Abstract
Exposure to potentially traumatic events and post-migration living difficulties (PMLDs) may explain the high rates of posttraumatic stress disorder (PTSD) and depression in resettled refugees. Latent class analyses (LCAs) in refugees have identified subgroups that differ in symptom profiles of PTSD and comorbid symptoms. However, knowledge on longitudinal symptom profiles in refugees is sparse. Examining longitudinal PTSD and depression symptom profiles could provide information on risk factors underlying worsening of symptoms post-resettlement. Self-rated PTSD (Posttraumatic Diagnostic Scale) and depression (Patient Health Questionnaire–9) symptoms were assessed among 613 refugees who had resettled in Australia up to two years previously (W1) and at 6 months follow-up (W2). PTSD and depression symptom profiles were identified using LCAs for W1 and W2 separately. Latent transition analysis was used to examine (predictors of) changes in symptom profiles, including gender, age, trauma exposure, and PMLDs. Four classes were identified that were consistent across timepoints: a No symptoms (W1 61%; W2 68%), Low PTSD/Moderate depression (W1 16%; W2 10%), Moderate PTSD/depression (W1 16%; W2 14%), and High symptoms class (W1 7%; W2 7%). Higher levels of problems with PMLDs, including being discrimination and family separation, predicted movements out of the No symptom class at W1 to classes with psychopathology at W2. To conclude, most participants did not develop PTSD or depression symptoms. The risk of developing these symptoms seems higher when problems with interpersonal PMLDs increased, pointing to the need for considering these stressors when addressing the mental health needs in this population.
Highlights
Exposure to potentially traumatic events and post-migration living difficulties (PMLDs) may explain the high rates of posttraumatic stress disorder (PTSD) and depression in resettled refugees
We explored which commonly reported risk factors for distress in refugees were related to change in symptom profiles over time, including background characteristics, exposure to potentially traumatic events (PTEs), and PMLDs
Based on prior research (Chen et al, 2017; Li et al, 2016; Tay et al, 2017), we focused on the following seven PMLDs that have been consistently associated with poorer mental health in refugees: 1) hous ing problems, 2) financial difficulties, 3) job insecurity, 4) separation from family, 5) worry about family members, 6) being discriminated against, and 7) difficulties accessing treatment for health or mental health problems
Summary
Exposure to potentially traumatic events and post-migration living difficulties (PMLDs) may explain the high rates of posttraumatic stress disorder (PTSD) and depression in resettled refugees. Many refugees face interpersonal difficulties, such as separation from, and worry about, family members, and being discriminated against, which likely increase distress levels (Bendjo et al, 2019; Colic-Peisker and Walker, 2003; Correa-Velez et al, 2010) It is often chal lenging for resettled refugees to access mental health services due to various reasons, such as lack of knowledge about existing services, self-stigma, and distrust in health care system, which may result in long-term impaired mental health (Byrow et al, 2020). An LCA in a repre sentative refugee sample in Australia yielded five distinct classes based on PTSD, depression, and anxiety symptoms; a high comorbid symptom class, high PTSD class, high depression/anxiety class, moderate PTSD class, and resilient class (Nickerson et al, 2019a) These prior LCA studies show that different symptom profiles of PTSD and comorbid symptoms can be distinguished in people with a refugee background
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