Attachment, emotion regulation, and their roles in refugee post-traumatic stress and post-migration living difficulties.

Background: Upon arrival in the host country, refugees and asylum seekers (RAS) experience a range of post-migration living difficulties (PMLD), which are often linked to psychological symptoms such as post-traumatic stress (PTS). Initial research suggests that attachment insecurity partly explains the association between PMLD and psychological symptoms in RAS. However, the mechanisms through which attachment insecurity may act as a mediator are not well understood, though emotion dysregulation is one of the potential candidates.Objectives: This study investigated (1) whether attachment insecurity (i.e. anxiety and avoidance) mediate the association between PMLD and PTS, and (2) whether this mediation model can be extended to emotion dysregulation.Methods: 134 treatment-seeking RAS living in Switzerland completed questionnaires assessing PMLD, attachment insecurity, emotion dysregulation, and PTS. Two models were tested: (1) a parallel mediation analysis with attachment anxiety and avoidance as mediators, and (2) a serial mediation analysis with attachment anxiety as the first and emotion dysregulation as the second mediator.Results: First, PMLD was indirectly associated with PTS through attachment anxiety but not avoidance. Second, the association between PMLD and PTS was further explained by a pathway through attachment anxiety and emotion dysregulation.Conclusions: Although this study is limited by its cross-sectional design, we identified attachment anxiety and emotion dysregulation as potential mechanisms explaining how PMLD affects symptoms of PTS in RAS. Systematically assessing attachment style and addressing emotion regulation may therefore help improve treatment of refugee and asylum-seeking patients.

Attachment anxiety but not avoidance mediated the relationship between post-migration living difficulties and post-traumatic stress through emotion dysregulation in treatment-seeking refugees and asylum seekers.Attachment and emotion regulation are important psychological processes to consider when studying refugee mental health.Systematically assessing attachment style and addressing emotion regulation may help improve treatment of refugee and asylum-seeking patients.

Influence of post-migration living difficulties on mental health among refugees and asylum seekers: A scoping-review on clinical tools.

BACKGROUND: The literature indicates an increasing interest in the mental health of refugees (R) and asylum seekers (AS) - particularly how it could be affected by previous exposure to trauma and violence - but less has been written about the issues they are forced to face during the post-migration period and how these also can affect mental health. Research shows that the mental health of R/AS is highly influenced by their post-migration conditions and may deteriorate due to post-migration social health-related determinants; in addition, a lack of language skills, discrimination, separation from family, poverty, and other stressors can contribute to social isolation. The difficulty in asking for help in case of psychological distress and, consequently, in accessing care, contributes to the worsening of their clinical condition. AIMS: The primary purpose of this study is to identify and provide a review of the clinical tools used to screen migrants (R/AS) at risk of developing psychological distress, identifying post-migration difficulties. METHODS: We searched studies in PubMed, Embase, Scopus, Cochrane (Central), and Cinahl (ultimate) with the last search on 14 April 2023, using a combination of keywords and Medical Subject Headings (MeSH). RESULTS: Our systematic search identified 1,878 records. After removing duplicates, we screened 1,238 records by title and abstract, retaining 97 for full text review. Of these, 68 met full eligibility criteria (1995-2023). A total of 30 social scales have been identified, as well as structured or semi-structured questionnaires and interviews. Translated into multiple languages, the tools can be self-administered or administered by trained professionals. PMLD is known for its effectiveness in evaluating the post-migration period and predicting mental health issues. CONCLUSIONS: Considering the limited number of studies and, consequently, the limited number of tools found, it can be inferred that not enough attention is given to post-migration in the broader sense.

Post-migration stress, quality of life, and mental health among accompanied and unaccompanied young refugees in Germany: How do adolescents feel after fleeing?

