The refugee post-migration stress scale (RPMS) – development and validation among refugees from Syria recently resettled in Sweden

Abstract

Background: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees. Results: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts. In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores. Conclusions: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.

Exploring Social and Financial Hardship, Mental Health Problems and the Role of Social Support in Asylum Seekers Using Structural Equation Modelling

“…Three subscales of the Refugee Post-Migration Stress Scale (RPMS) [ 14 ] were used to measure the construct of social and financial hardship based on asylum seekers’ responses to: (1) experiencing perceived discrimination ; (2) material and economic strain ; and (3) social strain while living in housing facilities in Sweden. RPMS is a concise, multidimensional self-assessment instrument for the evaluation of post-migration stress among refugees based on a theoretical conceptualization and empirical evidence of the construct of post-migration stress.…”

“…Social and financial hardship was first modelled as three correlated first-order latent variables using the subscales of the RPMS perceived discrimination (four items), material and economic strain (four items), and social strain (three items) on the basis of the previously suggested factorial structure of the RPMS [ 14 ]. Next, a modeled second order “umbrella” latent variable of social and financial hardship was examined with these three latent variables as indicators (see Supplementary Material ).…”

“…The financial hardship is linked to the restrictions placed by host governments on employment and livelihood resulting in being deprived of basic needs and necessities. Among forced migrants, reoccurring daily stressors faced in the host country have been shown to be associated with the severity of common mental health symptoms [ 14 ], and may have an equal or even stronger relationship with psychological problems than exposure to pre-migratory traumatic events [ 15 , 16 ]. Our own research on asylum seekers in Sweden has suggested that asylum seekers’ psychosocial situation may in fact act as a psychosocial vulnerability factor whereby post-migratory stressors, such as “feeling disrespected due to national background” and “feeling excluded or isolated”, act as consistent correlates of depression and anxiety [ 17 ].…”

Perceived stress and well-being of Polish migrants in the UK after Brexit vote

“…A vast amount of migration studies have explored perceived stress in the process or as an effect of moving countries. In particular, [42] verified following domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts. Another research has elaborated on the consequences of international migration on the example of Polish migrant workers in Scotland [43].…”

Resettled Syrian refugees in Jordan: Survival or health promotion

“…A qualitative interview conducted with 68 Syrian refugees in the North of Jordan revealed that emotional distress is a central concern and is frequently highlighted as the trigger for a non‐communicable disease or its exacerbation (McNatt et al., 2019). Stress among refugees could come from perceived discrimination, lack of support from host country, lack of materials, missing home country, concerns about family in home country, economic and social strain and family conflicts (Malm, Tinghög, Narusyte, & Saboonchi, 2020). There is a need to identify whether Syrian refugees use stress management to protect their health.…”