Mental Health of Refugees and Asylum Seekers: Assessment and Intervention

Abstract

With unprecedented numbers of displaced persons worldwide, mental health clinicians in high-income countries will increasingly encounter refugee and asylum-seeking patients, many of whom have experienced significant adversity before and after their migration. This paper presents a summary of the recent evidence on the assessment and treatment of refugees across the lifespan to inform clinicians' approaches to care of refugee patients in mental health care settings. Assessment and interventions for refugees are grounded in an ecosystemic approach which considers not only pre-migratory trauma, but social, familial, and cultural determinants of mental health in the host country. Evidence for psychotherapy and pharmacological treatments are reviewed, highlighting promising interventions while acknowledging that further research is needed. Ultimately, serving refugees necessitates a biopsychosocial approach that engages clinicians as medical experts, therapists, and advocates.

Feasibility Study of Determining Prevalence of Common Mental Health Disorders in Male Immigration Detainees

“…All of these factors make it difficult to generalise findings. 28,29,30,31,32,33,34 Although many studies have examined PTSD in refugees and asylum seekers, it is important to note that other mental health issues are equally important. When the prevalence of mental health issues is examined over time, longitudinal studies show similar patterns:  Most refugees continue to show low or no symptoms;  A significant minority show a pattern of gradual recovery;  A small group continue to experience chronic symptoms.…”

“…The factors are the same as those that support emotional wellbeing in the rest of the population, but refugees and asylum seekers often experience more of the risk and fewer of the protective factors. 42,43,44 A social determinants of health approach connects risk and protective factors in the material and social conditions of refugees' post-migration lives to broader social, economic and political factors. It recognises the contribution of daily stressors (that are not necessarily war or trauma related) to mental health, and advocates relief by reducing these stressors along with building capacity for self-recovery.…”

“…Many countries are now paying more attention to these social determinants of health when planning how best to support refugees. 45,46 Important factors can include:  Material determinants such as income; appropriate employment; quality healthcare; food, housing or safe environments;  Social determinants such as experiences of social exclusion, discrimination and low social status. Both material and social determinants can impact on physical and mental health quickly and in the more long-term through stress, perceptions of control, and ability to benefit from supportive social networks.…”

“…Many studies report evidence of loneliness and isolation amongst refugees. 86,87 Factors contributing to social isolation include language problems, discrimination, poverty and 'culture-shock'. Refugees' mental health is influenced by the extent to which they feel welcomed or experience hostility.…”

7ROSES, a transdiagnostic intervention for promoting self-efficacy in traumatized refugees: a first quantitative evaluation

“…Post-migration stressors predict late-onset PTSD (Bryant, O'Donnell, Creamer, McFarlane, & Silove, 2013), negatively impact treatment outcome in refugees (Buhmann, 2014;Whitsett & Sherman, 2017) and predict depression and anxiety (Schick et al, 2018). Addressing post-migration stressors in psychological treatments for resettled refugees has been recommended (Kronick, 2017;Slobodin & De Jong, 2015). However, it remains to be investigated whether such an approach improves the wellbeing of individuals (Hynie, 2018;Tribe, Sendt, & Tracy, 2017).…”