This study examines the impact of post-migration living difficulties (PMLDs) and quality of life (QoL) on the mental health of 55 young refugees who arrived in Germany either accompanied or unaccompanied. The results reveal that nearly 62% of the participants exhibited clinically significant symptoms of depression or post-traumatic stress disorder. Regression analyses indicate that psychopathology was associated with being unaccompanied and experiencing lower QoL, while QoL was associated with higher economic status and lower PMLDs. Mediation analysis further demonstrates that higher economic status and reduced PMLDs were associated with higher QoL, which, in turn, correlated with lower levels of psychopathology. These findings emphasise the importance of considering PMLDs and QoL, as well as economic status and being accompanied/unaccompanied, in the assessment and treatment of young refugees in the host country.

Post-migration stressors, mental health and well-being in resettled refugees from Syria: Do individuals' coping strategies matter?

BACKGROUND: The evidence is mixed as to whether individuals' coping strategies may mitigate the adverse mental health effects of post-displacement stressors in refugee populations, with some indications that the buffering effects of coping strategies are context dependent. The present study examined if problem-solving and acceptance coping strategies were effect modifiers between post-migration stressors and mental health in adult refugees from Syria resettled in Sweden. METHODS: Study aims were investigated using cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria granted permanent residency in Sweden between 2011 and 2013 (Nsample = 4000, nrespondents = 1215, response rate 30.4%). Post-migration stressors examined included: financial strain, social strain, host-country competency strain and discrimination. Two mental health outcomes were used: anxiety/depression, measured with the Hopkins Symptom Checklist-25; and well-being, measured with the WHO-5 Well-being Index. Both outcomes were modelled continuously. Coping strategies were measured using the BRIEF Cope scale. Interactions between coping strategies and post-migration stressors were tested in fully adjusted linear regression models using Wald test for interaction, corrected for multiple testing using the Benjamini-Hochberg procedure. RESULTS: Both problem-solving and acceptance coping strategies buffered the adverse association between financial strain and symptoms of anxiety/depression, and problem-solving coping strategies buffered the adverse association between host-country competency strain and anxiety/depression. CONCLUSIONS: The study suggests that individuals' coping strategies may to some degree buffer the adverse mental health effects of financial strain and host-country competency strain experienced by refugees in the resettlement phase. Although this pattern was only found in regard to anxiety/depression and not subjective well-being, the findings show that individual-level coping skills among refugees may contribute to adaptation in the face of post-settlement adversities. Notwithstanding the importance of attending to refugees' psychosocial conditions, refugees residing in refugee camps and newly resettled refugees might benefit from interventions aiming at enhancing individual coping resources and skills. The potential effect of increased controllability and decreased conflict-proximity also warrants further exploration in future studies.

Post-migration living difficulties, discrimination, and mental health of traumatized refugees in Germany: data from the refuKey project for timely and need-adapted treatment in a stepped-care setting.

Asylum seekers and refugees (ASR) experience many short-term and long-term post-migration stressors, e.g. discrimination after resettlement, leading to increased psychiatric morbidity in this population. Using data from the state-funded stepped-care project refuKey based in Lower Saxony, Germany, that aims to provide better mental health care access for ASR, we investigated the relationship between post-migration stressors and mental health in treatment-seeking ASR. In our naturalistic multi-centric study we assessed mental health (e.g. symptoms of depression, anxiety, traumatization, etc.), post-migration living difficulties, and perceived discrimination in ASR before and after treatment using questionnaires in eight languages consisting of internationally validated scales. Participants displayed poor mental health before, and significantly improved mental health parameters after treatment (p < 0.001). Post-migration living difficulties and perceived discrimination significantly predicted all mental health outcomes before treatment (p < 0.001) but not the treatment effects. However, perceived discrimination only contributed significantly to the prediction of quality-of-life and traumatization. Our findings suggest that refuKey-treatment helps despite the presence of post-migration living difficulties. Asylum policies should aim at reducing and overcoming post-migration living difficulties due to the strong association to mental health levels in treatment-seeking ASR.

Profiles of post-migration stressors and mental health in refugees: A latent class analysis.

Studies have documented the mental health effects of pre-migration trauma on resettled refugees and identified distinct psychological symptom profiles using person centred statistical techniques (e.g., latent class analysis; LCA). These techniques have advanced our understanding of the complex presentation of trauma and psychopathology in refugees. The current study employs LCA to examine patterns of exposure to stressors including post-migration stressors, allowing us to identify patterns of post-migration stress exposure and their association with mental health outcomes. Participants were 1085 Arabic, Farsi, Tamil, or English speaking adult refugees. Pre-migration trauma, post-migration stressors, PTSD, depression, anger, and functional impairment was measured. LCA was conducted to identify distinct classes of post-migration stressors and associations with mental health and adjustment in the resettlement environment. Latent class analysis revealed 5 classes of participants: high difficulties class (7.2%), immigration fear class (14.4%), social disconnection class (17.3%), moderate difficulties class (28.9%) and a low difficulties class (32.3%). Each of the five classes shared commonalities in addition to key differences associated with specific demographic characteristics and psychopathology. Post-migration stressors appear to map onto distinct profiles, which uniquely contribute to functional impairment and mental health outcomes in refugees. These findings have substantial implications for public health and social services working with resettled refugee communities.

Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers.

Background: Numerous traumatic experiences and post-migration living difficulties (PMLDs) increase the risk of developing symptoms of complex post-traumatic stress disorder (CPTSD) among Afghan refugees and asylum seekers, living in Austria. Research has repeatedly associated higher levels of CPTSD with higher levels of PMLDs. Summarizing PMLDs into empirically derived factors might facilitate a further understanding of their interaction with symptom presentation within distinct clusters of CPTSD. Objective: The current study aimed to investigate homogeneous subgroups of ICD-11 CPTSD and their association with demographic variables, traumatic experiences, and empirically derived factors of PMLDs. Method: Within a randomized controlled trail (RCT) CPTSD, PMLDs, and traumatic experiences were assessed in a sample of 93 treatment-seeking Afghan refugees and asylum seekers through a fully structured face-to-face and interpreter-assisted interview using the ITQ, the PMLDC, and a trauma checklist. Underlying clusters of CPTSD, superior factors of PMLDs, and their associations were investigated. Results: In total, 19.4% of the sample met the diagnostic criteria for PTSD and 49.5% for CPTSD. We identified a 2-cluster solution consisting of two distinct subgroups as best fitting: (1) a CPTSD cluster and (2) a PTSD cluster. The multitude of PMLDs was summarized into four superior factors. CPTSD cluster membership was associated with childhood potentially traumatic experience types, and one of four PMLD factors, namely 'language acquisition & barriers'. Conclusions: The results suggest that not PMLDs in general, but rather specific types of PMLDs, are associated with CPTSD. An assumed bidirectional relationship between these PMLD factors and CPTSD symptoms might lead to a downward spiral of increasing distress, and could be considered in treatment strategies.

Antecedentes: Numerosas experiencias traumáticas y dificultades de vida post-migración (DVPM) aumentan el riesgo de desarrollar síntomas de trastorno de estrés postraumático complejo (TEPT-C) entre los refugiados y solicitantes de asilo afganos que viven en Austria. La investigación ha asociado repetidamente niveles más altos de TEPT-C con niveles más altos de DVPM. Resumir las DVPM en factores derivados empíricamente podría facilitar una mayor comprensión de su interacción con la presentación de síntomas dentro de distintos grupos de TEPT-C.Objetivo: El presente estudio tuvo como objetivo investigar subgrupos homogéneos de TEPT-C según la CIE-11 y su asociación con variables demográficas, experiencias traumáticas y factores derivados empíricamente de DVPM.Método: Dentro de un estudio controlado aleatorizado (ECA), se evaluaron TEPT-C, DVPM y experiencias traumáticas en una muestra de 93 pacientes, refugiados afganos y solicitantes de asilo, a través de una entrevista cara a cara totalmente estructurada y asistida por un intérprete utilizando el ITQ, el PMLDC y una lista de verificación de traumas. Se investigaron los grupos subyacentes de TEPT-C, los factores superiores de DVPM y sus asociaciones.Resultados: En total, el 19,4% de la muestra cumplió los criterios de diagnóstico de TEPT y el 49,5% de TEPT-C. Identificamos 2 grupos que constan de dos subgrupos distintos: (1) un grupo de TEPTC y (2) un grupo de TEPT. Las distintas DVPM se resumieron en cuatro factores superiores. La pertenencia al grupo de TEPT-C se asoció con tipos de experiencias potencialmente traumáticas en la infancia y uno de los cuatro factores de DVPM, denominada, 'adquisición y barreras del lenguaje'.Conclusiones: Los resultados sugieren que no las DVPM en general, sino los tipos específicos de DVPM, están asociados con el TEPT-C. Una supuesta relación bidireccional entre estos factores de DVPM y los síntomas de TEPT-C podría conducir a una espiral de angustia creciente, y podría considerarse en las estrategias de tratamiento.

Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden: a cross-sectional study.

BACKGROUND: Forced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden. METHODS: A cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture. RESULTS: About half of the participants (53.3, 95% CI: 48.6-58.1) met the recommendations for Sufficient PA. One third of the participants (33.3, 95% CI: 28.7-37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1-16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F(2, 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001). CONCLUSIONS: Insufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with lower PTSD symptom severity. An increased focus on assessment and promotion of PA is justified and discussed as particularly pertinent considering the much extended time of asylum-seeking processes. The results support previous evidence of PA as a potentially important factor in the context of PTSD and forced migrants' health.

Exploring how Syrian women manage their health after migration to Germany: results of a qualitative study.

BACKGROUND: In the recent years, the number of Syrians living in Germany increased drastically due to the massive displacement caused by the Syrian conflict. Syrian migrant women in Germany are challenged by both the migration process and the changing of social roles. Seeking out healthcare may be hampered by linguistic and cultural barriers, but the new context may offer opportunities for health and well-being (free access to health care, civil/human rights). Little is known about how Syrian women manage their health after their resettlement in Germany. METHODS: In depth interviews in Arabic were conducted with 9 Syrian women who were recruited through purposive sampling (18-55 years, migrated in 2011-2017, different education levels), focusing on capabilities to control one's health and to navigate the German healthcare system, and social/environmental barriers and facilitators to effectively manage their health. Interview transcripts were analysed using qualitative content analysis. RESULTS: The women reported their health to be impaired by post-migration stressors, such as perceived discrimination, loss of social status and worrying about the future. Many interviewees felt disempowered and incompetent to successfully and actively navigate the German healthcare system, lacking information and not understanding their rights and options under the health insurance plan. The language barrier added to feeling vulnerable. Many women experienced doctors declining to treat them for capacity reasons; when treated, they often did not feel taken seriously or were dissatisfied with the emotional/cultural aspects of care. If possible, Arabic doctors were sought out. Some women, however, described improved resources for health, and appreciated better women's rights as a source of power. CONCLUSIONS: The lack of information about the structure and offers of the German healthcare system, language and culture specific barriers as well as socio-cultural challenges are undermining the ability of Syrian women to manage their health effectively after their resettlement in Germany. Providing tailored information on the German healthcare system, creating a health-literacy supportive environment, and improving cultural sensitivity in healthcare provision could help Syrian women better utilize medical care offered in Germany.

The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden.

BACKGROUND: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees. RESULTS: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores. CONCLUSIONS: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.

Longitudinal investigation of the relationships between trauma exposure, post-migration stress, sleep disturbance, and mental health in Syrian refugees.

