Health-related quality of life in refugee youth and the mediating role of mental distress and post-migration stressors

Abstract

Purpose The aim of this study is to explore how potentially traumatic events (PTEs) from war and flight influence health-related quality of life (HRQoL) in young refugees after recent resettlement. In a model based on earlier theory, we tested if post-migration stressors and mental distress mediated the effect of PTEs on HRQoL, individually and in serial. We also explored how different types of post-migration stressors influenced different dimensions of HRQoL. Methods This study used a cross-sectional design where 160 Syrian youth recently resettled in Norway completed questionnaires at school between May and December 2018. Correlations between types of post-migration stressors and dimensions of HRQoL were explored and a serial multiple mediator model was tested. Models were adjusted for age and gender, using two types of mental distress; post-traumatic stress disorder (PTSD) and general mental distress. Results Higher levels of PTEs reduced experienced HRQoL, but this direct effect was mediated by post-migration stressors alone and in serial with mental distress. Despite high levels of mental distress, this did not affect HRQoL independently, only in serial mediation with increased post-migration stressors. Economic concerns and discrimination were types of post-migration stressors affecting several dimensions of HRQoL. Conclusion Quality of life in refugee is affected by past events from war, stressors in current resettlement and elevated mental distress through complex interrelations. The study reiterates the importance of considering structural and everyday post-migration stressors in policy and intervention to improve the health and wellbeing of refugee youth.

Syrian Refugee Youth Resettled in Norway: Mechanisms of Resilience Influencing Health-Related Quality of Life and Mental Distress

“…The mean score for general mental distress (HSCL-10) ( n = 127) was 1.77 ( SD = 0.61), and 36% had scores above the recommended threshold (≥1.85) considered an indication of mental distress ( 35 ). Almost half the participants (48%) had scores above the recommended threshold for PTSD (≥17) ( 37 ). The mean score for global HRQoL (44.52, SD = 10.05) was lower than norm data (48.51, SD = 9.28) and 26% reported low HRQoL ( 39 ).…”

“…Previous articles from the “Good Start” project ( 31 , 37 ), have established the importance of direct and indirect pre- and post-migration risk factors on quality of life. This study adds to this knowledge by exploring the role of resilience factors, specifically promotive and protective mechanisms of influence.…”

“…This study forms part of a larger research project “Good starts—mental health and resilience in Syrian refugee youth” with two previously published articles including the same study sample ( 31 , 37 ). The present study utilised a cross-sectional, questionnaire-based design.…”

“…The recruitment period lasted from May to December 2018, and a total of 160 youth from Syria were included in the final sample. For further details concerning methods and materials, see also ( 31 , 37 ).…”

“…In their ecological model of refugee distress, Miller and Rasmussen proposed a mediational effect where PTEs increase the amount of experienced post-migrations stressor (34). Later studies have found empirical support for this model (33,(35)(36)(37). One proposed mechanism is that trauma sensitises a person to future adversity, triggering an overreaction to ongoing demands (5,38).…”