Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees

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Abstract

Background

Refugees have been shown to present high prevalence rates of trauma-related mental disorders. Despite their psychological impairment, they are expected to meet high functional requirements in terms of social integration into, and financial independence from, the host society.

Methods

This cross-sectional study examined the relationship of mental health problems, post-migration living difficulties (PMLD), and social integration in a sample of 104 refugees seeking treatment for severe posttraumatic stress and comorbid symptoms in two outpatient clinics in Switzerland.

Results

Despite an average time of residence in Switzerland of over 10 years, participants showed poor integration and a high number of PMLD. Integration difficulties were closely associated with psychological symptoms, but not with socio-demographic parameters such as education or visa status.

Conclusions

Psychological impairment in treatment-seeking traumatized refugees is associated with poor integration. To foster social integration, it is crucial to better understand and address the specific needs of this highly vulnerable population.

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Most cited references 49

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

Jutta Lindert, Ondine Ehrenstein, Stefan Priebe … (2009)

Prevalence rates of depression and anxiety among migrants (i.e. refugees, labor migrants) vary among studies and it's been found that prevalence rates of depression and anxiety may be linked to financial strain in the country of immigration. Our aim is to review studies on prevalence rates of depression and/or anxiety (acknowledging that Post-traumatic Stress Disorder (PTSD) is within that class of disorders), and to evaluate associations between the Gross National Product (GNP) of the immigration country as a moderating factor for depression, anxiety and PTSD among migrants. We carried out a systematic literature review in the databases MEDLINE and EMBASE for population based studies published from 1990 to 2007 reporting prevalence rates of depression and/or anxiety and or PTSD according to DSM- or ICD- criteria in adults, and a calculation of combined estimates for proportions using the DerSimonian-Laird estimation. A total of 348 records were retrieved with 37 publications on 35 populations meeting our inclusion criteria. 35 studies were included in the final evaluation. Our meta-analysis shows that the combined prevalence rates for depression were 20 percent among labor migrants vs. 44 percent among refugees; for anxiety the combined estimates were 21 percent among labor migrants vs. 40 percent among (n=24,051) refugees. Higher GNP in the country of immigration was related to lower symptom prevalence of depression and/or anxiety in labor migrants but not in refugees. We conclude that depression and/or anxiety in labor migrants and refugees require separate consideration, and that better economic conditions in the host country reflected by a higher GNP appear to be related to better mental health in labor migrants but not in refugees.

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Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors.

D Silove, I Sinnerbrink, A. Field … (1997)

Research into the mental health of refugees has burgeoned in recent times, but there is a dearth of studies focusing specifically on the factors associated with psychiatric distress in asylum-seekers who have not been accorded residency status. Forty consecutive asylum-seekers attending a community resource centre in Sydney, Australia, were interviewed using structured instruments and questionnaires. Anxiety scores were associated with female gender, poverty, and conflict with immigration officials, while loneliness and boredom were linked with both anxiety and depression. Thirty subjects (79%) had experienced a traumatic event such as witnessing killings, being assaulted, or suffering torture and captivity, and 14 subjects (37%) met full criteria for PTSD. A diagnosis of PTSD was associated with greater exposure to pre-migration trauma, delays in processing refugee applications, difficulties in dealing with immigration officials, obstacles to employment, racial discrimination, and loneliness and boredom. Although based on correlational data derived from'a convenient' sample, our findings raise the possibility that current procedures for dealing with asylum-seekers may contribute to high levels of stress and psychiatric symptoms in those who have been previously traumatised.

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Language proficiency and adverse events in US hospitals: a pilot study.

Stephen P Schmaltz, Chandrika Divi, J Loeb … (2007)

To examine differences in the characteristics of adverse events between English speaking patients and patients with limited English proficiency in US hospitals. Six Joint Commission accredited hospitals in the USA. Adverse event data on English speaking patients and patients with limited English proficiency were collected from six hospitals over 7 months in 2005 and classified using the National Quality Forum endorsed Patient Safety Event Taxonomy. About 49.1% of limited English proficient patient adverse events involved some physical harm whereas only 29.5% of adverse events for patients who speak English resulted in physical harm. Of those adverse events resulting in physical harm, 46.8% of the limited English proficient patient adverse events had a level of harm ranging from moderate temporary harm to death, compared with 24.4% of English speaking patient adverse events. The adverse events that occurred to limited English proficient patients were also more likely to be the result of communication errors (52.4%) than adverse events for English speaking patients (35.9%). Language barriers appear to increase the risks to patient safety. It is important for patients with language barriers to have ready access to competent language services. Providers need to collect reliable language data at the patient point of entry and document the language services provided during the patient-provider encounter.

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Author and article information

Journal

Journal ID (nlm-ta): Eur J Psychotraumatol

Journal ID (iso-abbrev): Eur J Psychotraumatol

Journal ID (publisher-id): EJPT

Title: European Journal of Psychotraumatology

Publisher: Co-Action Publishing

ISSN (Electronic): 2000-8066

Publication date (Electronic): 12 February 2016

Publication date Collection: 2016

Volume: 7

Electronic Location Identifier: 10.3402/ejpt.v7.28057

Affiliations

[1 ]Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland

[2 ]Faculty of Medicine, University of Zurich, Zurich, Switzerland

[3 ]Outpatient Clinic for Victims of Torture and War, Swiss Red Cross, Bern, Switzerland

[4 ]Department of Psychology, University of Bern, Bern, Switzerland

[5 ]School of Psychology, University of New South Wales, Sydney, NSW, Australia

[6 ]Psychiatric Services Thurgau, Münsterlingen, Switzerland

Author notes

[* ]Correspondence to: Matthis Schick, Department of Psychiatry and Psychotherapy, University Hospital Zürich, Culmannstrasse 8, CH-8091 Zürich, Switzerland, Email: matthis.schick@ 123456usz.ch

[† ]These authors contributed equally to this paper

Responsible Editor: Brian Hall, University of Macau, Macau (SAR), People’s Republic of China.

This paper is part of the Special Issue: Global mental health: trauma and adversity among populations in transition. More papers from this issue can be found at www.ejpt.net

Article

Publisher ID: 28057

DOI: 10.3402/ejpt.v7.28057

PMC ID: 4756625

PubMed ID: 26886484

SO-VID: 17373b9c-afdb-44e5-ba08-0037720099b0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

History

Date received : 18 May 2015

Date revision received : 28 December 2015

Date accepted : 28 December 2015

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Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees

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Abstract

Background

Methods

Results

Conclusions

Related collections

Special series on COVID-19 and Mental Health

Most cited references 49

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

Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors.

Language proficiency and adverse events in US hospitals: a pilot study.

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Cited by 85

Most referenced authors 546