Background High prevalence of sleep disturbance, which is associated with poor mental health, has been observed among non-treatment seeking refugees. However, no longitudinal research has investigated the chronicity of untreated sleep disturbance and its impact on refugees' mental health. OBJECTIVE: This longitudinal study investigated associations between mental health (posttraumatic stress disorder, anxiety, depression), sleep symptoms (insomnia severity, pre-sleep arousal), and factors predicting mental health, over a 12-month period. METHOD: Syrian refugees (N = 69) from a cross-sectional study (Time 1) participated in the current 12-month (Time 2) follow-up study. Participants completed a series of questionnaires examining sleep, trauma exposure, post-migration living difficulties, and mental health at both time points. RESULTS: When compared to Time 1, participants showed a significant increase in post-migration stress at Time 2. However, there was an improvement in their mental health and levels of sleep disturbance. Half of the participants met criteria for moderate (36%) or severe sleep disturbance (15%) at Time 2. Forty-two per cent of the participants had moderate to severe sleep disturbance at both Time 1 and Time 2. When predicting mental health at 12-month follow-up, only pre-sleep arousal at Time 1 uniquely predicted mental health at Time 2. Mediation analysis indicated that change in pre-sleep arousal (from Time 1 to Time 2) significantly mediated the relationship between change in post-migration stress and change in mental health symptoms. CONCLUSIONS: This study demonstrated that sleep symptoms have an indirect and long-term impact on mental health among refugees. Understanding modifiable factors, such as sleep, mediating the relationship between trauma exposure and PTSD symptoms is important, as such factors can be targeted in psychological interventions for refugees.

Antecedentes: Se ha observado en refugiados que no están en búsqueda de tratamiento una alta prevalencia de alteraciones del sueño, que se asocia con una salud mental pobre. Sin embargo, no existen estudios longitudinales que hayan investigado la cronicidad de las alteraciones del sueño no tratadas y su impacto en la salud mental de los refugiados.Objetivo: Este estudio longitudinal investigó las asociaciones entre salud mental (trastorno de estrés postraumático, ansiedad, depresión), síntomas del sueño (severidad del insomnio, activación previa al sueño), y factores predictores de salud mental, a lo largo de un periodo de 12 meses.Método: Refugiados sirios (N=69) de un estudio transversal (Momento 1) participó en el siguiente seguimiento a los 12 meses (Momento 2). Los participantes completaron una serie de cuestionarios examinando el sueño, la exposición al trauma, las dificultades vitales luego de la migración y la salud mental en ambos momentos de medición.Resultados: En comparación al Momento 1, los participantes mostraron un aumento 2significativo del estrés posterior a la migración en el Momento 2. Sin embargo, hubo una mejora en su salud mental y los niveles de alteración del sueño. La mitad de los participantes cumplieron los criterios para alteraciones del sueño moderadas (36%) o severas (15%) al Momento 2. Cuarenta y dos por ciento de los participantes tuvieron alteraciones del sueño moderadas a severas en ambos Momentos 1 y 2. Al predecir la salud mental en el seguimiento a 12 meses, sólo la activación previa al sueño en el Momento 1 predijo únicamente la salud mental al Momento 2. Los análisis de mediación indicaron que el cambio en la activación previa al sueño (desde el Momento 1 al Momento 2) medió significativamente la relación entre cambio en el estrés posterior a la migración y cambio en los síntomas de salud mental.Conclusiones: Este estudio demostró que los síntomas del sueño tienen un impacto indirecto y en el largo plazo en la salud mental de los refugiados. Es importante el entendimiento de los factores modificables, tales como el sueño, que mediaron la relación entre la exposición al trauma y los síntomas, dado que tales factores pueden ser abordados en las intervenciones psicológicas para refugiados.

Trauma-afflicted refugees' experiences of participating in physical activity and exercise treatment: a qualitative study based on focus group discussions.

