Mental health in adult refugees from Syria resettled in Norway between 2015 and 2017: a nationwide, questionnaire-based, cross-sectional prevalence study

Abstract

Background The number of forcibly displaced people globally has never been higher, with refugees from Syria constituting the largest displaced population worldwide. Many studies have documented elevated levels of mental health problems in refugee populations, though prevalence estimates of common mental disorders vary considerably between studies, explained both by methodological and contextual factors. Objective Using questionnaire-based screening checklists to approximate the prevalence of and investigate risk factors for post-traumatic stress disorder (PTSD), anxiety and depression among adult refugees from Syria resettled in Norway and to compare estimates with a sister-study in Sweden. Method Cross-sectional survey of a randomly selected sample from the National Population Register in Norway of adult refugees from Syria who were granted residency rights in Norway between 2015 and 2017 ( N sample = 9,990; n respondents = 902). Above-threshold scores on the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptoms Checklist (HSCL-25) defined caseness for PTSD (HTQ>2.06); anxiety (HSCL anxitey >1.75); and depression (HSCL depression >1.80). Results Weighted, checklist-positive prevalence estimates for PTSD, anxiety and depression were 29.7% (25.4%-34.4%), 30.1% (25.7%-34.9%), and 45.2% (40.6%-49.8%), respectively. Cumulative exposure to potentially traumatic experiences before or during flight was a clear risk factor for all outcomes, and female gender was a risk factor for anxiety and depression, though only in adjusted analyses. The choice of HTQ cut-off to define PTSD caseness (2.5 vs. 2.06) had a notable effect on prevalence estimates. Conclusion In line with prior evidence, the present study suggests adult refugees from Syria resettled in Norway have higher rates of anxiety and depression and markedly higher rates of PTSD compared to general, non-refugee populations, and that this is clearly linked to past traumatic experiences. Prevalence estimates were highly consistent with estimates from the sister-study in Sweden, which used almost identical methodology. Findings underline the importance of screening for and intervening on mental health problems in newly arrived refugees.

Associations between postmigration living situation and symptoms of common mental disorders in adult refugees in Europe: updating systematic review from 2015 onwards

“…Another study [ 30 ] found differences in reporting anxiety and PTSD symptoms between asylum seekers and individuals with residence permit, but not in depressive symptoms. Five studies found no significant association between legal status and symptoms of depression, anxiety, or PTSD [ 21 , 26 , 29 , 31 , 37 ].…”

Chronic pain, mental health and functional impairment in adult refugees from Syria resettled in Norway: a cross-sectional study

“…Our collaborating project in Sweden, with very similar study population, methodology and prevalence estimates of mental ill health [59,60], however, also found that close to 30% of participating refugees experienced pain/ discomfort at moderate/severe/extreme levels. Though, in the Swedish survey, pain was also measured by a single item from the standardized EQ-5D questionnaire developed by the EuroQol Group [69].…”

Chronic pain, mental health and functional impairment in adult refugees from Syria resettled in Norway: a cross-sectional study

“…al. Our collaborating project in Sweden, with very similar study population, methodology and prevalence estimates of mental ill health [ 59 , 60 ], however, also found that close to 30% of participating refugees experienced pain/discomfort at moderate/severe/extreme levels. Though, in the Swedish survey, pain was also measured by a single item from the standardized EQ-5D questionnaire developed by the EuroQol Group [ 69 ].…”

“…Furthermore, there was no difference in the proportion with anxiety and depression scores above cut-off when participants who returned the questionnaire within a month after study launch ( n = 433) were compared with those who responded later and after a reminder had been sent out ( n = 464). There was a tendency, however, that a higher proportion of early-responders had a PTSD score above cut-off [ 60 ]. This provides some evidence that willingness to participate (operationalized through how soon participants returned the questionnaire) was not strongly related to mental ill health.…”

“…The choice of cut-off was made to be consistent with the sister-study in Sweden [ 59 ], and was pre-registered prior to study start. It was also the chosen cut-off in a prior publication assessing the burden of mental ill health in the present study sample [ 60 ]. The 16 items used from the HTQ (section IV) are also scored from 1 (“not at all”) to 4 (“very much”), and a mean-item score was created for those with < 3 missing.…”