Post-migration Stressors Research Articles

The Association of Migration-Related Stress with Poor Mental Health Among Recently Resettled Afghan Refugees

BackgroundThe resettlement of Afghan refugees in Oklahoma City, OK, provides a critical context for examining the mental health challenges faced by this population due to post-migration stressors. MethodsThis study utilized online surveys to recently resettled Afghan refugees in Oklahoma City, with support provided by bilingual research assistants to accommodate low literacy rates. Surveys, initially in English, were professionally translated into Dari and Pashto and validated through back-translation. ResultsParticipants (N= 348) were majority of Pashtun ethnicity. High rates of mental health issues were evident, with 62.1% of participants screening positive for depression and 20.1% for probable GAD. Logistic regression analysis revealed that lower pre-migration socioeconomic status (SES) and high post-migration stressors such as discrimination and loss of homeland were significantly associated with increased mental health problems. Stress related to the worry for and loss of their homeland was a substantial predictor of high distress (AOR= 2.71, p <.001), anxiety (AOR= 1.99, p =.001) and depression (AOR= 2.65, p<.001). Experiences of discrimination post-resettlement was also associated with anxiety (AOR 4.92, p <.001). DiscussionThe findings highlight the profound impact of post-migration stressors on the mental health of Afghan refugees. This study underscores the need for targeted interventions to address the specific challenges faced by refugees, such as language barriers, employment, legal support, and anti-discrimination measures, to facilitate better integration and improve mental health outcomes. ConclusionEnhanced community integration programs and comprehensive support services are essential to mitigate the mental health challenges faced by Afghan refugees, suggesting a broader application for such approaches in similar resettlement contexts globally.

Depression Among Resettled Karen Refugees in the United States: An Exploratory Pilot Study

Due to prolonged ethnic and religious persecution, the Karen have endured numerous traumatic experiences including systematic violence and mistreatment, resulting in long-term psychological sequelae. This study examines the prevalence of depression among Karen refugees from Burma ( N = 37) using a culturally grounded mental health screening tool within a primary health care community clinic in the southern United States. A total of 48.60% met the clinical cutoff for depression. The researchers identified three themes: (a) manifestations of depression, (b) depression linked to post-migration stressors, and (c) importance of support and education about depression. Family service organizations and resettlement agencies can assist Karen refugees by connecting them with social and tangible support, as well as providing education about depression. Future research should include Karen refugees from various parts of the United States to improve generalizability.

Associations of stressful life events with stress symptoms and well-being of adolescent refugees: mediation by post-migration stressors and protective resources?

Objective This paper focuses on the relationship between stressful life events experienced by young refugees and their reports of psychological and somatic stress symptoms and well-being. It examines whether this relationship is mediated by personal and social resources and by acculturation hassles experienced in the host country. Methods Path analyses were calculated based on data from 147 adolescents aged 11 to 18 years from the Middle East after their flight to Germany to test the proposed mediation model. Results The number of experienced stressful life event types was directly linked to current psychological and somatic stress symptoms. The association with psychological stress symptoms was partially mediated by acculturation hassles experienced in the host culture. Well-being was not related to stressful life events but showed significant associations with available social resources. A closer inspection of the mediation by acculturation hassles showed that discrimination hassles and socio-cultural adaptation hassles are important mediators in the relationship between stressful life events and the included outcome variables. Conclusion The results indicate that stressful life events as well as resources and acculturation hassles should be considered in measures to improve the adjustment of young refugees.

Refugees' integration and emotional distress over the course of 9 months.

