The mental health status of asylum seekers in middle- to high-income countries: a synthesis of current global evidence

The indirect role of perceived survival expectations in the association between perceived hope and suicidal thoughts among palestinians amid war in Gaza

Understanding how hope can be protective against suicide may improve prevention efficiency by helping identify and target those most at risk for suicide, and develop individualized treatment strategies. However, no studies have yet focused on the processes underlying the relationship between hope and suicidality in war-affected populations. The objective of this study was to explore the direct and indirect effects of hope on suicidal ideation through perceived survival expectations in Palestinian adults who currently live in Gaza in the midst of war. This is a cross-sectional study that has adopted the snowball sampling method and used an Internet-based survey that was distributed during the month of September 2024. The target population consisted of 534 adult Gazan people from the general population who were aged over 18 years and were living in Gaza Strip at the time of data collection. 44.6% of participants had suicidal ideation. A total of 43%, 44% and 45% of participants perceived < 50% chances of living for the next year, the next 5 years, and the next 10 years, respectively. After adjusting for covariates (age, education status, and living arrangements), perceived survival expectations at 5 years (indirect effect: Beta = -0.004; Boot SE = 0.002; Boot CI -0.01; -0.001) and 10 years (indirect effect: Beta = -0.01; Boot SE = 0.004; Boot CI -0.02; -0.003) mediated the association between hope and suicidal ideation. Higher hope was significantly associated with higher perceived survival expectations at 5 years, and directly with lower suicidal ideation. Finally, higher perceived survival expectations at 5 and 10 years were significantly associated with lower suicidal ideation. Our findings contend that hope might confer protection against suicide through the indirect effect of perceived survival expectations in individuals living in a constantly life-threatened state. Future experimental research is warranted to test whether intervening on low perceived survival expectations can be successful in mitigating related psychopathological outcomes, including suicidal ideation.

(Complex) PTSD in Ukrainian refugees: Prevalence and association with acts of war in the Danish refugee cohort (DARECO)

BACKGROUND

The Russian invasion of Ukraine has driven millions of Ukrainians away from their homes. Among these, the majority have likely experienced war-related potentially traumatic events, and some will experience symptoms of posttraumatic stress disorder (PTSD). The aims of the study are to estimate the prevalence of PTSD and Complex PTSD (CPTSD) in displaced Ukrainians and examine associations between war- and other potentially traumatic exposures and (C)PTSD.

METHODS

Questionnaires were distributed to all registered adult Ukrainians (18+) who arrived in Denmark between February 24th 2022 and February 15th 2023 (N = 18,389). We estimate the prevalence of war exposures, other potentially traumatic exposures, and (C)PTSD. In logistic regression analyses, we test if exposure to war and other potentially traumatic events are associated with PTSD and CPTSD.

RESULTS

The final sample size was 6993 (38.0 %). Responders were more likely to be female and younger than non-responders. Prevalence of PTSD and CPTSD was 15.9 % and 13.5 %, respectively. Female gender, high education, and loss of a relative due to the war were associated with (C)PTSD. Direct and indirect exposure to war and combat was related to PTSD but not CPTSD, while exposure to war prior to the 2022 invasion was related to CPTSD but not PTSD.

LIMITATIONS

The study is cross-sectional and based on self-report.

CONCLUSION

Close to one third of the sample fulfill the criteria of PTSD or CPTSD. War exposures are differentially related to PTSD and CPTSD. The findings illustrate that trauma-related psychopathology is a pertinent problem in displaced Ukrainians.

Prevalence of mental disorders and related risk factors in refugees and asylum seekers in Campania

Introduction

In recent years, the increasing presence of refugees and asylum seekers displaced from their country of origin, determined significant social, economic, humanitarian and public health implications in host countries, including Italy. These populations are exposed to several potential stressful experiences which make them vulnerable to psychological distress. In fact, the majority of studies addressing the topic found a higher prevalence of mental disorders, especially post-traumatic stress disorder and major depressive disorder, in refugees and asylum seekers with respect to the general population. However, heterogeneous prevalence rates have been reported among studies, due to methodological factor as well as to the impact of a variety of risk factors related to stressful experiences lived in the country of origin, during the migration journey and in the host country.

Objectives

The aim of the present study was to assess the prevalence of the main psychiatric diagnoses in a large group of adult refugees and asylum seekers (N=303) in the reception centers of two provinces of the Campania region, as well as to investigate the impact of potential risk factors on the occurrence of psychiatric disorders.

