Refugees demonstrate high rates of 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 of refugees and asylum seekers, but psychological effects of post-migration stressors in the settlement environment is also a significant factor. A meta-analysis of 181 studies of conflict-affected populations, including refugees and displaced persons, estimated that PTSD is prevalent at 30.6%. (Liddell and Nickerson, 2016)
Migrants are often subjected to specific risk factors for mental health problems, mainly related to exposure to stressful and traumatizing experiences, including racial discrimination, urban violence, abuse by law enforcement officers, forced removal or separation from their families, detention, etc. reclusion, and/or deportation. Stress and trauma have been robustly associated with risks for mental disorder, including but not limited to Post Traumatic Stress Disorder (PTSD), major depressive disorder, psychosis and suicide.
Stress is currently conceptually understood as a complex, multidimensional process by which some environmental factor (the stressor) triggers a physical and psychological response to which the individual must adapt.
Adaptation is understood as a dynamic process by which the individual’s thoughts, feelings, behaviour and bio-physiological mechanisms continually change to fit a changing environment. When the adaptation resources of the organism are overwhelmed, a mental disorder can prevail, with symptoms and associated behaviour, potentially PTSD. As it requires constant adaptation to a new environment, the migration process is generally assumed to be a major chronic environmental stressor. (Bustamante, Cerqueira and Leclerc, 2017)
Survivors of political violence, which includes individuals forced to flee their country due to political persecution as well as those who have been subject to physical or psychological torture at the hands of government actors, evidence high rates of anxiety disorders such as posttraumatic stress disorder (PTSD), whether they are resettled in the developing or in Western countries.
Research with this population often focuses on pre-migration traumatic events with little regard to post-migration deprivation and structural needs in countries of resettlement. However, studies that account for post-migration factors indicate that they are important in moderating pre-migration traumatic experiences.
In a meta-analysis of 56 studies of refugees, asylum-seekers, and other displaced persons, Porter and Hassam found that numerous structural post-migration conditions, such as housing accommodation and restricted economic opportunities, moderated mental health outcomes, regardless of resettlement location affect the mental health of the migrants. (Chu and Keller, 2013)
The challenge in offering access to appropriate mental health services to migrants arises from cultural and linguistic barriers and the impact of their exposure to traumatic events and stressors. Traumatic factors are usually associated with the experience of migration, but they could also occur in pre-migratory stages, during the migratory process, or even in the post migratory period. (Bustamante, Cerqueira and Leclerc, 2017)
The impact of resettlement stressors over and above that of pre-migration trauma has substantial implication for practice and service delivery. In particular, the potentially deleterious impact of post-migration difficulties highlights the need for interventions to consider psychological distress in refugees from a psychological perspective rather than simply from a trauma-focused perspective.
Closer examination of the underlying mechanisms that influence the relationship between post-migration stressors and migrant/refugee mental health and longitudinal research to discern causality would be useful to inform policy and interventions that promote better psychological functioning among the migrants.