High prevalence rates of mental disorders are reported in refugees due to experiencing substantial pre-, peri-, and post-migration stress. While long-term studies indicated that emotional distress of refugees either stagnates or ameliorates over time, long-term research on refugees' integration and its' interaction with emotional distress is limited. The examined long-term predictors for refugees' emotional distress and integration in this study were, amongst others, severe physical abuse in childhood, residence status and length of stay. The sample included 46 refugees, 91.3% male, mean age 20.8 years. Trained psychologists screened for emotional distress with the use of the Refugee Health Screener in a semi-structured interview. Integration progress was screened using the Integration Index with the subdimensions psychological, economic, political, social, linguistic and navigational integration. Longitudinal differences for emotional distress and integration sub-dimensions were evaluated by sign tests and t-tests. The longitudinal course of integration was evaluated with a Mixed ANOVA. Further, two hierarchical regression analyses were performed to analyze longitudinal predictors of emotional distress and integration. Overall, emotional distress decreased, and integration increased over time. In particular, the sub-dimensions of social, economic, and linguistic integration increased significantly over time. Two regression analyses determined significant predictors of (a) emotional distresst1 (adjusted R2 = 0.46): psychotherapy (ß = 0.35, p = 0.020), emotional distresst0 (ß = 0.34, p = 0.031), and integrationt0 (ß = -0.29, p = 0.043), and one significant predictor of (b) integrationt1 (adjusted R2 = 0.70): integrationt0 (ß = 0.89, p < 0.001). This is the first study to longitudinally examine the Integration Index with all subdimensions. Over the course of 9 months refugees' overall integration, and the sub-dimensions of social, economic, and linguistic integration increased. Whilst the emotional distress of initially highly distressed refugees ameliorated over the course of nine months, their symptom severity remained clinically significant. Results emphasize the importance of early integration for the long-term development of mental health and integration in refugees. Refugees' emotional distress and integration are intertwined and need to be addressed promptly after refugees' entry into the host country.

The Socio-Ecological Factors Associated with Mental Health Problems and Resilience in Refugees: A Systematic Scoping Review.

Despite the immense challenges to mental health faced by refugees, research consistently finds that many nevertheless demonstrate remarkable resilience. However, a systematic account of the scientific literature on resilience among refugees is currently lacking. This paper aims to fill that gap by comprehensively reviewing research on protective and risk factors affecting refugees' resilience and mental health problems across four socio-ecological levels: individual, family, community, and society. We conducted a systematic search in the databases PsycINFO, Web of Science, and SocINDEX, as well as contacted topic experts to seek out unpublished manuscripts. This yielded 223 studies (171 quantitative, 52 qualitative), which were subjected to systematic content coding. We found consistent evidence for substantive risk factors, including traumatic experiences and gender at the individual level and postmigration stress and unemployment at the societal level. We found social support to be a clear protective factor at the family and community levels. We discuss these findings in the context of policy and intervention programs and make recommendations at different socio-ecological levels for supporting refugees' resilience.

Is cultural appropriateness culturally specific? Intersectional insights from a community-based participatory mental health intervention study conducted with diverse cultural groups.

Growing evidence supports the importance of culturally appropriate mental health interventions, yet it is not always feasible to develop culturally grounded interventions or adapt existing interventions for each cultural group. In addition, these approaches do not recognize the multiple intersecting aspects of culture and identity that individuals, families, and communities possess. Thus, an essential question is whether culturally appropriate mental health interventions have to be culturally specific. We address this question by examining processes of the Refugee Well-being Project (RWP), a community-based mental health intervention for refugees resettled in the United States, which included people from multiple cultural groups (Afghanistan, Great Lakes region of Africa, Iraq, and Syria) and was grounded in common experiences of forcibly displaced people from marginalized backgrounds. RWP incorporates a practice-based concept of culture, an intersectional view of identity, and a multilevel approach to address postmigration stressors. Semistructured qualitative interviews were conducted with 290 participants at preintervention, followed by interviews at three timepoints with a purposively selected subsample (n = 66). Additional interviews (n = 101) were conducted with refugee and student partners. Four themes demonstrated key principles for creating culturally appropriate interventions with diverse groups: (a) recognize cultural complexity in practice; (b) focus on how racism and discrimination are experienced in everyday life; (c) de-center dominant US culture; and (d) create an egalitarian, inclusive space to put principles into action. We conclude that mental health interventions implemented with multiple, diverse groups can be culturally appropriate and effective without being culturally specific.

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.

Psycho-social Stressors Experienced by Young war Refugees in Developed Countries: A Scoping Review.

