ContextLittle is known about the long-term mental health of trauma-exposed
refugees years after permanent resettlement in host countries.ObjectiveTo assess the prevalence, comorbidity, and correlates of psychiatric
disorders in the US Cambodian refugee community.Design, Setting, and ParticipantsA cross-sectional, face-to-face interview conducted in Khmer language
on a random sample of households from the Cambodian community in Long Beach,
Calif, the largest such community in the United States, between October 2003
and February 2005. A total of 586 adults aged 35 to 75 years who lived in
Cambodia during the Khmer Rouge reign and immigrated to the United States
prior to 1993 were selected. One eligible individual was randomly sampled
from each household, with an overall response rate (eligibility screening
and interview) of 87% (n = 490).Main Outcome MeasuresExposure to trauma and violence before and after immigration (using
the Harvard Trauma Questionnaire and Survey of Exposure to Community Violence);
weighted past-year prevalence rates of posttraumatic stress disorder (PTSD)
and major depression (using the Composite International Diagnostic Interview
version 2.1); and alcohol use disorder (by the Alcohol Use Disorders Identification
Test).ResultsAll participants had been exposed to trauma before immigration. Ninety-nine
percent (n = 483) experienced near-death due to starvation and 90%
(n = 437) had a family member or friend murdered. Seventy percent
(n = 338) reported exposure to violence after settlement in the
United States. High rates of PTSD (62%, weighted), major depression (51%,
weighted), and low rates of alcohol use disorder were found (4%, weighted).
PTSD and major depression were highly comorbid in this population (n = 209;
42%, weighted) and each showed a strong dose-response relationship with measures
of traumatic exposure. In bivariate analyses, older age, having poor English-speaking
proficiency, unemployment, being retired or disabled, and living in poverty
were also associated with higher rates of PTSD and major depression. Following
multivariate analyses, premigration trauma remained associated with PTSD (odds
ratio [OR], 2.08; 95% CI, 1.37-3.16) and major depression (OR, 1.56; 95% CI,
1.24-1.97); postmigration trauma with PTSD (OR, 1.65; 95% CI, 1.21-2.26) and
major depression (OR, 1.45; 95% CI, 1.12-1.86); and older age with PTSD (OR,
1.76; 95% CI, 1.46-2.13) and major depression (OR, 1.47; 95% CI, 1.15-1.89).ConclusionMore than 2 decades have passed since the end of the Cambodian civil
war and the subsequent resettlement of refugees in the United States; however,
this population continues to have high rates of psychiatric disorders associated
with trauma.

/pdf/mental-health-of-cambodian-refugees-2-decades-after-l4fu039poz.pdf

Mental health of Cambodian refugees 2 decades after resettlement in the United States

Depression and anxiety in labor migrants and refugees--a systematic review and meta-analysis.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/wps.20438

The contemporary refugee crisis: an overview of mental health challenges

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.

The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers

Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country. The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints. A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively). General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25. More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms. Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.

/pdf/physical-and-mental-health-of-afghan-iranian-and-somali-2n318jz0xe.pdf

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands

Clinically, a long asylum procedure seems to be associated with psychiatric disorders. However, data on this issue are lacking. In a national community-based study, using random sampling, we compared two groups of Iraqi asylum seekers, who had resided less than 6 months (N = 143) and more than 2 years (N= 151), respectively, in The Netherlands. Respondents were interviewed with fully structured, culturally validated, translated questionnaires. Psychiatric (DSM-IV) disorders were measured with the Composite International Diagnostic Interview 2.1 and evaluated in relation with premigration and postmigration adverse life events. Overall prevalence of psychiatric disorders was 42% in the first group and 66.2% in the second. The prevalence rates of anxiety, depressive, and somatoform disorders were significantly higher in the second group. Posttraumatic stress disorder was high in both groups but did not differ (p > .05). On logistic regression of all relevant risk factors, a long asylum procedure showed an odds ratio of 2.16 (confidence interval = 1.15-4.08) for psychopathology. The conclusion is that, indeed, the duration of the asylum procedure is an important risk factor for psychiatric problems. Both politicians and mental health workers should take note of this finding.

Bettine A. Schreuders

Papers

Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands.