The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences

Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.

Post-migration journey: Asylum, trauma and resilience, different trajectories - A comparison of the mental health and post-migration living difficulties of documented and undocumented migrants in Belgium

BACKGROUND

Research on the impact of post-migration experiences on the mental health of migrant populations has shown a predictive link between post-migration living difficulties and psychological distress. While many studies have focussed on refugees and asylum seekers, there is a considerable gap in the literature concerning undocumented migrants.

AIMS

The aim of this study was to assess the differences in mental health between documented and undocumented migrants in Belgium. It identified the post-migration difficulties encountered by these two groups and measured their impact on their levels of trauma, resilience, anxiety, depression and their assumptive world.

METHOD

This study involved 69 participants, aged 18 to 68 years, who were either documented or undocumented resident in Belgium. Our data collection included the Post-Migration Living Difficulties Checklist for the measurement of post-migration difficulties, the Posttraumatic Stress Disorder Checklist - DSM-V version for the measurement of trauma, the World Assumptions Questionnaire for the measurement of the assumptive world, the Hopkins Symptom Checklist-25 for the measurement of depressive and anxiety disorders and the Adult Resilience Measure - Revised for the measurement of resilience.

RESULTS

Our analyses showed that the mental health of undocumented migrants was poorer than that of documented migrants, with higher levels of trauma, anxiety and depression, a more negative assumptive world, a lower sense of control and lower total and personal resilience. Our results also revealed that post-migration living difficulties were more severe and more numerous for undocumented migrants, and that they were associated to different themes in both groups.

CONCLUSIONS

The fact that post-migration experience plays such an important role in the mental health of migrant populations raises significant clinical, political and societal considerations. Furthermore, it would appear that undocumented migrants represent a distinct migratory group with their own specificities in terms of migration journey and mental health.

Factors Predicting Mental Health Among Women in Low-Income Communities of a Changing Society: A Mixed-Methods Study

Purpose

To explore women's mental health in India's rapidly changing society.

Participants and Methods

A convenience sample of low-income women (N = 286) in a medium-sized city in South-India participated in a mixed-methods, exploratory study in 2022. Institutional Review Board (IRB) approval was received from Loma Linda University in the US, and Christian Medical College-Vellore in India, in accordance with the declaration of Helsinki, prior to data collection. All study materials were forward and back translated for Tamil, the local language. Phase 1(n = 25) involved audio recorded key-informant interviews and focus groups. Verbatim transcripts were inductively coded, and emerging themes identified. Phase 2 (n = 261) entailed a quantitative survey including demographics, health history, and validated scales measuring mental health symptoms, coping strategies, social support, living situation, and life satisfaction. Data collectors were gender and language matched, research trained, community health nurses.

Results

Qualitative themes included: 1) benefits of living in the city, 2) double duty for women doing household work and paid work, 3) challenges of living in the urban environment, 4) advantages of living in the village, 5) struggles associated with village life. Quantitative results: the average Hopkins Symptoms Checklist (HSCL) score of 1.82 (SD = 0.70) exceeded the 1.65 cut-off score for anxiety and depression symptomology. Among participants with elevated HSCL scores (n = 129) the average was markedly elevated (M = 2.39, SD = 0.56). These women were more likely to rely on wishful thinking, religious coping, and reported more post-migration living difficulties, less social support, and less satisfaction with life. Regression analysis further explored variables associated with participant HSCL scores.

Conclusion

In this sample of low-income urban-dwelling women depression and anxiety symptomology was elevated. Given the limited mental health workforce and cultural stigmatization of mental health issues, further attention is required.

The psychological impact of the Syrian crisis on refugees living in Lebanon

PURPOSE

This study aims to evaluate the impact of war on Syrian refugees' life in Bekaa/Lebanon, focusing on psychological and physical symptoms, and to assess the prevalence of the most common symptoms of posttraumatic stress disorder (PTSD) in affected patients recruited in the study.

