Health-related quality of life in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden: a nation-wide, cross-sectional study

Quality of life in unaccompanied young refugees: the role of traumatic events, post-migration stressors and mental distress

BACKGROUND

Unaccompanied young refugees (UYRs) are exposed to numerous potentially traumatizing events and post-migration stressors before, during, and after migration. These adverse experiences may affect their mental health and their quality of life. Consequently, this study aimed to focus on the quality of life of UYRs and identify factors that may influence it.

METHODS

Potentially traumatic events (PTEs) and posttraumatic stress symptoms (CATS-2), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), as well as post-migration stressors (DSSYR) and quality of life (WHOQOL-BREF) were assessed in N = 158 UYRs (MAge = 16.92, SDAge = 1.41, 84.2% male) residing in different child welfare facilities in Germany. Serial mediation models were used to examine the influence of the above-mentioned factors on quality of life.

RESULTS

UYRs reported a mean of 6.18 (SD = 3.27) PTEs and 9.72 (SD = 4.49) post-migration stressors. The average quality of life ranged between M = 57.72 (SD = 16.46) for environmental quality of life to M = 66.39 (SD = 20.71) for social quality of life. PTEs significantly reduced the reported physical (b = -1.78, p <.001), psychological (b = -1.15, p =.025), and social quality of life (b = -1.98, p <.001) of UYRs. However, these direct effects were mediated by post-migration stressors alone and in series with mental distress.

CONCLUSIONS

The quality of life of UYRs was not only associated with traumatic experiences but also with post-migration stressors and mental distress. Quality of life captures additional aspects of well-being and therefore, psychosocial care should not only address mental distress but also consider quality of life to achieve a sustainable improvement in the well-being of UYRs. Changes at the political-structural level, aiming to reduce post-migration stressors, could potentially improve the quality of life of UYRs.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00017453. Registered on December 11, 2019.

'Sweden has changed me': a qualitative study exploring the sexual health needs and associated mental health aspects of young male former unaccompanied minors, asylum seekers and refugees in Region Stockholm, Sweden

OBJECTIVES

Sexual health needs of young refugees and asylum-seeking men are seldom explored or addressed, adversely affecting their mental and physical well-being. By interviewing young male former unaccompanied minors, refugees and asylum seekers in Stockholm, Sweden, this study aimed to get a deeper understanding of what they needed to achieve a positive and respectful approach to sexuality, romantic and consensual relationships. Additionally, we explored how their sexual health needs were related to their mental health, as well as the factors influencing both.

DESIGN

An exploratory qualitative study using semi-structured interviews was employed. Theoretical sampling was used for participant selection. Analysis of the data was performed using constructivist grounded theory.

SETTING

The study took place in Stockholm, Sweden.

PARTICIPANTS

A total of 32 young male (aged 16-28) former unaccompanied minors, asylum seekers and refugees from Afghanistan, Eritrea and Syria were interviewed.

RESULTS

Our analysis showed that our participants' sexual and mental health needs followed a process of individual change. One core category described the different stages of the process: 'On my way, but not there yet'. It contains four subcategories: 'being on the move: the migration journey'; 'newly arrived: contrasting old and new values and learning new concepts'; 'navigating relationships, love and sex'; and 'the respectful man'. We identified six key factors that influenced their sexual and mental health needs: attending school/receiving accurate sexual information, support to adapt, experiencing enjoyable relationships, restrictive parental values, exposure to stigma/discrimination and the negative image of young male refugees.

CONCLUSIONS

This study highlighted that the sexual health needs and related mental health aspects of young former unaccompanied minors, asylum seekers and refugees change over time and are influenced by contextual factors. Educational interventions aiming to improve the well-being of this population must address both sexual and mental health aspects, including issues related to gender norms, relationships, sex and consent.

Suicide among post-Arabellion refugees in Germany

BACKGROUND

Although immigrants are considered to be vulnerable to mental illness, there is limited knowledge regarding their suicide mortality.

