Authors: Corrado Barbui; Federico Tedeschi; Ceren Acarturk; Minna Anttila; Teresa Au; Josef Baumgartner; Ken Carswell; Rachel Churchill; Pim Cuijpers; Eirini Karyotaki; Thomas Klein; Markus Koesters; Tella Lantta; Michela Nosè; Giovanni Ostuzzi; Massimo Pasquini; Eleonora Prina; Marit Sijbrandij; Lorenzo Tarsitani; Giulia Turrini; Ersin Uygun; Maritta Välimäki; Lauren Walker; Johannes Wancata; Ross G. White; Marianna Purgato · Research
What Factors Increase the Risk of Mental Disorders in Refugees and Asylum Seekers?
A large study identifies key risk factors for mental disorders in refugees and asylum seekers resettled in Western Europe and Turkey.
Source: Barbui, C., Tedeschi, F., Acarturk, C., Anttila, M., Au, T., Baumgartner, J., Carswell, K., Churchill, R., Cuijpers, P., Karyotaki, E., Klein, T., Koesters, M., Lantta, T., Nosè, M., Ostuzzi, G., Pasquini, M., Prina, E., Sijbrandij, M., Tarsitani, L., . . . Purgato, M. (2023). Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies. International Journal of Social Psychiatry, 69(3), 664-674. https://doi.org/10.1177/00207640221132430
What you need to know
- One in four refugees and asylum seekers developed a diagnosable mental disorder over a 6-month period, with depression being the most common.
- Lower education level, shorter migration journey, and coming from war-torn countries were associated with higher risk of developing mental disorders.
- Higher levels of psychological distress, depression symptoms, and exposure to traumatic events at baseline predicted later development of mental disorders.
- Implementing policies to reduce exposure to traumatic experiences and providing targeted psychological support to high-risk groups may help prevent mental disorders in this population.
Background and Study Overview
As global conflicts and crises continue to displace millions of people, understanding and addressing the mental health needs of refugees and asylum seekers has become increasingly important. This study aimed to identify risk factors for developing mental disorders among refugees and asylum seekers resettled in Western European countries and Turkey.
The researchers analyzed data from two large prevention studies that enrolled over 1,100 refugees and asylum seekers who did not have mental disorders at the start of the study. Participants were followed for 6 months to see who developed mental health conditions. The study examined various factors that might influence mental health outcomes, including demographic characteristics, migration experiences, and exposure to traumatic events.
Key Findings: Who is at Higher Risk?
The study found several factors that were associated with an increased risk of developing mental disorders:
Education and Country of Origin
Refugees and asylum seekers with lower levels of education were more likely to develop mental disorders. This finding aligns with research in the general population showing that higher education can have a protective effect against mental health problems. Education may provide people with better coping skills and resources to deal with the challenges of resettlement.
Those coming from countries with ongoing conflicts, particularly Syria and Iraq, were at higher risk. This likely reflects the intense and prolonged exposure to traumatic experiences in these war-torn regions.
Migration Journey
Interestingly, people who had shorter migration journeys (less than one month) were at higher risk compared to those with longer journeys. The researchers suggest this could be because a longer journey might allow more time for psychological adjustment or indicate access to more resources for a safer passage.
Psychological Factors
Higher levels of psychological distress, depression symptoms, and exposure to traumatic events at the start of the study predicted later development of mental disorders. This highlights the cumulative impact of stress and trauma on mental health.
Types of Mental Disorders
Depression was the most common mental disorder that developed, followed by post-traumatic stress disorder (PTSD) and anxiety disorders. After 6 months, about 20% of participants had developed depression, 7% had PTSD, and 4% had an anxiety disorder.
The Impact of Traumatic Experiences
The study found a clear link between exposure to traumatic events and the risk of developing mental disorders. Participants who reported more traumatic experiences, especially those related to violence and abuse, were more likely to develop mental health problems.
Examples of traumatic events associated with higher risk included:
- Imprisonment
- Serious injury
- Sexual abuse
- Forced isolation or separation from family
- Torture
- Domestic violence
This finding underscores the need for policies and interventions that aim to reduce exposure to traumatic experiences both before and after resettlement.
Protective Factors: The Role of Psychological Support
The study also examined the impact of a psychological intervention called Self-Help Plus (SH+). Participants who attended more SH+ sessions had a lower risk of developing mental disorders. This suggests that providing accessible, culturally appropriate psychological support can be an effective strategy for preventing mental health problems in refugee populations.
Implications for Policy and Practice
The findings of this study have important implications for how host countries can better support the mental health of refugees and asylum seekers:
1. Targeted Prevention Efforts
By identifying groups at higher risk (e.g., those with lower education, from conflict zones, or with high initial distress), resources can be directed towards providing extra support and early intervention for these individuals.
2. Trauma-Informed Care
Given the strong link between traumatic experiences and mental health outcomes, it’s crucial that health and social services for refugees are trauma-informed and equipped to address the impact of past experiences.
3. Accessible Psychological Support
Scaling up evidence-based psychological interventions like SH+ could help prevent the development of mental disorders. These interventions should be culturally adapted and easily accessible.
4. Addressing Post-Migration Stressors
While the study focused on pre-migration factors, it’s important to recognize that stressors in the host country (e.g., uncertainty about legal status, discrimination, economic hardship) can also impact mental health. Policies that address these issues may help promote better mental health outcomes.
5. Education and Skill Development
Supporting refugees in continuing their education or developing new skills may have protective effects on mental health, in addition to aiding integration and economic stability.
Conclusions
- Mental disorders, especially depression, are common among refugees and asylum seekers, with one in four developing a condition within 6 months.
- Key risk factors include lower education, coming from conflict zones, and high levels of pre-existing psychological distress and trauma exposure.
- Targeted prevention efforts, trauma-informed care, and accessible psychological support are crucial strategies for protecting the mental health of refugee populations.
- Addressing both pre-migration trauma and post-migration stressors is important for comprehensive mental health support.