Background: Refugees with prolonged and repeated experiences of trauma, often in combination with post-migration living difficulties, are subjected to severe levels of stress and stress-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever. However, the effect of PA and exercise has received scarce attention in the context of PTSD, and particularly in the field of refugees' health. Objective: The objective of this study was to explore the experience of participation in PA and exercise as part of the treatment for trauma-afflicted refugees. Method: An explorative qualitative research design was used. Six focus group discussions were conducted with 33 female and male participants that had experience of group-based PA and exercise treatment. The gathered data was analysed by qualitative content analysis. Results: The analysis resulted in one over-arching theme reflecting the participants overall experience of PA and exercise as a process of building resilience. Participants experienced improvements in both physical and mental health domains. Increased self-awareness and self-confidence were seen as additional important benefits, and the interruption of daily stressors provided a sense of relief and recovery. The treatment group settings were experienced as becoming a vehicle for overcoming social fear and isolation, which also carried an empowering and strength-building impact over to participants' family life and social relationships. Treatment characteristics were experienced as highly supportive and often referred to as the basis of other positive experiences and perceived health benefits. Conclusions: The result of this study outlines a detailed account of trauma-afflicted refugees' experiences and preferences of PA and exercise-based treatment from a broad range of perspectives. These findings provide a starting point for future research in this field and indicate a particular need for both research and intervention development to include the real-life impact of participating in such treatments.

Antecedentes: Los refugiados que presentar experiencias traumáticas prolongadas y repetidas, a menudo en combinación con dificultades de vida post migratorias, están sometidos a niveles severos de estrés y de mala salud relacionada con el estrés, incluido el trastorno de estrés postraumático (TEPT). La actividad física (PA por sus siglas en inglés) es una manera bien establecida y efectiva de aliviar el estrés. Sin embargo, el efecto de la PA y el ejercicio ha recibido escasa atención en el contexto del TEPT, particularmente en el campo de la salud de refugiados.Objetivo: el objetivo de este estudio fue explorar la experiencia de participación en PA y ejercicio como parte del tratamiento en refugiados afectados por el trauma.Método: se utilizó un diseño de investigación exploratoria cualitativa. Se condujeron discusiones en 6 grupos focales con 33 participantes femeninos y masculinos que habían experimentado el tratamiento de PA y ejercicio. Los datos recolectados fueron analizados por un análisis de contenido cualitativo.Resultados: Los análisis resultaron en una temática general que reflejaba la experiencia global de los participantes de la PA y el ejercicio como un proceso de construcción de resiliencia. Los participantes experimentaron mejoría en dominios tanto de salud mental como física. El incremento de la auto-conciencia y la confianza en sí mismo fueron vistos como beneficios adicionales importantes, y la interrupción de estresores diarios llevó a un sentimiento de alivio y recuperación. El setting de tratamiento grupal fue experimentado como un vehículo para superar el miedo social y el aislamiento, lo que llevó a un impacto de empoderamiento y construcción de fortaleza en la vida familiar y relaciones sociales de los participantes. Las características del tratamiento fueron experimentadas como de alto nivel de apoyo y en muchas ocasiones referida como la base de otras experiencias positivas y beneficios de salud percibidos.Conclusiones: El resultado de este estudio destaca un relato detallado de las experiencias y preferencias de refugiados afectados por el trauma en los tratamientos basados en PA y ejercicio desde un rango amplio de perspectivas. Estos hallazgos proveen de un punto de partida para investigación futura en este campo e indica una particular necesidad tanto para investigación como para el desarrollo de intervenciones para incluir el impacto en la vida real de participar en tales tratamientos.

Patterns and predictors of posttraumatic stress disorder in refugees: A latent class analysis.