DESIGN AND METHODS

This observational study was conducted over a period of 1 month-June 2019-in three main camps in the Bekaa region. After taking approval, a total number of 108 Syrian refugees were interviewed and asked about their quality of life and health conditions in camps, after leaving their country. A validated questionnaire was filled by field researchers to gather information on refugees' psychological distresses, physical symptoms, and future perspective.

FINDINGS

During the 4 weeks of study, 108 refugees completed the questionnaire; psychological assessment showed 73.8% of refugees who were exposed to the fighting atmosphere, suffered from one or more psychological symptoms related to PTSD. In addition, 50.5% of the refugees were <30 years old, and among those, 83.5% believed that they have no future for themselves and their families, while 15.4% lost hope in a better life. Seventy-four percent reported at least one physical symptom in the past 4 weeks that is related to PTSD. Furthermore, 64.3% strongly agreed that there is lack of awareness and medical care including psychological and mental health, while 56.1% strongly agreed on the important role of pharmacists and other healthcare professionals in providing advice to patients on their overall health and mental health.

CONCLUSION

Syrian refugees at the assessed camps suffered from psychological distress that requires urgent attention. Current medical and psychological support is absent, and further assessment is needed.

Occurrence and correlates of depressive symptoms among the resettled Afghan refugees in a regional area of Australia

AIMS

Refugees and asylum seekers are at high risk of mental health problems such as post-traumatic stress disorder (PTSD) and depression. Elucidating the occurrence and correlates of these problems in specific resettled refugee populations may be helpful in informing tailored prevention and health promotion programs. We sought to elucidate the occurrence and correlates of depressive symptoms among Afghan refugees resettled in Launceston, a regional town of Australia.

METHODS

We conducted a cross-sectional survey of 66 resettled Afghan refugees residing in Launceston in April 2019. We used the Hopkins symptoms checklist (HSCL-25) and the post migration living difficulties scale (PMLD) to measure depression symptoms and post-migration variables, respectively. Demographic characteristics and levels of physical activity were also assessed. Multivariate analysis was used to examine factors associated with depressive symptoms.

RESULTS

High levels of depressive symptoms were reported by 21.2% of participants (95% CI: 12.1%-33.0%) and were more common among female participants (41.2%, 95% CI: 18.4%-67.1%) than male participants (14.3%, 95% CI: 5.9%-27.2%). Isolation (loneliness, being or feeling alone) (OR = 19.5, 95% CI: 1.9-203.5) and physical inactivity (OR = 9.2, 95% CI: 1.8-45.8) were the only variables independently associated with depressive symptoms.

CONCLUSIONS

Depressive symptoms were common among Afghan refugees living in Launceston, particularly women, and were associated with isolation and physical inactivity. Hence these factors might usefully be targeted in local health promotion and prevention programs.

The health-related quality of life of Syrian refugee women in their reproductive age

Background

Health-Related Quality of Life (HRQoL) for refugee women in reproductive age is highly affected by physical, political, psychosocial and environmental conditions in countries of asylum. HRQoL is enormously affected by the satisfaction of this vulnerable group with the physical, psychological, emotional and social care services provided in this critical time. Therefore, this study aimed toassess the HRQoL among Syrian refugee women of reproductive age living outside camps in Jordan.

Methods

A cross-sectional correlational study was conducted with a convenience sample of 523 Syrian refugee women in the host communities in Jordan.Health-related quality of life (HRQOL) was measured using the short-form 36 (SF-36) questionnaire.

Results

Significant negative correlations were found between SF-36 individual subscales score and the length of marriage, the number of children, parity and family income. The strongest correlations were between pain scale and length of marriage (r =  − .21), and between Energy/Fatigue and ‘number of children’ (r =  − .21). Conversely, antenatal care was positively correlated with physical, role emotional, pain, and general health. Physical functioning and general health were predicted significantly with less years of marriage, younger age at marriage, less violence and by higher family income.