Methods

The diagnosis of psychiatric disorders and the identification of subjects at high risk to develop psychosis were carried out by means of structured diagnostic interviews. The following variables were explored as potential risk/protective factors to the occurrence of psychiatric disorders: socio-demographic variables, migration status (refugees/asylum seekers) and characteristics of the reception center,assessed by means of an ad hoc questionnaire; cognitive indices assessed by using standardized neuropsychological tests; traumatic experiences and level of political terror in the country of origin, assessed by means of reliable and valid self-report questionnaires.

Results

At least one mental disorder was found in 29.7% of the sample. Most prevalent diagnoses were depressive disorders, anxiety disorders and PTSD. Women showed, with respect to men, a higher prevalence of anxiety disorders, higher trauma levels, and came from more at-risk countries. Higher trauma levels, better cognitive abilities and unemployment and refugee status were associated to the presence of a current psychiatric disorder in the whole sample.

Conclusions

Our findings showed a higher prevalence of depressive disorders and PTSD in the sample of refugees and asylum seekers with respect to the general population and highlighted the role of potential risk factors whose identification may guide the implementation of preventive strategies and early treatments in these people.

The impact of temporary residence permit on symptom severity and treatment outcome among refugees with PTSD

Despite an increased focus on the impact of post-migratory factors on the health of trauma-affected refugees, research on the influence of residence permit is limited. This influence may manifest on the outcome of psychiatric treatment. Accordingly, the aim of this study was to examine the role of temporary residence permit on symptom severity and treatment outcome among trauma-affected refugees in PTSD treatment. The sample consisted of 897 patients, who were allocated into three groups based on their residence permit: temporary residence permit, permanent residence permit, and Danish citizenship. The outcome measures were symptoms of PTSD (Harvard Trauma Questionnaire), depression and anxiety (Hopkins Symptom Checklist-25 and Hamilton Depression and Anxiety Rating Scales), quality of life (WHO-5 Well-being Index), and functioning (The Sheehan Disability Scale), evaluated before and after psychiatric treatment. Temporary residents tended to have less severe symptoms prior to treatment. Overall, no significant differences were observed between the three groups on treatment outcome. However, Danish citizens had a poorer treatment outcome on Hamilton Depression Scale compared with temporary residents. This study is one of the first to investigate treatment implications of residence permit in a clinical setting. The interactions between mental health and individual post-migratory factors are complex. Further research is still needed to understand how residence status affects mental health and treatment outcomes for refugees.

Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany

Objective: Asylum seekers often experience ethnic discrimination on the flight or in the host country, which may be associated with chronic stress and impaired mental health. Dysregulation of the hypothalamic-pituitary-adrenal axis, a known physiological correlate of chronic stress, can be assessed using hair cortisol concentrations (HCC). The present study aimed to investigate how different forms of perceived ethnic discrimination are associated with mental health outcomes, HCC, and protective factors in asylum seekers living in Germany.Methods: Somatic symptoms (PHQ-15), symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), different forms of ethnic discrimination (active harm, passive harm, institutional discrimination), and protective factors (in-group identification, social support) were assessed cross-sectionally in 144 asylum seekers (average age 32 years, average duration of stay in Germany nine months; 67% men). HCC were obtained from 68 participants. Multiple regression analyses were conducted and social support and in-group identification were tested as potential moderators.Results: Active ethnic discrimination was positively associated with all assessed mental health outcomes, and all forms of ethnic discrimination positively correlated with depressive symptoms. Ethnic discrimination was not associated with HCC. When controlling for other possible influences (e.g. age, gender, traumatic events), passive harm was negatively associated with depressive symptoms (β = -0.17, p = .033) and active harm was positively associated (β = 0.28, p = .022) with somatic symptoms. After the inclusion of the protective factors, the associations were no longer significant. Lower social support was associated with higher depressive symptoms (β = -0.35, p < .001), posttraumatic stress (β = -0.77, p < .001), and somatic symptoms (β = -0.32, p < .001), but did not moderate the associations between ethnic discrimination and the mental health outcomes.Conclusions: Perceived ethnic discrimination may negatively influence asylum seekers' mental health but does not seem to be associated with HCC. Social support was associated with psychological symptom severity, but did not buffer the effects of ethnic discrimination on mental health.

