Adult Refugees Research Articles

The impact of posttraumatic stress disorder and head injury on reactive and appetitive aggression in adult Syrian refugees in Lebanon.

Refugees are highly vulnerable to mental health disorders and head injuries. The primary aim of this study is to examine the impact of posttraumatic stress disorder (PTSD) and head injury on reactive and appetitive aggression in adult Syrian refugees in Lebanon. A cross-sectional study was conducted targeting adult Arab United Nations High Commissioner for Refugees-registered Syrian refugees residing in Beirut and southern regions of Lebanon. Eligible refugees completed a battery of questionnaires including the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Trauma Events and Head Injury sections of the Harvard Trauma Questionnaire, the Buss-Perry Aggression Questionnaire, and the Appetitive Aggression Scale. A total of 191 Syrian refugees participated in the study: 62.83% were females, and the mean age was 31.01 years (SD = 10.98). The severity of PTSD (adjusted B = 0.18, 95% CI [0.05, 0.31], p = .006), having experienced at least one head injury trauma event (adjusted B = 10.20, 95% CI [1.61, 18.79], p = .020), and the severity of somatic symptoms (adjusted B = 0.71, 95% CI [0.23, 1.20], p = .004) were significant risk factors of reactive aggression. As for appetitive aggression, males (females adjusted OR [aOR] = 0.06, 95% CI [0.02, 0.18], p < .001), younger individuals (aOR = 0.95, 95% CI [0.91, 0.99], p = .024), and higher severity of somatic symptoms (aOR = 1.20, 95% CI [1.09, 1.32], p < .001) were significant risk factors. PTSD and head injury are independent risk factors for reactive aggression but not appetitive aggression in Syrian refugees in Lebanon, while the severity of somatic symptoms is an independent risk factor for both reactive and appetitive aggression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Task design, L1 literacy, and second language oracy

Abstract This paper reports a replication of part of Tavakoli and Foster’s (2008) investigation into the influence of narrative task design on second language (L2) oral performance. The initial study found in part that narratives with both foreground and background information elicited significantly greater syntactic complexity than those with only foreground information. This close replication adds the variable of literacy, conducting the study with adult refugees to New Zealand with low first language (L1) literacy. Participants narrated two of the four cartoon strips in Tavakoli and Foster (2008). In contrast to the initial study, background information in the narrative tasks had no impact on the syntactic complexity, lexical diversity, or fluency of performances. However, given the tendency of participants to omit background events, this outcome is discussed in terms of visual literacy, and aptness to describe rather than connect the cartoon frames. The implications for the use of narrative tasks with such learners are explored.

Determinants of health among Ukrainian refugees in Germany: comparison with other refugee groups

Abstract Background 6.5 million Ukrainian refugees have been displaced globally since 2022, with 1 million seeking asylum in Germany. Little is known about the health determinants for this group, limiting the evidence base for policy intervention. Methods We use a nationally representative survey of adult Ukrainian refugees in Germany (IAB-BiB/FReDA-BAMF-SOEP study; n = 5943), conducted in 2023, to analyse the effect of sociodemographic, pre-migration (experienced war intensity, traumatic experiences) and post-migration factors (time since arrival, accommodation, social networks) on self-rated health using multiple logistic regression. We contrast these findings with estimates of identical models obtained from a subset of the IAB-BAMF-SOEP-sample of non-Ukrainian refugees within one year of arrival (n = 1195). Results In the Ukrainian sample, post-migration factors are particularly critical for health, with those experiencing discrimination (OR 1.83; 95%CI: 1.51,2.21) and social isolation (OR: 2.70; 95%CI: 2.23, 3.28) affected by ill health, while those with high German proficiency (OR 0.34; 95%CI: 0.18, 0.64) and contact with Germans (OR: 0.66; 95%CI: 0.53,0.83) are protected. Pre-migration factors do not affect self-rated health. Among refugees from other countries of origin, post-migration factors are not associated with health within the first year of arrival, with exception of social isolation (OR: 2.03; 95%CI: 1.32,3.13). Discussion Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances. While other refugee groups may have had riskier escape journeys and worse arrival conditions, this is unrelated to self-rated health in the first year. This underscores the importance of considering pre-migration contexts when evaluating subjective health. Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system. Key messages • Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances. • Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system.

Health status by time of arrival among Ukrainian refugees in Norway

Abstract Background Over 75000 refugees from Ukraine have come to Norway since February 2022. Previous studies show that the refugees have poor health for several domains, and reports suggest that those fleeing Ukraine at later stages have even poorer health. However, more systematic knowledge is lacking. This study aimed to measure self-reported health in a sample of adult refugees from Ukraine according to month of arrival to Norway in 2022. Methods Data were collected via an online, digital questionnaire, in a cross-sectional study design between 28.10.22 - 31.01.23. Recruitment was via multiple potential physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. The survey included self-reported health outcomes: overall health, oral health, presence of long-term illnesses or disabilities, and a short version of Hopkins Symptom Checklist (HSCL-5). Results Among 727 respondents, 82% were female, 65% aged 30-49 years, 69% had higher education and 53% responsibility for children in Norway. 383 arrived February-April (T1), 200 May-August (T2) and 144 September-December (T3). Compared to T1, later periods had higher proportions of males, a younger age distribution and lower proportions with higher education. Proportions reporting poor/very poor overall health, presence of long-term illness, and long-term disability were highest in T3. Oral health and HSCL-5 showed an opposite trend, with lower proportions reporting poorer health in both later periods. Respondents in T3 were still more likely to report poor health and long-term illnesses after adjusting for sex, age and education. Conclusions Respondents arriving later in 2022 generally reported poorer long-term health, but less psychological distress than those arriving earlier. These findings may help to inform planning of health services to refugees from Ukraine, especially in areas receiving large numbers of refugees. Key messages • Refugees from Ukraine arriving earlier to host countries appear to have generally better health compared to those arriving later. • Refugee health services should plan and scale accordingly when large numbers of refugees are expected as a result of international crises.

Evaluating the efficacy of support groups in the metaverse for Ukrainian refugees: a protocol for a randomized clinical trial

BackgroundThe Ukrainian crisis, sparked by the Russian invasion, has generated one of the most extensive refugee crises in modern history. Addressing the mental health challenges of Ukrainian refugees is critical to promoting their resilience and successful integration into host communities. Traditional support group interventions might be challenging to implement for geographically dispersed populations, making the metaverse an innovative and inclusive platform for providing much-needed support to such populations.Methods/designDisplaced Ukrainian refugee adults (18 years or older) without current psychiatric diagnoses or current involvement in therapeutic interventions are included in the study. Participants are randomized to one of three conditions: (1) Metaverse Support Groups, (2) In-Person Support Groups, or (3) Waitlist. Both intervention groups (Metaverse and In-Person) undergo 5 support group sessions, and data are collected at baseline, mid-intervention, post-intervention, and 3-month follow-up. Primary outcomes are depressive symptomatology and anxiety. Secondary outcomes are perceived social support, well-being, and gender-based violence awareness.DiscussionTo our knowledge, this is the first attempt to test the efficacy of support groups in the Metaverse for the Ukrainian refugee population. This study can thus add substantially to the body of knowledge on effective interventions and policies for refugees.Trial registrationClinicalTrials.gov Identifier: NCT06142032 (https://clinicaltrials.gov/study/NCT06142032). Registered on November 8, 2023.

You Are Safe Here: Community Sponsorship Policy and Refugee Integration in the UK

Abstract Globally, resettlement is considered one of the most durable solutions for refugees. The UK has introduced a Community Sponsorship Scheme that enables communities to resettle refugee families providing them with enhanced integration support aided by volunteers. This paper investigates the nature of integration support that sponsored refugees receive utilising the analytical framework of UK’s Indicators of Integration (IoI). Data was collected from interviews with refugee adults resettled in diverse and less diverse areas. Our findings illustrate the importance of support given by volunteer groups to enable access to resources and connections. We establish that there is much potential for sponsorship programmes to add value to refugee support suggesting that the current expansion of sponsorship from its Canadian roots may help facilitate refugee integration. However, further research is needed to uncover the long-term experiences of sponsored refugees and to compare their outcomes to those of forced migrants arriving via different mechanisms.

A Study on the Relationship Between Post-Traumatic Stress Disorder, Depression and Anxiety Symptoms and the Quality of Life of Syrian Refugees: Case Study for the Province of Kayseri.

The aim of this study is to investigate the factors related to post-traumatic stress disorder (PTSD), depression and anxiety mental disorders, as well as the quality of life of Syrian refugees and to examine the relationships between mental health disorders and the quality of life of Syrian refugees. Data were collected via face-to-face surveys with 613 adult Syrian refugees in an urban setting. Brislin's methodology was used for translating scale items, involving initial translation, back-translation and review by another professional translator. The study utilised the PTSD Scale, Beck Anxiety Scale, Depression Scale and Quality of Life Scale (QOLS). Descriptive, correlational and multivariate regression analysis were applied. Findings of correlational analysis indicate that PTSD levels among Syrian refugees are significantly related to gender, income level and employment. Depression levels are significantly associated with trauma history, healthcare service use, marital status and employment. Anxiety levels are significantly related to gender, trauma history, healthcare service use, employment and income. According to the findings of the regression analyses, the relationships between depression, quality of life and PTSD are complex. Meanwhile, anxiety decreases quality of life and increases PTSD. Quality of life moderates the relationship between depression and PTSD, as well as between anxiety and PTSD. The study concludes that the mental disorder levels of Syrian refugees, in terms of PTSD, depression and anxiety, are linked to their socio-demographic characteristics. These results highlight the importance of social, economic and cultural factors, healthcare and social services and the socio-demographic characteristics of the region where refugees have settled after displacement.

Impact of the asylum determination process on mental health in the UK and EU+: a systematic review and thematic synthesis

IntroductionPeople seeking asylum are at increased risk of mental health difficulties due to premigration and postmigration experiences. The objective of this review was to understand how asylum determination process in...

Unintended Consequences of Welfare Cuts on Children and Adolescents

This paper studies the effects of a large welfare benefit reduction on the children in the affected families. The welfare cut targeted adult refugees who received residency in Denmark, and it reduced their disposable income by 30 percent on average over the first five years. We show that children exposed to the welfare cut during preschool and school-age obtained lower GPAs, experienced reduced well-being and overall education levels, and suffered lower employment and earnings as adults. Children in their teens at exposure faced large increases in conviction probabilities for violent and property crimes. (JEL I26, I31, I38, J13, J15, J31, K42)

Dissociative Subtype of Posttraumatic Stress Disorder and its Correlates Among Treatment-Seeking Refugees

ABSTRACT The dissociative subtype of posttraumatic stress disorder (PTSD-DS) denotes a severe type of PTSD associated with complex trauma exposure and psychiatric comorbidity. Refugees may be at heightened risk of developing PTSD-DS, but research is lacking. This cross-sectional study aimed to examine PTSD-DS and its demographic, trauma-related, and clinical correlates among a convenience sample of refugee patients over 18 years old who were diagnosed with PTSD according to DSM-5. PTSD-DS (Clinician-Administered PTSD Scale for DSM-5), trauma exposure (Life Events Checklist for DSM-5) and general psychopathology (Brief Symptom Inventory) were assessed at intake. T-tests, chi-square tests, and logistical regression analysis were conducted. The final sample consisted of 552 participants (177 (32.1%) women; 375 (67.9%) men; average age 40.0 years (SD = 11.2)) who originated from 63 countries. Of those, 158 (28.6%) met criteria for PTSD-DS. Participants with PTSD-DS scored significantly higher on PTSD symptom severity (t(550)=-5.270, p < .001), number of traumatic event types (t(456)=-3.499, p < .001), and exposure to sexual assault (χ(1) = 6.471, p = .01) than those without PTSD-DS. The odds of having PTSD-DS increased by 14.1% with exposure to each additional traumatic event type (OR = 1.141, CI 0.033–1.260). In conclusion, around 29% of adult treatment-seeking refugees with PTSD met the criteria for PTSD-DS. Those exposed to multiple traumatic event types including sexual assault, regardless of sex, were especially at risk. Having PTSD-DS was associated with more severe PTSD. Prioritizing trauma-focused treatment for those with PTSD-DS is recommended.