Conclusion

This study suggests low HRQoL scores for women of reproductive age across all domains. Several factors such as years of marriage, age at marriage, the number of children, violence, antenatal care and family income affected the women’s general health. The provision of appropriate and accessible reproductive and maternal healthcare services in antenatal visits is critical for ensuring the immediate and long-term health and wellbeing of refugee women and their families.

The prevalence and correlates of symptoms of post-traumatic stress disorder (PTSD) among resettled Afghan refugees in a regional area of Australia

Background: Post-traumatic stress disorder (PTSD) is common among resettled refugee populations and may be particularly problematic for refugees who have resettled in rural and regional areas.Aims: The aim of this study was to examine the occurrence and correlates of PTSD among Afghan refugees resettled in a regional area of Australia, namely, Launceston, Tasmania.Methods: A cross-sectional survey was conducted with 66 resettled Afghan refugees living in Launceston using the Post Migration Living Difficulties Scale (PMLD) and Impact of Event Scale-Revised (IES-R). Descriptive statistics and multivariable analysis of variables associated with a probable diagnosis of PTSD were conducted.Results: Approximately half of participants 48.8% (95% CI: 36.0-61.1%) met an operational definition of probable PTSD diagnosis according to the IES-R. In multivariable logistic regression analysis, communication difficulties (OR = 14.6, 95% CI: 1.7-124.7), separation from family (OR = 9.9, 95% CI: 1.8-55.5), and self-recognition of a mental health problem (OR = 13.8, 95% CI: 2.4-80.0) were strongly and independently associated with probable PTSD diagnosis. While most participants (81.2%) with a probable PTSD diagnosis recognised that they had a mental health problem, less than half (46.9%) had sought professional help for such a problem.Conclusions: The findings suggest that there are high rates of PTSD, and relatively low uptake of mental health care by sufferers, among resettled Afghan refugees in the regional area of Launceston, Australia. Factors that might usefully be targeted in health promotion, prevention and early intervention program include communication difficulties, issues of family separation and isolation and aspects of "mental health literacy" likely to detract from help-seeking.

Development and validation of the Stressful Experiences in Transit Questionnaire (SET-Q) and its Short Form (SET-SF)

Background: Previous studies have demonstrated that traumatic experiences from countries of origin (so-called pre-migratory factors), as well as stressors in countries of destination (so-called post-migratory factors), are related to the extent of mental health difficulties and psychological well-being of refugees. However, numerous risks that this population is exposed to during transit have so far been neglected. Objective: The aim of this research was to construct and validate a questionnaire for assessing stressful and traumatic experiences in transit as well as its short form, which would at the same time provide information on one's stressful experiences as well as existing risks that refugees are exposed to on their journey. Method: The study was realized in three phases - item construction, item revision and instrument validation. In the validation phase, a total of 226 refugees completed the Stressful Experiences in Transit Questionnaire (SET-Q), along with Harvard Trauma Questionnaire (HTQ) Parts I and IV, Hopkins Symptom Checklist-25 (HSCL-25) and Beck Depression Inventory - II (BDI-II). Results: Refugees were exposed to an average of 13 stressful events during transit. SET-Q total score was positively correlated with HTQ Part IV Post-Traumatic Stress Disorder (PTSD) and Self-Perception of Functioning scales (SPFS) while the number of stressful experiences with the local population was positively related to BDI-II depression symptoms. Moreover, SET-Q scores were significant predictors of PTSD and SPFS even after traumatic experiences in the country of origin, assessed by HTQ Part I, were taken into account. A short form of the questionnaire (SET-SF) has also been developed. Conclusions: SET-Q is a valid instrument for measuring the scope of stressful experiences refugees have been exposed to during transit, targeted for this population specifically. Furthermore, SET-SF has the potential to assess the same extent of stressful experiences with a significantly reduced number of items.

Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul

There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.