The Increased Vulnerability of Refugee Population to Mental Health Disorders

Around the world, the number of refugees displaced by war or violence reaches over 19 million. Rates of mental health disorders, such as anxiety disorders, post-traumatic stress disorder (PTSD) and depression were higher among refugee populations in comparison to the general population. This increased vulnerability has been linked to experiences prior to migration, such as war exposure and trauma. Additionally, anxiety and other mental health disorders can manifest due to stressors post-migration, such as separation anxiety and the added load of resettlement in a new country. In general, increased rates of these disorders remain prevalent in refugee populations long after resettlement; however, some studies have shown otherwise.1 In the Karenni refugees along the Burmese-Thai border, depression and anxiety rates (41% and 42%, respectively) were higher than the average rates of depression and anxiety among the general US population (7% and 10%, respectively).2 These rates have been linked to traumatic events like violence, harassment, and a lack of basic needs. Moreover, the mental health of refugees is thought to be distinct from the experiences of other traumatized populations, such as veterans and sexual assault victims, due to their unique traumatic experiences as well as acculturative stress that follows the resettlement process, which features entirely new settings, practices, and a lack of familiar support systems.3 Furthermore, this population showed a correlation of depression and anxiety disorders with post-resettlement hardships in regards to finding employment and adapting to a new environment culturally and linguistically. In another population, 82.6% of Cambodian refugees residing in a refugee camp on the Thailand-Cambodia border self-reported depression. Fifty-five percent were confirmed by the Hopkins Symptoms Checklist to have experienced symptoms of major depression.2 Symptoms of depression include changes in weight, sleep pattern, exhibiting a depressed mood for much of a day, a loss of interest in activities, lack of energy, feelings of worthlessness and guilt almost daily, lack of focus, and recurrent thoughts of death and suicide, which can include attempting or creating plans for suicide. Symptoms of PTSD include intrusion, avoidance, and hyperarousal. PTSD typically is associated with traumatic experiences. These traumatic events can include experiencing war, being held prisoner/hostage, torture and physical violence, death of a loved one, serious accidents/explosions, sexual harassment, and serious illness. Symptoms of generalized anxiety disorder include restlessness, irritability, fatigue, excessive worrying, having trouble relaxing, sleeping, and focusing.4 The current refugee demographic is a highly heterogeneous group, however, there has been an increase of refugees from Arabic speaking countries in recent years.5 Europe, in particular, has seen a large increase of asylum applicants from Arabic speaking countries, the most frequent being Syria (35.9% of applications) and Iraq (6.9% of applications). Despite the growth of Arabic speaking refugees, few studies have investigated the mental health of these populations in recent years. The large variations in results show that the refugee population is a diverse group. Complications in studies that inhibit direct comparison between refugee populations include the use of different psychometric instruments to measure mental health.5 Another factor that could promote the symptoms of PTSD, depression, and anxiety is acculturative stress. While trauma related to war negatively impacts mental health, the effects of acculturative stress on mental health among refugees resettled in Australia and Austria demonstrated that stress which accompanies the migration process can have similar effects.6 One cause of these stressors is acculturation, the process of integrating into a new culture while also maintaining one’s origin culture and identity. This process is dependent on the attitudes of both the migrant and host groups. There are inconsistencies present in existing studies investigating the effects of acculturation on mental health; however, acculturative stress in migration has been identified as a mental health risk factor.6 The purpose of this review was to investigate the relationship between refugee populations and their increased vulnerability to post-traumatic stress disorder, depression, and anxiety disorders. This study also examined the factors before, during, and after the migration process associated with increased vulnerability of refugees to mental health disorders.