‘At some points you feel awful because you are going to start again’: The ambiguous role of education in highly skilled refugee women’s integration experiences

In refugee and migration studies, education has been situated as both a marker of integration and a facilitator of progress in other domains. This paper draws on the accounts of three highly skilled women who have experienced forced migration to highlight some of the ambiguities of education’s role in pathways to social and economic inclusion. A case study approach allows for a detailed and contextual exploration of how intersections of age, caring responsibilities and immigration status influence women’s ability to engage with education. Participants’ accounts confirm that accessing desired and appropriate educational provision can propel people towards their longer-term goals. However, provision that is inaccessible or perceived to be below women’s skill levels can be experienced as exclusionary and demoralising, with attendant impact on women’s perceptions of integration and hopes for the future. Women deploy several strategies to overcome these obstacles, including leveraging existing social connections and re-evaluating their future career pathways. Yet these strategies are not always fully successful. Our findings point towards the need for improved provision for adult refugees and a concerted effort by educational institutions to tackle continuing systemic barriers to education.

“Business as usual won’t work … ”: Therapists’ experiences and preparedness for providing refugees with trauma-related interventions

Objective Worldwide, the numbers of refugees and displaced people being exposed to traumatic and inhumane experiences are escalating, resulting in an enhanced need for appropriate psychological management of trauma in this at-risk group. This study explores therapists’ perspectives on and preparedness for supporting adult refugees with trauma-related interventions. Method Therapists (N = 17), with varying ranges of experiences supporting adult refugee clients, were recruited nationally, and participated in semi-structured interviews, exploring their experiences and preparedness for therapeutically supporting refugee clients with trauma-related interventions. Data were analyzed using reflexive thematic analysis. A Patient Public Involvement (PPI) approach was embedded within this study. Results Five major themes were developed throughout the analysis: (i) Therapists’ Fears and Apprehensions in Meeting Client Complexities, (ii) Preparation and Support for Competency Development, (iii) Adjusting Preconceptions of the Nature of Therapeutic Work, (iv) Humanity Within the Therapeutic Relationship, and (v) Balancing Therapeutic Meaningfulness and Hardships. Conclusion Therapist training must reflect trauma-informed care and inter-cultural awareness to allow therapists to feel better prepared within mainstream and specialist services. Further, therapists’ well-being needs to be prioritized to prevent vicarious trauma, burn-out and ultimately, improve interventions for clients.

Making Sense of Complexity in Refugee Family Systems: Second-Generation Somali and Hmong Refugee Adults’ Reflections on Their Relationships with Their First-Generation Refugee Parents

ABSTRACT The current study aimed to understand the relationships of 2nd generation (2G) refugees during their formative years with their 1st generation (1G) parents. We used a phenomenological approach to conduct individual interviews with six 2G refugees (three Hmong-Americans and three Somali-Americans) in the U.S. who fit the study’s inclusion criterion of being affected by their parents’ migration trauma. Themes emerging from participants’ narratives describe 1) 2G Refugee Relationship Quality with 1G Refugee Parents; 2) Integrating All Dimensions of 2G Intersectional Identities; 3) 2G Resiliency Resources; and 4) Moving Forward. The current study’s findings suggest ways that intergenerational trauma affected 2G refugees’ relationships with their parents and added layers of complexity to the normative challenges of adolescent development. Researchers are encouraged to employ a family system lens to consider the effects of migration trauma across generations when examining relationship dynamics in refugee families. It is important for clinicians to consider the systemic impacts of refugee stress and trauma when working with refugee adolescents and their families.