The mental health of migrants living in limbo: A mixed-methods systematic review with meta-analysis

The number of forcibly displaced people has more than doubled over the past decade. Many people fleeing are left in limbo without a secure pathway to citizenship or residency. This mixed-methods systematic review reports the prevalence of mental disorders in migrants living in limbo, the association between limbo and mental illness, and the experiences of these migrants in high income countries. We searched electronic databases for quantitative and qualitative studies published after January 1, 2010, on mental illness in precarious migrants living in HICs and performed a meta-analysis of prevalence rates. Fifty-eight articles met inclusion criteria. The meta-analysis yielded prevalence rates of 43.0 % for anxiety disorders (95 % CI 29.0-57.0), 49.5 % for depression (40.9-58.0) and 40.8 % for posttraumatic stress disorder (30.7-50.9). Having an insecure status was associated with higher rates of mental illness in most studies comparing migrants in limbo to those with secure status. Six themes emerged from the qualitative synthesis: the threat of deportation, uncertainty, social exclusion, stigmatization, social connection and religion. Clinicians should take an ecosocial approach to care that attends to stressors and symptoms. Furthermore, policymakers can mitigate the development of mental disorders among migrants by adopting policies that ensure rapid pathways to protected status.

(Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden

BACKGROUND

The COVID-19 pandemic has made visible the scale of health disparities in society, highlighting how the distribution of infection and deaths differs between population subgroups within countries. Asylum seekers represent a potentially vulnerable group; early in the pandemic, concerns were raised about their housing situation, usually involving overcrowded, camp-like accommodations, and the effects of COVID-19 in relation to this. Hence, this study aimed to explore asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers.

METHODS

In this qualitative study, 14 semi-structured interviews were conducted with asylum seekers at two accommodation centers in Sweden. Participants represented a diverse group of asylum seekers in regard to age, educational background, and gender. Data were analyzed using qualitative content analysis.

RESULTS

Experiences related to COVID-19 were highly dependent on the living situation at the accommodation centers and the experience of feeling unsafe in shared spaces. This was enhanced by the experiences of a challenging mix of COVID-19 messages where different understandings of COVID-19 and related measures existed, together with a feeling of loss of control and safety in shared rooms. Additionally, participants felt more isolated from the outside society and missed prior social activities. Adding to this experience of isolation was an increasing mistrust regarding the authorities' pandemic response.

CONCLUSION

This study highlights the importance of understanding the specific challenges and vulnerabilities of asylum seekers at accommodation centers during the pandemic, shaped by their housing situation and legal status. The findings underscore the need for context-specific support, holistic disease prevention approaches, and tailored health communication strategies using diverse formats. Additionally, the findings emphasize the crucial need to identify and mobilize existing community resources in planning and implementing pandemic control measures. Furthermore, the study emphasizes governmental responsibility in providing secure housing, and to address long-term vulnerabilities beyond pandemics.

Post-migration journey: Asylum, trauma and resilience, different trajectories - A comparison of the mental health and post-migration living difficulties of documented and undocumented migrants in Belgium

BACKGROUND

Research on the impact of post-migration experiences on the mental health of migrant populations has shown a predictive link between post-migration living difficulties and psychological distress. While many studies have focussed on refugees and asylum seekers, there is a considerable gap in the literature concerning undocumented migrants.

AIMS

The aim of this study was to assess the differences in mental health between documented and undocumented migrants in Belgium. It identified the post-migration difficulties encountered by these two groups and measured their impact on their levels of trauma, resilience, anxiety, depression and their assumptive world.

METHOD

This study involved 69 participants, aged 18 to 68 years, who were either documented or undocumented resident in Belgium. Our data collection included the Post-Migration Living Difficulties Checklist for the measurement of post-migration difficulties, the Posttraumatic Stress Disorder Checklist - DSM-V version for the measurement of trauma, the World Assumptions Questionnaire for the measurement of the assumptive world, the Hopkins Symptom Checklist-25 for the measurement of depressive and anxiety disorders and the Adult Resilience Measure - Revised for the measurement of resilience.

RESULTS

Our analyses showed that the mental health of undocumented migrants was poorer than that of documented migrants, with higher levels of trauma, anxiety and depression, a more negative assumptive world, a lower sense of control and lower total and personal resilience. Our results also revealed that post-migration living difficulties were more severe and more numerous for undocumented migrants, and that they were associated to different themes in both groups.

CONCLUSIONS

The fact that post-migration experience plays such an important role in the mental health of migrant populations raises significant clinical, political and societal considerations. Furthermore, it would appear that undocumented migrants represent a distinct migratory group with their own specificities in terms of migration journey and mental health.

Mental deterioration of refugees and asylum seekers with uncertain legal status in Australia: Perceptions and responses of legal representatives

BACKGROUND

Many developed countries have introduced strict measures designed to deter people seeking asylum. Measures such as held detention, insecure visas, restrictions work and services all impact the mental health of asylum seekers. In 2014 Australia introduced a 'fast track assessment' (FTA) system of processing refugee claims for asylum seekers who arrived by boat, those found to be refugees were only eligible for temporary residence. Legal professionals play a pivotal role in protecting the rights of asylum seekers and gain unique insight into the impact of the legal system has on clients mental health.

