted visas through offshore and onshore humanitarian programmes, respectively. Post-traumatic stress disorder (PTSD) was measured with the Post-traumatic Stress Disorder 8 items (PTSD-8) and severe mental illness was measured with the Kessler Screening Scale for Psychological Distress (K6). Pre-migration potentially traumatic events and post-migration stressors related to asylum process and resettlement were measured with a self-reported questionnaire.
Findings: Of the 2399 participants, 762 (31%; 95% CI 29·4–33·2) had PTSD and 394 (16%; 95% CI 14·2–17·2) had severe mental illness. The mean number of pre-migration potentially traumatic events was 2·1 (SD 1·4). 64%, 59%, 49%, and 18% of participants reported poor social integration, economic problems, worrying about family or friends overseas, and loneliness as post-migration stressors. Pre-migration potentially traumatic events and post-migration stressors were positively associated with PTSD and severe mental illness. Factors significantly modifying the association between pre-migration potentially traumatic events and mental health after controlling for confounding factors were resettlement related stressors, including loneliness (odds ratio 1·17, 95% CI 1·05–1·28 for PTSD and 1·28, 1·16–1·41 for severe mental illness) and the number of social integration stressors (1·10, 1·05–1·16 for PTSD).
Interpretation: Our data suggest that post-migration resettlement-related stressors were the most important correlates of mental health in humanitarian migrants, accounting for both direct and indirect associations. Targeting resettlement-related stressors through augmenting psychosocial care programmes and social integration would be a key approach to improve humanitarian migrants’ mental health.
Current Psychiatry Reports
Pfefferbaum, B., Jacobs, A. K., Van Horn, R. L., & Houston, J. B. (2016). Effects of Displacement in Children Exposed to Disasters. Current Psychiatry Reports, 18(8). https://doi.org/10.1007/s11920-016-0714-1
The literature on children’s responses to disasters is well developed with increasing attention to the confounding experiences of displacement. This paper presents an overview of the emotional and behavioral effects of displacement on children and adolescents and describes their educational adjustment in terms of both academic achievement and school behavior. A summary of family effects elucidates how children’s functioning is influenced through the family system in which they are embedded. The psychosocial impact of displacement reflects the myriad social losses that children and their families may face. Information from this review of the current literature on the effects of displacement may inform the design and delivery of support and intervention services for children and families following disasters.
Epidemiology and Psychiatric Sciences (Cambridge Core)
Miller, K. E., & Rasmussen, A. (2016). The mental health of civilians displaced by armed conflict: an ecological model of refugee distress. Epidemiology and Psychiatric Sciences, 1–10. https://doi.org/10.1017/S2045796016000172
Early research on the mental health of civilians displaced by armed conflict focused primarily on the direct effects of exposure to war-related violence and loss. Largely overlooked in this war exposure model were the powerful effects of ongoing stressors related to the experience of displacement itself. An ecological model of refugee distress is proposed, drawing on research demonstrating that mental health among refugees and asylum seekers stems not only from prior war exposure, but also from a host of ongoing stressors in their social ecology, or displacement-related stressors. Implications of this model for addressing the mental health and psychosocial needs of refugees and other displaced populations are considered.
Journal of Immigrant and Minority Health
Ao, T., Shetty, S., Sivilli, T., Blanton, C., Ellis, H., Geltman, P. L., … Lopes Cardozo, B. (2016). Suicidal Ideation and Mental Health of Bhutanese Refugees in the United States. Journal of Immigrant and Minority Health, 18(4), 828–835. https://doi.org/10.1007/s10903-015-0325-7
Refugee agencies noticed a high number of suicides among Bhutanese refugees resettled in the United States between 2009 and 2012. We aimed to estimate prevalence of mental health conditions and identify factors associated with suicidal ideation among Bhutanese refugees. We conducted a stratified random cross-sectional survey and collected information on demographics, mental health conditions, suicidal ideation, and post-migration difficulties. Bivariate logistic regressions were performed to identify factors associated with suicidal ideation. Prevalence of mental health conditions were: depression (21 %), symptoms of anxiety (19 %), post-traumatic stress disorder (4.5 %), and suicidal ideation (3 %), significant risk factors for suicidal ideation included: not being a provider of the family; perceiving low social support; and having symptoms of anxiety and depression. These findings suggest that Bhutanese refugees in the United States may have a higher burden of mental illness relative to the US population and may benefit from mental health screening and treatment. Refugee communities and service providers may benefit from additional suicide awareness training to identify those at highest risk.