Breathing democratic air: North Korean refugees’ journey to sociocultural learning about democracy

This study investigates the acquisition of normative knowledge and values about democracy by North Korean refugees in the United States through everyday experiences and academic concepts. Drawing on Vygotsky’s sociocultural theory, which posits that knowledge is socially constructed and forms the basis of a society’s culture, an analysis is conducted on the sociocultural learning experiences of democracy among North Korean refugees. Utilizing Clarke’s situational analysis of interview transcripts, various scenes of sociocultural learning about democracy and the interpretation of these experiences by North Korean refugees compared to their past in North Korea are uncovered. A common space (e.g. ESL courses) for teaching refugees about democracy can serve as a valuable platform for non-traditional, adult refugee learners, regardless of their educational background, affordability or status. The study’s findings underscore the significance of providing refugees with opportunities for democratic education in a new cultural context, with potential implications for democratic citizenship education.

Severe Cognitive Impairment in Trauma-Affected Refugees-Exploring the Impact of Traumatic Brain Injury.

Background/Objectives: This study explores the relationship between cognitive performance measured by the Symbol Digit Modality Test (SDMT) and the severity of self-reported head injury, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), depression, pain, and psychosocial dysfunction in a population of trauma-affected refugees. Refugees, especially those who have been subjected to torture, often face various difficulties, such as PTSD, depression and somatic disturbances (e.g., pain), which can significantly impact their day-to-day functioning. Methods: Participants included 141 adult refugees (38% women) with a mean age of 45.4 years (SD = 9.4) and 9.7 years (SD = 4.9) of education who were referred for treatment of post-traumatic distress to DIGNITY, Danish Institute Against Torture. Participants completed standardized self-report measures of PTSD, anxiety, depression, pain, and health-related disability and measures of trauma history, physical injuries including head injury and loss of consciousness, and the SDMT, a quick standardized performance-based measure of cognitive impairment. Results: Eighty-eight percent of participants evidenced signs of substantial cognitive impairment as indexed by lower SDMT scores. Those with a self-reported history of TBI, marked by loss of consciousness, exhibited lower SDMT scores and higher health-related disabilities. Severity of PTSD, depression, anxiety, and pain were highly correlated with lower SDMT scores. TBI history was not significantly associated with the severity of PTSD, depression, anxiety, or pain, suggesting a complex interplay among these factors. Conclusions: Cognitive impairments are prevalent in trauma-affected refugees, interacting with symptoms of post-traumatic stress and pain, likely explaining the high disability levels in this population. Further research should employ a broader range of cognitive measures and detailed investigations of head injury/TBI experiences to investigate their impact on overall functioning, treatment response, and longer-term outcomes. This study adds to a small but growing body of studies documenting cognitive impairments in trauma-affected refugees, highlighting the importance of addressing cognitive impairments in treatment for trauma-affected refugees, particularly those with histories of torture and TBI. Clinicians working with trauma-affected refugees should consider the assessment of cognitive difficulties as part of comprehensive care planning.

The Acquisition of Greek as a Second/Foreign Language by the Imprisoned Adult Refugees and Migrants in Corfu: A Comprehensive Study on the Teaching Material Used During Their Formal Education

The Acquisition of Greek as a Second/Foreign Language by the Imprisoned Adult Refugees and Migrants in Corfu: A Comprehensive Study on the Teaching Material Used During Their Formal Education

Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 - October 2023.

From September 2022 an increase in Corynebacterium diphtheriae (C. diphtheriae)infections was reported in Europe. Our study focuses on 31 adolescent and young adult refugees with cutaneous C. diphtheriae infections detected in Germany. We examined treatment regimens and outcomes to provide targeted insights into the management of this infection. We distributed a standardized survey, focused on children and adolescents presenting to paediatric clinics through the German Paediatric Infectious Diseases Society (DGPI) and additional professional contacts in Germany. Data were extracted from routine medical documentation and reported anonymously. A total of 31 individuals with cutaneous C. diphtheriae infection were reported by 9 centres. Two of these showed diphtheria toxin (DT) related systemic symptoms and four exhibited systemic inflammation requiring complex management. The remaining 25 cases, with exclusively cutaneous manifestations, were afebrile. Treatment with topical antiseptics and systemic antibiotics, mainly aminopenicillin/beta-lactamase inhibitors (BLI) (35%) or clindamycin (25%), achieved eradication in all but two cases treated with aminopenicillin/BLI. Treatment duration varied between 5 and 17 days. In refugees presenting with chronic skin wounds, C. diphtheriae should be included into the differential diagnosis. Fever seems to be a valuable marker to differentiate severe cases with potentially DT-mediated sequelae from exclusively cutaneous diphtheria (CD). For afebrile CD, topical antiseptics and oral antibiotic therapy with clindamycin for 7 days, followed by clinical surveillance appears to be a safe treatment regimen. Patients with CD who present with fever or pharyngitis should be thoroughly investigated including blood and pharyngeal swab cultures.

Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review.

Refugees within the post-migration context experience higher rates of mental health symptoms due to a variety of pre- and post-migration factors. However, there is a lack of research in understanding best practices in culturally grounded interventions aimed at improving well-being outcomes. Recent research shows group interventions are a potential pathway to mental health treatment for refugees. This systematic review aimed to (1) assess best practices among group-based interventions within the refugee context, (2) provide literature-informed guidance on best practices within group-based interventions for this population, and (3) examine the impact of group-based interventions on the mental health outcomes of adult refugees in the post-migration context in high-income countries. A systematic literature search was conducted using Academic Search Complete, Social Work Abstracts, and PsycINFO. A total of 2,243 studies were identified, with 19 meeting the inclusion criteria to be from a peer-reviewed journal article; be published from 2003 to 2023; be written in English; have a study population of refugees in the post-resettlement context in a high-income country; include a group-based intervention model; and be quantitative or mixed methods. Results demonstrated that group-based interventions improve mental health symptoms, including post-traumatic stress disorder, depression, and anxiety. Studies varied on their use of culturally grounded mechanisms in developing and implementing interventions. Future research is needed to understand the longitudinal impacts of group-based interventions on mental health and better support current practices to facilitate access to intervention implementation.

The impact of age-related differences in emotion dysregulation on refugee mental health and social outcomes.

The refugee experience is typically characterized by exposure to numerous premigration traumatic events and postmigration stress in the resettlement environment. Refugees' experiences can lead to elevated rates of psychopathology, including posttraumatic stress disorder (PTSD) and depression. Emotion regulation is a key mechanism contributing to mental health outcomes among refugees. This study examined the impact of age on the association between emotion regulation and critical social outcomes relevant to refugee resettlement, such as social engagement and functional impairment. Participants were 1,081 Arabic-, Farsi-, Tamil- and English-speaking adult refugees. Premigration trauma exposure, postmigration stressors, PTSD symptoms, depressive symptoms, emotion regulation, social engagement, and functional impairment were measured. A series of hierarchical regression and Poisson regression analyses revealed emotion dysregulation as a significant predictor of functional impairment, β =.36, p <.001, and social engagement, Exp B = 0.99, p =.002. A significant interaction between age and emotion dysregulation was associated with both PTSD, β =.05, p =.048 and depressive symptoms, β =.06, p =.010, suggesting a stronger positive association between emotion dysregulation and both PTSD and depressive symptom severity for older individuals. Postmigration stressor exposure, emotion dysregulation, and older age are important factors that may negatively impact social engagement and functional impairment in the resettlement environment. Additionally, higher levels of trauma exposure may negatively impact social engagement. These findings have implications for public health and social services in the context of resettled refugee communities.

Refugee Housing Accessibility with a Strategic Digital City Project

Adequate housing is pivotal for the refugee’s well-being, demanding strategic urban management to facilitate their integration. The research objective is to analyze housing access for adult refugees within the context of a strategic digital city, focusing on adult refugees and city strategies as a subproject of the strategic digital city project. The research methodology adopted is a case study in Curitiba, the research employs both qualitative and quantitative techniques, guided by a research protocol. Results suggest that addressing housing access challenges entails more than mere provision; it involves safeguarding rights, stability, integration, and participation in public policies and municipal strategies within the strategic digital city framework and the right to the city. These findings underscore the necessity for support services and robust collaboration among diverse stakeholders and public policies to tackle the multifaceted refugee issue, thereby fostering their integration and well-being in the host society. The conclusion emphasizes prioritizing concepts such as privacy and dignity in housing, highlighting the urgent need for effective policies catering to refugees' diverse needs.