Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies

Abstract

Background: In asylum seekers and refugees, the frequency of mental disorders, such as depression, anxiety and post-traumatic stress disorder, is higher than the general population, but there is a lack of data on risk factors for the development of mental disorders in this population. Aim: This study investigated the risk factors for mental disorder development in a large group of asylum seekers and refugees resettled in high- and middle-income settings. Methods: Participant-level data from two randomized prevention studies involving asylum seekers and refugees resettled in Western European countries and in Turkey were pooled. The two studies randomized participants with psychological distress, but without a diagnosis of mental disorder, to the Self-Help Plus psychological intervention or enhanced care as usual. At baseline, exposure to potentially traumatic events was measured using the Harvard Trauma Questionnaire-part I, while psychological distress and depressive symptoms were assessed with the General Health Questionnaire and the Patient Health Questionnaire. After 3 and 6 months of follow-up, the proportion of participants who developed a mental disorder was calculated using the Mini International Neuropsychiatric Interview. Results: A total of 1,101 participants were included in the analysis. At 3- and 6-month follow-up the observed frequency of mental disorders was 13.51% (115/851) and 24.30% (207/852), respectively, while the frequency estimates after missing data imputation were 13.95% and 23.78%, respectively. After controlling for confounders, logistic regression analysis showed that participants with a lower education level ( p = .034), a shorter duration of journey ( p = .057) and arriving from countries with war-related contexts ( p = .017), were more at risk of developing mental disorders. Psychological distress ( p = .004), depression ( p = .001) and exposure to potentially traumatic events ( p = .020) were predictors of mental disorder development. Conclusions: This study identified several risk factors for the development of mental disorders in asylum seekers and refugees, some of which may be the target of risk reduction policies. The identification of asylum seekers and refugees at increased risk of mental disorders should guide the implementation of focused preventative psychological interventions.

Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model

“…The present findings builds on evidence from previous research on the SH+ showing how exposure to more PTEs (especially inter-human violence) is associated with a lack of effect in preventing the onset of mental health disorders, even in the absence of criteria for a clinical diagnosis of PTSD at baseline (Barbui et al, 2023 ). This is generally consistent with the grounding framework of the agenda of the Lancet Commission on global mental health, which states that ‘ … The binary approach to diagnosing mental disorders, although useful for clinical practice, does not accurately reflect the diversity and complexity of mental health needs of individuals or populations’ (Patel et al, 2018 ).…”

Impairments in psychological functioning in refugees and asylum seekers

“…Its first part focuses on 16 specific traumatic events and one item ‘other (e.g., domestic violence)’, and had been assessed in a binary yes or no question in this study. In a principal component analysis including a larger sample of refugees and asylum seekers HTQ items had been pooled in three thematic domains ‘lack of basic needs’ (three items, ‘factor 1’), ‘violence and abuse’ (eight items, ‘factor 2’) and ‘being close to death’ (six items, ‘factor 3’) ( Barbui et al, 2023 ). Internal consistency was high with Cronbach’s alpha of 0.87 (subscores’ alphas 0.75–0.80).…”

Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement

“…Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), there has also been a substantial increase in migration towards high-income countries (HICs) (Abubakar et al , 2018; Matlin et al , 2018). Existing evidence suggests that refugees resettled in both LMICs and HICs exhibit a heightened frequency of psychiatric disorders compared with the general population (Barbui et al , 2022; Peconga and Høgh Thøgersen, 2019). Identifying modifiable factors associated with mental illness is of paramount importance in planning public health interventions and promoting the overall well-being of refugees.…”