Refugees escaping political unrest and war are an especially vulnerable group. Arrival in high-income countries (HICs) is associated with a 'new type of war', as war refugees experience elevated rates of psycho-social and daily stressors. The purpose of this scoping review is to examine literature on psycho-social stressors amongst young war refugees in HICs and impact of stressors on intergenerational transmission of trauma within parent-child dyads. The secondary objectives are to identify the pre-migration versus post-migration stressors and provide a basis to inform future research projects that aim to lessen the burden of stress and inform evidence-based improvements in this population. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension (PRISMA-ScR) guided the reporting of this review that was performed using a prescribed scoping review method. Extracted from five databases, 23 manuscripts published in 2010 or later met the inclusion criteria. Three themes emerged: pre-migration stressors, migration journey stressors and uncertainty, and post-migration stressors. While post-migration environments can mitigate the health and well-being of war refugees, socio-cultural barriers that refugees often experience at the host country prevent or worsen their psycho-social recovery. To assist the success of war refugees in HICs, therapeutic interventions must follow an intersectional approach and there needs to be a wider application of trauma informed models of care. Findings of this review may help inform future intervention studies aiming to improve the psycho-social health of this population.

Impact of immigrant-related stress on mental health among Mexican-origin families: Implications for a shifting and complex immigration climate.

Latinx immigrant families may face stressful experiences premigration, en route to the host country, and once they arrive in the host country (postmigration). The present study examines the impact of premigration stress and postmigration stress (together defined as immigrant-related stress) on the mental health of Mexican-origin parents and their children using both cross-sectional and longitudinal methodology. Data collection across four timepoints occurred from 2013 to 2018. At Time 1, 104 families were enrolled in the study and met the following criteria: (1) At least one Mexican-origin immigrant parent; (2) One child between the ages of 6-10 years; and (3) Family income at or below 150% of the federal poverty line. Hierarchical multiple regression and hierarchical linear modeling (HLM) were used to analyze the cross-sectional and longitudinal data, respectively. HLM models revealed that higher postmigration stress over time (2013-2018) was related to higher mental health problems among parents and children. Higher premigration stress was associated with higher parent-reported child mental health problems, while postmigration stress was associated with higher parent mental health problems. Specifically, discrimination emerged as a salient factor of poor parent mental health. Immigrant-related stress was related to higher total parent and child mental health problems. This study demonstrates the strong impact of postmigration stress on mental health over the span of several years and during a time of heightened stress for many Mexican immigrant communities. The results inform the need for family-wide interventions that address the complexities of immigrant-related stress as well as comprehensive policy changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

THE MODERATING EFFECT OF RESILIENCE AND SOCIAL SUPPORT ON THE RELATIONSHIP BETWEEN POST-MIGRATION STRESS AND PSYCHOLOGICAL WELL-BEING AMONG UKRAINIAN REFUGEES IN ROMANIA

This study explores the connection between Post-migration Stress and Psychological Well-Being among Ukrainian refugees in Romania, with a focus on the moderating roles of Resilience and Social Support. Using scales for stress, well-being, resilience, and social support, data was collected from Ukrainian refugees (N = 84), mostly women aged 18 to 68. The analysis, conducted before significant changes in government support, revealed a negative correlation between post-migration stress and psychological well-being. Both resilience and social support showed moderating effects in the relationship between post-migration stress and environmental mastery (a facet of psychological well-being construct). The study also examined demographic variations within the refugee community in relation to stress, well-being, social support, and resilience, highlighting potential impacts of subsequent changes in refugees’ circumstances on research outcomes.

Frequency Of Psychological Stress And Barriers To Accessing Mental Health Services For Leipzig Citizens Of Afghan And Iraqi Citizenship

Aim of the study was to report evidence on mental health needs and access to mental health and psychosocial support for Leipzig citizens of Afghan and Iraqi citizenship in the presence of mental stress and, above all, to identify barriers to access to care. All adults in Leipzig with Iraqi or Afghan citizenship, who were not born in Germany were contacted. Various instruments (PHQ-9, GAD-7, SSS-8, PCL-5/LEC-5) to screen for symptoms of depression, anxiety, somatization disorder or PTSD and one item for self-reported emotional problems were used. Questions on health care utilization and barriers to care followed. 51.4% screened positive in at least one of the tests and self-reported emotional problems. 38.2% of those in need of treatment did not seek help. Frequent reasons for not seeking help were, that the people wanted to solve the problem on their own or that the problem did not bother them very much. A lack of trust and understanding regarding the healthcare system and fear of discrimination and stigmatisation were also perceived as additional barriers to care. The study revealed a high percentage of mental health needs. This could be due to the high number of traumatic events and post-migration stressors. A longer period of residence in Germany and easier access to the public health system through the health insurance card could have encouraged the health care utilization. The treatment gap was caused by barriers to care such as a lack of knowledge or trust of the German health care system and fear of stigmatisation and discrimination. More information about access to care structures and more low-threshold services need to be implemented. These should be organised on an interdisciplinary basis and focus on culturally and racially sensitive care. Mental health awareness should be strengthened and under no circumstances should the access to care be restricted any further.