AIMS

To investigate standardised mortality ratios (SMR) for suicide among the largest immigrant populations in Germany before and after the refugee movement of 2015.

METHOD

Data on immigrants and the general population in Germany between 2000 and 2020 were provided by the scientific section of the Federal Statistical Office. SMR with 95% confidence intervals were calculated by indirect standardisation for gender, age and calendar year for the pre-2015 and post-2015 time interval, first for all the immigrant populations studied and second for the Syrian, Afghan and Iraqi populations separately.

RESULTS

Immigrants from the countries studied showed a lower suicide risk compared with the German reference population (SMR = 0.38, 95% CI = 0.35-0.41). No differences in SMR were found between pre- and post-2015 time intervals, in either the aggregate data for all populations or the data for Syrian, Afghan and Iraqi populations. Post-2015, Afghan immigrants (SMR = 0.68, 95% CI = 0.54-0.83) showed a higher SMR than Syrians (SMR = 0.30, 95% CI = 0.25-0.36) or Iraqis (SMR = 0.37, 95% CI = 0.26-0.48).

CONCLUSIONS

Despite the many and varied stresses associated with flight, comparison of the pre- and post-2015 time intervals showed that the suicide risk of the populations studied did not change and was considerably lower than that of the German reference population. We attribute this to lower suicide rates in the countries of origin but also to flight-related selection processes that favour more resilient individuals.

Female education ban by the Taliban: A descriptive survey study on suicidal ideation, mental health, and health-related quality of life among girls in Afghanistan

BACKGROUND

Following the Taliban's resurgence, Afghan girls were probited from attending school and university, likely causing adverse psychological effects. Therefore, the present study investigated depression, suicidal ideation, and quality of life (QoL) among Afghan girls banned from education by the Taliban.

METHODS

A survey study assessed depression, suicidal ideation, and QoL among 426 females prohibited from attending secondary schools, high schools, and universities by the Taliban. The study used the CES-D 20 Scale to assess depression, and the WHOQOL-Bref Questionnaire to assess QoL. Associations between variables were tested with chi-square tests, and predictors of QoL were analyzed through multivariate regression analysis.

RESULTS

Among the 426 participants, 87.6% exhibited depression symptoms and 49.8% reported suicidal thoughts. Significant predictors of overall QoL included monthly family income (B = 0.147, P = 0.001), recent others' behavior toward participants (B = -0.247, P < 0.001), physical illness (B = 0.110, P = 0.011), experiencing a recent traumatic event (B = 0.108, P = 0.015), depression (B = -0.159, P < 0.001) and suicidal ideation (B = -0.187, P < 0.001).

CONCLUSIONS

In Taliban-ruled Afghanistan, the results indicated that female students who have been prohibited from studying in classes have a high prevalence of depression and suicidal ideation. Having depression and suicidal ideation significantly predicted decreased quality of life among female students.

A systematic review of studies on resilience and risk and protective factors for health among refugee children in Nordic countries

The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0-18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied  risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.

Syrian Refugee Youth Resettled in Norway: Mechanisms of Resilience Influencing Health-Related Quality of Life and Mental Distress

Background: The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms to inform future interventions and policy. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect.

Methods: This was a cross-sectional study of Syrian youth recently resettled in Norway, aged 13–24 years. Regression and moderation analyses were used to explore different interactions, including moderated mediation using the PROCESS macro for SPSS.

Result: A direct main effect of promotive resilience was found for health-related quality of life (HRQoL) and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of protective resilience were found. Post-migration stressors mediated the effects of potentially traumatic events (PTE) from war and flight, and this indirect effect was present at all levels of resilience.

Conclusion: Despite high risk exposure and mental distress, resilience was also high. Broad resilience interventions targeting multiple factors would likely benefit the group, but these should include both individual assets and building supportive environments. Additionally, reducing current stress and providing treatment for those in need could enable recovery and increase the efficacy of resilience factors already present.