The 10-year course of mental health, quality of life, and exile life functioning in traumatized refugees from treatment start

Abstract

Refugee patients with severe traumatic experiences may need mental health treatment, but treatment results vary, and there is scarcity of studies demonstrating refugees’ long-term health and well-being after treatment. In a 10-year naturalistic and longitudinal study, 54 multi-origin traumatized adult refugee patients, with a background of war and persecution, and with a mean stay in Norway of 10.5 years, were recruited as they entered psychological treatment in mental health specialist services. The participants were interviewed face-to-face with multiple methods at admittance, and at varying points in time during and after psychotherapy. The aim was to study the participants’ trajectories of symptoms of post-traumatic stress, anxiety and depression, four aspects of quality of life, and two aspects of exile life functioning. Linear mixed effects analyses included all symptoms and quality of life measures obtained at different times and intervals for the participants. Changes in exile life functioning was investigated by exact McNemar tests. Participants responded to the quantitative assessments up to eight times. Length of therapy varied, with a mean of 61.3 sessions (SD = 74.5). The participants improved significantly in symptoms, quality of life, and exile life functioning. Improvement in symptoms of posttraumatic stress, anxiety, and depression yielded small effect sizes (r = .05 to .13), while improvement in quality of psychological and physical health yielded medium effect sizes (r = .38 and .32). Thus, long-time improvement after psychological therapy in these severely traumatized and mostly chronified refugee patients, was more notable in quality of life and exile life functioning than in symptom reduction. The results imply that major symptom reduction may not be attainable, and may not be the most important indication of long-term improvement among refugees with long-standing trauma-related suffering. Other indications of beneficial effects should be applied as well.

“I Have No Capacities That Can Help Me”: Young Asylum Seekers in Norway and Serbia – Flight as Disturbance of Developmental Processes

“…Follow-up studies on refugees in receiving countries show variable outcomes regarding mental health and quality of life, but many show resilient development ( Vaage et al, 2010 ; Bogic et al, 2015 ). There is, however, a tendency of long-term mental health problems ( Opaas et al, 2020 ), especially since support and treatment tend to come late and be insufficient ( Pumariega et al, 2005 ; Opaas and Varvin, 2015 ).…”

“…Research among refugees in Europe, North America, and Australia has shown an overrepresentation of mental health suffering among individuals with a refugee background compared to the majority populations ( Fazel et al, 2005 , 2012 ; Priebe et al, 2010 ; Sabes-Figuera et al, 2012 ; Bogic et al, 2015 ; Hocking et al, 2015 ; Hassan et al, 2016 ), even after many years in the host country ( Vaage et al, 2010 ; Opaas et al, 2020 ). In addition to war-related trauma preceding flight, many refugees have suffered adverse and potentially traumatic experiences during childhood and adolescence ( Opaas and Varvin, 2015 ).…”

“Imagine, 7 Years Without a Future”: A Qualitative Study of Rejected Asylum Seekers' Life Conditions in Norway

“…Participants expressed how the lack of social interaction and associated care makes one invisible as a human being, losing sources to confirm one's identity and life story. This is especially important in the identity-forming years of adolescence, particularly as refugees meet the challenges of acculturation together with the normal developmental tasks of adolescence (Streeck-Fischer, 2019 ; Opaas et al, 2020 ).…”

“…This study is about rejected asylum seekers' life conditions in Norway. In general, it is well documented that asylum seekers and refugees have greater rates of mental health problems than host communities (Priebe et al, 2010 ; Bogic et al, 2015 ; Silove et al, 2017 ; Opaas et al, 2020 ). The upheavals associated with the refugee experience also have serious impacts on developmental paths and especially on identity development (Varvin et al, 2021 ).…”

Predictors of the 10 year course of mental health and quality of life for trauma-affected refugees after psychological treatment

“…This naturalistic and longitudinal study followed 54 trauma-affected refugee patients with repeated face-to-face interviews and assessments for up to 10 years after their entry to psychological treatment in specialist-level mental health outpatient services for the adult population in the Oslo region, Norway. Previous publications can be referred to for baseline results, 3 year follow-up, 6.5 year follow-up for a subgroup of 22, and 10 year trajectories of the participants’ mental health, quality of life, personality, and exile life functioning (Opaas et al, 2016 ; Opaas & Hartmann, 2013 , 2021 ; Opaas & Varvin, 2015 ; Opaas, Wentzel-Larsen, & Varvin, 2020 ). At the 3 year follow-up, including almost all of the participants, and where time-points were fixed (at treatment start, after 1 year, and after 3 years), effect sizes of symptoms and QoL changes were large to medium.…”