Increasing perceived health and mental health literacy among separated refugee Ukrainian families with urgent needs occasioned by invasion-a group intervention study with participatory methodology in Sweden.

With the increasing numbers of refugees from Ukraine affected by the ongoing war, there is a high risk of trauma-related stress due to low local health and mental health literacy care. Perceived good health is a human right. Earlier studies show that intervention for refugees can reduce and prevent post-migration stress and anxiety. The present explorative study aimed to investigate the feasibility and effectiveness of a short, trauma-focused group intervention (in Swedish "hälsoskola") for Ukrainian-speaking refugees (EU's mass refugee directive). This intervention was part of an ESF project aiming to get the subjects closer to the labor market in Västernorrland County, Sweden. A mixed-methods design, a participatory methodology, and an evaluation were used. Data were obtained with a short questionnaire in Ukrainian. It included a visual analogue health-rating scale, an observation, and an oral evaluation in groups. For practical and ethical reasons, there was no control group. Each group met five times for 2 h, a total of 10 h excluding pre- and post-assessment. There were eight sets of five group sessions per set, a total of 40 sessions. Brief initial and concluding breathing exercises sought to reduce stress among the participants. Baseline data were obtained from 99 participants, mostly females. Data gathered directly after the group intervention from 57 participants who had filled in both the pre- and post-questionnaires showed that (1) perceived anxiety/stress was significantly reduced (chi-2 25,53, df = 4, p < 001). (2) The participants showed significantly better perceived health as assessed on a visual analogue scale (average change from 63.16 to 71.18, p < 0.001). This result was supported by the participants' questions, which were qualitatively evaluated using thematic content analysis. Five general themes stemmed from questions raised in dialogue with the participants plus observation with the respective local expert. The participants received answers to their questions, and their perceived negative attitudes to authorities changed to more positive ones. By dialogue between the participants' needs of knowledge and direct answers by the local expert, respectively, was feasible and effective as they perceived trust and health and mental health literacy increased. Implications for primary prevention are discussed.

The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences.

Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.

Social Determinants and Mental Health in Newly Arrived Young Migrants in Spain

IntroductionResearch has shown that factors related with the migratory process (such as travelling alone, living away from family, and discrimination after arrival) considerably increase the risk of mental health problems in young migrants. Moreover, they are among the most vulnerable migration groups with a high risk of social exclusion.ObjectivesTo identify coping strategies and behavioural changes used to deal with perceived discrimination and its impact on the emotional well-being and mental health of newly arrived young migrants in Spain.MethodsA subsample of 15 audio-recorded in-depth qualitative interviews were analysed from the national action-research Migrasalud project (II IN 190517 EN 162 FA 01). The interviews were transcribed, translated from Arabic to Spanish, and analysed through content analysis.ResultsMost participants were males (93.3%; n=14), ranging from 18 to 20 years, and from Morocco (93.3%; n=14). All participants were from foster care placements in Barcelona and arrived to Spain as minors. Newly arrived young migrants reported that they perceived themselves as being healthy before the migratory process. Adverse experiences during the journey and discrimination after arrival impacted their well-being and mental health. Specifically, they reported perceived discrimination in their daily life due to culture, language, or origin. This negatively impacted their well-being and mental health, increasing their emotional distress response and ‘undervalued or inferior’ and ‘vulnerable’ feelings about themselves. Concerning coping with discrimination, they reported using internalised coping strategies such as ‘ignoring’ or ‘not responding’ for fear of having their legal documents revoked or not obtaining them. Their behavioural changes often occurred when they perceived unfair treatment or prejudice towards their migrant status or their socioeconomics, culture or religion. These changes were motivated by being more accepted by the local community by ‘westernisation or cultural assimilation’ and by ‘creating a good image’ of oneself and its culture.ConclusionsFindings establish that the cumulative experience of post-migration stressors (such as discrimination) negatively impacts their mental health and well-being in the long term. This suggests the need for specific policies and services to address this population’s effects of post-migration risk factors. Further research is needed to explore the causes and effects of perceived discrimination on mental health more closely and to develop more targeted and effective interventions.Disclosure of InterestNone Declared