BACKGROUND: Although elevated rates of posttraumatic stress disorder (PTSD) have been well-documented in refugees, no study has investigated the heterogeneity of DSM-5 PTSD symptomatology in such populations. This study aimed to determine whether there are unique patterns of DSM-5 defined PTSD symptomatology in refugees, and investigate whether factors characteristic of the refugee experience, including trauma exposure and post-migration stress, predict symptom profiles. METHODS: Participants were 246 refugees and asylum-seekers from an Arabic-, English-, Farsi-, or Tamil-speaking background who had been resettled in Australia. Participants completed measures of post-migration living difficulties, trauma exposure, PTSD symptoms and functional disability. Latent class analysis was used to identify PTSD symptom profiles, and predictors of class membership were elucidated via multinomial logistic regression. RESULTS: Four classes were identified: a high-PTSD class (21.3%), a high-re-experiencing/avoidance class (15.3%), a moderate-PTSD class (23%), and a no PTSD class (40.3%). Trauma exposure and post-migration stress significantly predicted class membership and classes differed in degree of functional disability. LIMITATIONS: The current study employed a cross-sectional design, which precluded inferences regarding the stability of classes of PTSD symptomatology. CONCLUSIONS: This study provides evidence for distinct patterns of PTSD symptomatology in refugees. We identified a novel class, characterized by high-re-experiencing and avoidance symptoms, as well as classes characterized by pervasive, moderate, and no symptomatology. Trauma exposure and post-migration stress differentially contributed to the emergence of these profiles. Individuals with high and moderate probability of PTSD symptoms evidenced substantial disability. These results support conceptualizations of PTSD as a heterogeneous construct, and highlight the importance of considering sub-clinical symptom presentations, as well as the post-migration environment, in clinical contexts.

Mental Health Effects of Stress over the Life Span of Refugees.

Information about the relative impact of stressful events across the lifespan on the mental health of refugees is needed. Cross-sectional data from a community sample of 135 Kurdish and 117 Vietnamese refugees were fit to a path model about the effects of non-war stress, war-related stress, and post-migration stress on mental health. Kurdish and Vietnamese data were generally consistent with the model. However, war-related stress produced no direct but a large indirect effect through post-migration stress on mental health in Kurds. Vietnamese data indicated a modest direct war-related stress effect but no indirect influence through post-migration stress. Different types of stressful events lead to adverse mental health of displaced refugees in a somewhat group-dependent manner. Implications for prevention and treatment are discussed.

Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey.

OBJECTIVES: To estimate the prevalence of and associations between anxiety, depression, post-traumatic stress disorder (PTSD), low subjective well-being (SWB), potential traumas and postmigration stress among refugees from Syria resettled in Sweden. DESIGN: A cross-sectional and population-based questionnaire study based on a known and complete sample frame. The survey included multiple measures of mental ill health and factors of particular relevance for refugees. Weighted analyses were conducted to calculate representative prevalence rates and associations. Associations were investigated through a series of logistic regression analyses. All analyses were supplemented with robust 95% CIs. SETTING: Sweden. PARTICIPANTS: A random sample of 1215 individuals (response rate 30.4%) from Syria aged 18-64 years that were granted residency in Sweden on grounds of asylum between 2011 and 2013. MAIN OUTCOME MEASURES: Anxiety, depression, PTSD and low SWB were assessed through Hopkins Symptom Checklist, Harvard Trauma Questionnaire and WHO-5 Well-being Index, using established cut-offs. RESULTS: A majority of the participants met the criteria for at least one of the studied types of mental ill health, and the comorbidity was high. Depression was the most the common type with 40.2% (95% CI 36.9% to 43.3%), followed by low SWB with 37.7% (95% CI 34.8% to 40.1%), anxiety with 31.8% (95% CI 29.2% to 34.7%) and PTSD with 29.9% (95% CI 27.2% to 32.6%). Refugee-related potentially traumatic events (PTEs) experienced before or during migration was common as was substantial levels of postmigration stress. Most types of refugee-related PTEs, especially being exposed to interpersonal violence, and postmigration stress were associated with increased risks for anxiety, depression, low SWB and PTSD. CONCLUSIONS: Mental ill health, in terms of anxiety, depression, low SWB and PTSD, are highly elevated and comorbid among refugees from Syria. Increased attention from multiple societal sectors to adequately support Syrian refugees' mental health needs, promoting recovery and reducing postmigration stress are needed.

