Health-related quality of life in refugee youth and the mediating role of mental distress and post-migration stressors

Cecilie Dangmann,Øivind Solberg,Per Normann Andersen

doi:10.1007/s11136-021-02811-7

Abstract

PurposeThe aim of this study is to explore how potentially traumatic events (PTEs) from war and flight influence health-related quality of life (HRQoL) in young refugees after recent resettlement. In a model based on earlier theory, we tested if post-migration stressors and mental distress mediated the effect of PTEs on HRQoL, individually and in serial. We also explored how different types of post-migration stressors influenced different dimensions of HRQoL.MethodsThis study used a cross-sectional design where 160 Syrian youth recently resettled in Norway completed questionnaires at school between May and December 2018. Correlations between types of post-migration stressors and dimensions of HRQoL were explored and a serial multiple mediator model was tested. Models were adjusted for age and gender, using two types of mental distress; post-traumatic stress disorder (PTSD) and general mental distress.ResultsHigher levels of PTEs reduced experienced HRQoL, but this direct effect was mediated by post-migration stressors alone and in serial with mental distress. Despite high levels of mental distress, this did not affect HRQoL independently, only in serial mediation with increased post-migration stressors. Economic concerns and discrimination were types of post-migration stressors affecting several dimensions of HRQoL.ConclusionQuality of life in refugee is affected by past events from war, stressors in current resettlement and elevated mental distress through complex interrelations. The study reiterates the importance of considering structural and everyday post-migration stressors in policy and intervention to improve the health and wellbeing of refugee youth.

Highlights

Forced migration due to conflict is increasing worldwide, resulting in people seeking refuge in other countries
We found that potentially traumatic events (PTEs) reduced quality of life and that this was mediated by post-migration stressors alone or in sequence with mental distress, but not by mental distress alone
Our models propose that experiences from forced migration influence quality of life negatively through increasing mental distress and postmigration stressors

Summary

Introduction

Forced migration due to conflict is increasing worldwide, resulting in people seeking refuge in other countries. Suggesting that previous research overlooked the importance of post-migration stressors, Miller and Rasmussen [10] proposed a model including both previous war exposure and current resettlement stressors to explain mental distress in refugees. This “ecological model of refugee distress” builds on social ecological models such as Bronfenbrenner [11], in which factors at multiple levels influence human development. This model has shown greater explanatory power, it is still important to explore the interrelated pathways of these pre- and post-migration factors to understand how and when to implement interventions [3]

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