Multiple trauma exposure and psychopathology in Syrian refugees living in Turkey: A latent class analysis

BackgroundAfter the Syrian civil war, millions of Syrian refugees migrated to neighboring countries, with the majority settling in Turkey. The prevalence of mental disorders is notably higher among refugee populations. However, prior research on Syrian refugees have mostly used variable-centred approaches which have known limitations. Thus, the present study sought to examine the occurrence and co-occurrence of traumatic experiences among Syrian refugees living in Turkey using latent class analysis (LCA). Additionally, this study aimed to identify the associations between latent class membership and trauma-related psychopathology. MethodsParticipants included 593 Syrian refugees living in Turkey. LCA was used to identify latent classes of trauma exposure. Demographic predictors of the latent classes were examined and associations with PTSD, CPTSD, depression and anxiety were also explored. ResultsThree latent classes were identified based on trauma exposure; a “multiple traumas” class, “war and human suffering” class, and “low exposure, combat-exposed” class. Odds of PTSD, CPTSD, depression, or anxiety diagnosis did not differ significantly between classes, with the exception of the “multiple traumas” class who were more likely to meet the criteria for anxiety diagnosis compared to the “low exposure” class. LimitationsHistoric psychiatric symptoms or post-migration stressors could not be accounted for in this study, which may explain the lack of significant differences in most mental health outcomes by trauma exposure class. DiscussionThe latent classes identified in this study correspond with previous research regarding trauma in Syrian refugees. However, this study largely failed to find significant differences in mental health diagnoses between classes. Future research should consider the effect of post-migration stressors in refugee populations, which may play a crucial role in mental health outcomes.

Post-migration stress, quality of life, and mental health among accompanied and unaccompanied young refugees in Germany: How do adolescents feel after fleeing?

This study examines the impact of post-migration living difficulties (PMLDs) and quality of life (QoL) on the mental health of 55 young refugees who arrived in Germany either accompanied or unaccompanied. The results reveal that nearly 62% of the participants exhibited clinically significant symptoms of depression or post-traumatic stress disorder. Regression analyses indicate that psychopathology was associated with being unaccompanied and experiencing lower QoL, while QoL was associated with higher economic status and lower PMLDs. Mediation analysis further demonstrates that higher economic status and reduced PMLDs were associated with higher QoL, which, in turn, correlated with lower levels of psychopathology. These findings emphasise the importance of considering PMLDs and QoL, as well as economic status and being accompanied/unaccompanied, in the assessment and treatment of young refugees in the host country.

Perspectives Matter: Insecure Residency Status Accounts for Aggressive Emotions in Adolescent Refugees

Unaccompanied refugees are a high-risk group for trauma-induced psychiatric disorders. Besides traumatic experiences pre- and during migration, post-migration stressors such as insecure residency status affect refugees’ mental health and foster aggressive emotions. High levels of psychological distress and psychopathology distort time perspectives. Consequently, an insecure residency status linked to distress may influence a refugee’s time perspective. This study investigated psychological distress, PTSD symptoms, aggressive emotions, and time perspectives in 33 unaccompanied adolescent refugees with and without secure residency status in Germany. Refugees with precarious residency status showed higher levels of overall distress and aggression than individuals with secure residency status. Both groups revealed a distorted time perspective profile, but individuals with a residence permit showed a stronger orientation toward the present hedonistic perspective than those without a permit. Higher aggressive emotions were related to insecure status, higher levels of psychological distress, more pronounced PTSD symptoms, and lower orientation to future time perspective. Distorted time perspectives among refugees may be caused by traumatic experiences and having been uprooted, independently of their residency status in the host country. A higher future orientation may buffer the association between distorted time perspectives and aggressive emotions in the highly stressed group of unaccompanied adolescent refugees.

Post-migration stressors, mental health and well-being in resettled refugees from Syria: Do individuals’ coping strategies matter?

