The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review

Abstract

AimsDespite the magnitude and protracted nature of the Rohingya refugee situation, there is limited information on the culture, mental health and psychosocial wellbeing of this group. This paper, drawing on a report commissioned by the United Nations High Commissioner for Refugees (UNHCR), aims to provide a comprehensive synthesis of the literature on mental health and psychosocial wellbeing of Rohingya refugees, including an examination of associated cultural factors. The ultimate objective is to assist humanitarian actors and agencies in providing culturally relevant Mental Health and Psychosocial Support (MHPSS) for Rohingya refugees displaced to Bangladesh and other neighbouring countries.MethodsWe conducted a systematic search across multiple sources of information with reference to the contextual, social, economic, cultural, mental health and health-related factors amongst Rohingya refugees living in the Asia-Pacific and other regions. The search covered online databases of diverse disciplines (e.g. medicine, psychology, anthropology), grey literature, as well as unpublished reports from non-profit organisations and United Nations agencies published until 2018.ResultsThe legacy of prolonged exposure to conflict and persecution compounded by protracted conditions of deprivations and displacement is likely to increase the refugees' vulnerability to wide array of mental health problems including posttraumatic stress disorder, anxiety, depression and suicidal ideation. High rates of sexual and gender-based violence, lack of privacy and safe spaces and limited access to integrated psychosocial and mental health support remain issues of concern within the emergency operation in Bangladesh. Another challenge is the limited understanding amongst the MHPSS personnel in Bangladesh and elsewhere of the language, culture and help-seeking behaviour of Rohingya refugees. While the Rohingya language has a considerable vocabulary for emotional and behavioural problems, there is limited correspondence between these Rohingya terms and western concepts of mental disorders. This hampers the provision of culturally sensitive and contextually relevant MHPSS services to these refugees.ConclusionsThe knowledge about the culture, context, migration history, idioms of distress, help-seeking behaviour and traditional healing methods, obtained from diverse sources can be applied in the design and delivery of culturally appropriate interventions. Attention to past exposure to traumatic events and losses need to be paired with attention for ongoing stressors and issues related to worries about the future. It is important to design MHPSS interventions in ways that mobilise the individual and collective strengths of Rohingya refugees and build on their resilience.

An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial

“…Parallel but separate procedures were applied in developing and refining both the IAT and CBT interventions. The systematic process of cultural adaptation of both therapies was guided by the framework of Bernal and Saez-Sanriago [33] and based on an extensive review of cultural idioms of distress and local terminologies for mental health symptoms [34,35]. Parallel draft manuals and associated materials were translated into the relevant dialects with the assistance of bilingual mental health professionals.…”

“…Strengths of the study include the systematic recruitment strategy in that participants were drawn from a representative sample of refugees from 3 community-based epidemiological studies, yielding a pool of participants that reflected the demographic profile of each; for example, our sample replicated the general pattern in the community by generating a larger sample of men amongst the Rohingya [38]. There was extensive work done to adapt and pilot the materials and procedures prior to conducting the RCT [34,35], including a systematic process of translation and adaptation of the manuals to ensure their cultural, contextual, and linguistic appropriateness. The entire intervention was conducted by lay counsellors from the respective communities, consistent with the principles of task shifting which enhances the capacity to scale up the interventions in real-life service settings.…”

Theoretical background, first stage development and adaptation of a novel Integrative Adapt Therapy (IAT) for refugees

“…The approach was both systematic and based on extensive less formal interactions during the process of engagement with each refugee group as well as with NGOs and UNHCR officers in both Malaysia and Bangladesh. The process of cultural adaptation was guided by the framework of Bernal and Saez-Santiago (2006), supplemented by information generated by a targeted desk review of cultural idioms of distress and local terminologies conducted in relation to each refugee group in each setting (see a comprehensive review of the Rohingya refugees (Tay et al, 2019b)). The first step was the translation of all materials including the manual into the appropriate dialects with the assistance of bilingual mental health professionals.…”

The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis

“…A recent systematic review of 8,176 Syrian refugees resettled in 10 countries reported a prevalence of 43% for PTSD, 40% for depression, and 26% for anxiety [8]. As the literature has focused on either specific cultural groups or specific host nations or has combined internally displaced populations with refugees and asylum seekers, there is a lack of estimates on the prevalence of mental illness in more representative refugee and asylum-seeker populations [9][10][11][12]. There is also a lack of research investigating the full breadth of mental illness, as the literature has mainly focused on PTSD and depression, hence the need for a comprehensive, worldwide, systematic review to investigate mental illness in the current refugee populations.…”