Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Prevalence rates of mental disorders are frequently increased in long-settled war refugees. However, substantial variation in prevalence rates across studies and countries remain unexplained.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To test whether the same sociodemographic characteristics, war experiences and post-migration stressors are associated with mental disorders in similar refugee groups resettled in different countries.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Mental disorders were assessed in war-affected refugees from the former Yugoslavia in Germany, Italy and the UK. Sociodemographic, war-related and post-migration characteristics were tested for their association with different disorders.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 854 war refugees were assessed (≥255 per country). Prevalence rates of mental disorders varied substantially across countries. A lower level of education, more traumatic experiences during and after the war, more migration-related stress, a temporary residence permit and not feeling accepted were independently associated with higher rates of mood and anxiety disorders. Mood disorders were also associated with older age, female gender and being unemployed, and anxiety disorders with the absence of combat experience. Higher rates of post-traumatic stress disorder (PTSD) were associated with older age, a lower level of education, more traumatic experiences during and after the war, absence of combat experience, more migration-related stress, and a temporary residence permit. Only younger age, male gender and not living with a partner were associated with substance use disorders. The associations did not differ significantly across the countries. War-related factors explained more variance in rates of PTSD, and post-migration factors in the rates of mood, anxiety and substance use disorder.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Sociodemographic characteristics, war experiences and post-migration stressors are independently associated with mental disorders in long-settled war refugees. The risk factors vary for different disorders, but are consistent across host countries for the same disorders.</jats:p></jats:sec>

Terrorism, civil war, one-sided violence and global burden of disease

“…Refugees/asylum seekers/displaced persons also suffer increased risk of other physical and mental disorders through exposure to substantial trauma including torture, sexual violence, mutilation and machete wounds, loss of property and detention (Amanda et al, 2010;Bogic et al, 2012;Mitike and Deressa, 2009 (Johannesson et al, 2011). Further, the association between exposure to natural disasters and mental disorders including substance use disorders (McFarlane et al, 1994), depression (Green and Solomon, 1995), and anxiety disorders (Fan et al, 2011) is well established in the literature.…”

Psychological Symptoms as Long-Term Consequences of War Experiences

“…Bosnia-Herzegovina, Croatia, Kosovo (which was a province of Serbia at the time), Republic of Macedonia and Serbia, and in Germany, Italy and the UK as the 3 European countries with the highest number of immigrants at the time of the war. Prevalence rates of mental disorders, on average 8 years after the war experience, and factors associated with different disorders in the two groups have been reported in previous papers [11,12]. Findings suggest that mental disorders are highly prevalent, with 33.5 and 28.3% of respondents reporting anxiety and mood disorders in the Balkan sample, while these figures were 43.7 and 43.4%, respectively, amongst the refugees [11,12].…”

“…Participants in Western Europe were identified through data registers, community organizations and snowballing [7,12]. Inclusion criteria were: born within the territory of former Yugoslavia; age between 18 and 65 years; experience of at least 1 war-related potentially traumatic event (to ensure that all participants had in fact been affected by war); no severe learning difficulty and no organic mental impairment; experience of the last war-related event at the age of 16 or older.…”

Identifying post-traumatic stress disorder in forced migrants

“…Although not recognised in current diagnostic systems (ICD10, DSM5), it is likely that cPTSD will be incorporated into ICD-11 1. It is characterised by the core symptoms of PTSD in addition to…”

“…People who have had to undergo forced migration are more likely to have experienced the sort of trauma that would predispose them to post-traumatic stress disorder (PTSD), and are therefore at higher risk of PTSD than the general population in their new country of settlement 1. However, identifying PTSD is often difficult because vulnerable patients can be reluctant to discuss the details of these traumas without having already established trusting relationships with their doctors.…”