BackgroundThe evidence is mixed as to whether individuals’ coping strategies may mitigate the adverse mental health effects of post-displacement stressors in refugee populations, with some indications that the buffering effects of coping strategies are context dependent. The present study examined if problem-solving and acceptance coping strategies were effect modifiers between post-migration stressors and mental health in adult refugees from Syria resettled in Sweden.MethodsStudy aims were investigated using cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria granted permanent residency in Sweden between 2011 and 2013 (Nsample = 4000, nrespondents = 1215, response rate 30.4%). Post-migration stressors examined included: financial strain, social strain, host-country competency strain and discrimination. Two mental health outcomes were used: anxiety/depression, measured with the Hopkins Symptom Checklist-25; and well-being, measured with the WHO-5 Well-being Index. Both outcomes were modelled continuously. Coping strategies were measured using the BRIEF Cope scale. Interactions between coping strategies and post-migration stressors were tested in fully adjusted linear regression models using Wald test for interaction, corrected for multiple testing using the Benjamini–Hochberg procedure.ResultsBoth problem-solving and acceptance coping strategies buffered the adverse association between financial strain and symptoms of anxiety/depression, and problem-solving coping strategies buffered the adverse association between host-country competency strain and anxiety/depression.ConclusionsThe study suggests that individuals’ coping strategies may to some degree buffer the adverse mental health effects of financial strain and host-country competency strain experienced by refugees in the resettlement phase. Although this pattern was only found in regard to anxiety/depression and not subjective well-being, the findings show that individual-level coping skills among refugees may contribute to adaptation in the face of post-settlement adversities. Notwithstanding the importance of attending to refugees’ psychosocial conditions, refugees residing in refugee camps and newly resettled refugees might benefit from interventions aiming at enhancing individual coping resources and skills. The potential effect of increased controllability and decreased conflict-proximity also warrants further exploration in future studies.

Migrants’ mental health recovery in Italian reception facilities

BackgroundForced migration leaves deep marks on the psychological well-being of migrants, with post-traumatic stress disorder (PTSD) and other psychological conditions being prevalent among them. While research has clarified the extent to which pre-migration trauma is a predictor of mental health outcomes, the role of post-migration stressors in the settlement environment are yet to be fully characterized.MethodsWe monitored mental health of a cohort of 100 asylum-seekers during their 14-day COVID-19-related quarantine in reception facilities in Rome, Italy, through the administration of six questionnaires (a demographic survey, the WHO-5 well-being index, the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), the Harvard Trauma Questionnaire, the Trauma and Loss Spectrum—Self Report, and the LiMEs—Italian version). Through the combination of statistical analysis and supervised learning, we studied the impact of the first contact with the reception system on asylum-seekers’ mental health and sought for possible risk and shielding factors for PTSD.ResultsWe find that sheltering in refugee centers has a positive impact on migrants’ mental health; asylum-seekers with PTSD reported more traumatic events and personality characteristics related to loss and trauma; life events are predictors of PTSD in asylum-seekers.ConclusionsWe identify past traumatic experiences as predictors of PTSD, and establish the positive role the immediate post-migration environment can play on migrants’ psychological well-being. We recommend for host countries to implement reception models that provide effective protection and integration of asylum-seekers, similar to those in the Italian system.

A machine learning approach using migration-related cultural stress to classify depression and post-traumatic stress disorder among hurricane survivors

BackgroundData science approaches have increasingly been used in behavioral health research and may be useful for addressing social factors contributing to disparities in health status. This study evaluated the importance of cultural stress-related factors in classifying depression and post-traumatic stress disorder (PTSD) among adult survivors (N = 319) of Hurricane Maria who migrated from Puerto Rico to the United States mainland. MethodsWe evaluated the performance of random forests (RF) and logistic regression (LR) for classifying PTSD and depression. Models included demographic, hurricane exposure, and migration-related cultural stress variables. We inspected area under the receiver operating characteristic curve (AUC), accuracy, balanced accuracy, F1 score, precision, recall, and specificity. ResultsNegative context of reception and language-related stressors were moderately important for accurately classifying depression and PTSD. For classifying depression, RF showed higher accuracy, balanced accuracy, specificity, precision, and F1. For classifying PTSD, RF showed higher accuracy, specificity, precision, and F1. LimitationsA more thorough classification model would also include biomarkers (e.g., of allostatic load), family, community, or neighborhood-level attributes. Findings may not generalize to other groups who have experienced crisis-related migration. ConclusionsFindings underscore the importance of culturally and linguistically appropriate and trauma-informed clinical services for recent migrants. Use of assessments to identify pre-migration and post-migration stressors could inform clinical practice with migrants presenting with behavioral health-related difficulties.