The Psychological Consequences of Pre-Emigration Trauma and Post-Migration Stress in Refugees and Immigrants from Africa.

Over 50 million people have been displaced, some as a result of conflict, which exposure can lead to psychiatric sequelae. The aims of this study were to provide estimates of pre-emigration trauma, post-migration stress, and psychological sequelae of immigrants and refugees from predominantly Sub-Saharan Africa who immigrated to Sweden. We also examined the predictors of the psychiatric sequelae as well as acculturation within the host country. A total of 420 refugees and immigrants were enrolled using stratified quota sampling. A battery of questionnaires including the Harvard Trauma Questionnaire, Post-Migration Living Difficulties Scale, the Cultural Lifestyle Questionnaire; and the Hopkins Checklist were administered. Descriptive statistics, Chi square analyses, Pearson correlations, analysis of variance, and logistic and linear regression were performed to test the aims of the study. Eighty-nine percent of participants reported at least one traumatic experience prior to emigration. Forty-seven percent of refugees reported clinically significant PTSD and 20 % reported clinically significant depressive symptoms. Males reported a significantly greater number of traumatic events [F(1, 198) = 14.5, p < 0.001] and post-migration stress than females [F(1, 414) = 5.3, p = 0.02], particularly on the financial, discrimination, and healthcare subscales. Females reported a higher prevalence of depressive symptoms when compared to males [F(1, 419) = 3.9, p = 0.05]. Those with a shorter duration in Sweden reported higher rates of PTSD [F(63, 419) = 1.7, p < 0.001]. The greater number of traumatic events was found to be significantly associated with the severity of PTSD symptoms [F(34, 419) = 9.6, p < 0.001]. Using regression analysis, 82 and 83 % of the variances associated with anxiety and depression, respectively, was explained by gender, education, religion, PTSD and post-migration stress. Sixty-nine percent of the variance associated with PTSD included education, number of traumatic events, depressive symptoms and post-migration stress. Forty-seven percent of the variance for acculturation was accounted for by a model that included age, education, duration in Sweden, anxiety, depression, and post-migration stress. These predictors were also significant for employment status with the exception of depressive symptoms. Multidimensional interventions that provide treatments to improve psychiatric symptoms in combination with advocacy and support to reduce stress (e.g., financial, access to health care) are recommended. The focus of the intervention may also be modified based on the gender of the participants.

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

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 Trauma Exposure and Psychological Distress for Asian American Immigrants: Linking the Pre- and Post-migration Contexts.

Drawing on the life course perspective and the assumptive world theory, this paper examines whether pre-migration trauma exposure is associated with psychological distress through post-migration perceived discrimination for Asian American immigrants. The study is based on cross-sectional data from the National Latino and Asian American Study (N = 1639). Structural equation model is used to estimate the relationship between pre-migration trauma, post-migration perceived discrimination, and psychological distress. Additional models are estimated to explore possible variations across ethnic groups as well as across different types of pre-migration trauma experience. Pre-migration trauma exposure is associated with higher levels of psychological distress, both directly and indirectly through higher level of perceived discrimination, even after controlling for demographic/acculturative factors and post-migration trauma exposure. This pattern holds for the following sub-types of pre-migration trauma: political trauma, crime victimization, physical violence, accidental trauma, and relational trauma. Multi-group analyses show that this pattern holds for all Asian immigrant subgroups except the Vietnamese. Studies of immigrant mental health primarily focus on post-migration stressors. Few studies have considered the link between pre- and post-migration contexts in assessing mental health outcomes. The study illustrates the usefulness of bridging the pre- and post-migration context in identifying the mental health risks along the immigrant life course.