Identifying the critical time points for mental health of asylum seekers and refugees in high-income countries.

Domenico Giacco

doi:10.1017/s204579601900057x

Abstract

High heterogeneity was found in the prevalence rates of mental disorders in adult asylum seekers and refugees in high-income countries. This may be related to different problems. Among them, there is a changing exposure to risk and protective factors for mental health at different phases of these people's life before migration, and during the migratory journey and resettlement. This study aimed at identifying and distinguishing time points in which distinct risk and protective factors for the mental health of asylum seekers and refugees may occur. Systematic review and narrative synthesis. A systematic search was carried out for the period January 2017-August 2019, given the existence of systematic reviews of the evidence up to January 2017. Two hundred and fifty-two studies were identified with our search and 31 studies were included. The critical time points identified are: (a) before the travel; (b) during the travel; (c) at initial settlement in the host country; (d) when attempting to integrate in the host country; (e) when the immigration status is challenged or revoked. Some factors such as sense of belonging in the host country can be risk factors or protective factors depending on the time point. These five critical time points can guide the development and selection of well-timed preventive and treatment interventions. They could also be used to stratify samples in epidemiological studies and meta-analyses. At present, we know much more on risk factors than on protective factors. Knowing more about protective factors may inform the development of interventions to foster them.

Highlights

The recent refugee crisis and migratory waves have been the focus of much political attention in high-income countries (Gianfreda, 2018)
This review has identified five time points at different stages of the migration process of asylum seekers and refugees in which different risk and protective factors may occur
The risk and protective factors identified have all been variably described in previous studies (Lindencrona et al, 2008; Steel et al, 2009; Bogic et al, 2012; Bogic et al, 2015)

Summary

Introduction

The recent refugee crisis and migratory waves have been the focus of much political attention in high-income countries (Gianfreda, 2018). The factors which may lead to refugees’ migration, i.e. exposure to political persecution and war (UNHCR, 2019) can predispose them to mental disorders (WHO, 2018). This gave impetus to the research in this field and a number of studies have assessed prevalence rates in different groups of asylum seekers and refugees and for different mental disorders When assessing prevalence rates of mental disorders in these groups, a number of problems may arise, which are reflected by a high heterogeneity in prevalence rates across studies (Priebe et al, 2016; Giacco and Priebe, 2018; Giacco et al, 2018) These problems are usually summarised as follows:

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