AIM

To investigate how legal professionals in Australia perceived the impact of the FTA process on their clients.

METHODS

Mixed methods comprising of two phases - (i) an online survey and (ii) follow-up focus groups and interviews with legal professionals involved in assisting asylum seekers in the FTA process. An inductive thematic analysis was used to analyse the data.

RESULTS

Survey results were obtained from 38 legal professionals. Follow up in depth qualitative focus groups and interviews were conducted with 16 survey participants. The data demonstrate that legal professionals encounter clients in complex seemingly insurmountable mental health crises including deepening mental distress and deterioration, feelings of hopelessness, defeat and entrapment. Interviewees shared compelling examples of what they believed constituted a direct connection between asylum seekers experiencing uncertainty and deteriorating mental health over time with fluctuations in hopelessness, anger, withdrawal and suicidality. These negative impacts were often compounded by separation from family.

CONCLUSIONS

The legal framework for determining whether an asylum seeker is a refugee can have a detrimental impact on the mental health of asylum seekers. The mental distress of asylum seekers and refugees is exacerbated by uncertainty linked to both delays in processing accompanied by sustained and ongoing uncertainty of legal status.

Medical evidence in asylum applications: Medical versus legal approaches

The purpose of this narrative review is to elucidate the ways the clinicians working on forensic medical evaluations can engage with asylum proceedings. We compare the legal and medical perspectives on different aspects of forensic medical evidence, asylum evaluations, and asylum applications. As asylum seekers must demonstrate a well-founded fear of persecution in order to receive asylee status, legal and medical professionals often need to collaborate in asylum cases. Although significant evidence has demonstrated that an objective expert medical opinion can support asylum claims, few studies have analyzed how the medical professional's role complements or is at odds with the goals of the legal system. This review summarizes and compares key aspects of the medical and legal perspectives on trauma, credibility, autobiographical memory, and medical evidence to better comprehend the role that medical professionals can play in writing medical affidavits for asylum applications. We dissect legal misconceptions surrounding trauma and the consequences of such misunderstandings and make recommendations for medical evaluators who are working in a forensic capacity.

Mental Health Risk and Protective Factors of Nigerian Male Asylum Seekers Hosted in Southern Italy: a Culturally Sensitive Quantitative Investigation

This study provides a culturally sensitive quantitative investigation aimed at assessing the post-traumatic symptomatology, post-migratory difficulties, and resilience of 36 Nigerian male asylum seekers hosted in the province of Caserta, South Italy. A survey composed by the Harvard Trauma Questionnaire-Revised (HTQ-R), the Post-Migratory Checklist (PLMD), and the Connor-Davidson Resilience Scale (CD-RISC) was administered to participants. Descriptive and correlation analyses were made in order to describe the mental health risk and protective factors and understand the relation between these. A linear regression analysis was used to evaluate the influence of post-migratory difficulties and resilience on PTSD. Stratified bivariate analyses were also computed to detect PTSD group and no-PTSD group differences about post-migration difficulties and resilience levels. Regression analysis showed that PMLD numbers significantly increased the risk of having PTSD. No significant effect emerged for the level of resilience. Statistically significant differences between the PTSD group and non-PTSD group in relation to post-migratory difficulties were also found. No differences in the resilience factors emerged. The results offer a glimpse into a specific ethnic group of asylum seekers and its mental health risks and protective factors, taking into consideration the specificities of their past and current life-story experiences. Clinical implications for professionals working in the field of forced migration will be outlined.

Is legal status associated with mental illness among newly arrived refugees in Sweden: an epidemiological study

BACKGROUND

There are about 80 million forcibly displaced people globally. Migrants are at heightened risk for mental illness compared to host country populations. While previous research highlights the need to adequately assess mental illness, few have taken the diversity among newly arrived migrants into account. This study aims to estimate the prevalence and associated risk factors of mental illness among asylum seekers, quota and other refugees in Stockholm, Sweden.

METHODS

Using a cross-sectional design, data was collected as part of a mental health screening initiative integrated into routine health examinations in two health care clinics in Stockholm. Screening was done with the Refugee Health Screener, RHS-13, a validated instrument for assessing mental health in refugee populations.

RESULTS

A total of 1163 individuals were eligible for screening, of whom 566 participated (response rate 48.6%). Among the participants, 47.9% indicated symptoms of mental illness. Compared with asylum seekers, the risk of mental illness was lower among quota and other refugees (adjusted odds ratio 0.60, 95% confidence interval 0.37-1.00). Female sex, higher age, coming from a middle-income country and low probability of being granted asylum were significant predictors of mental illness.

CONCLUSION

Refugee legal status is associated with mental illness. Asylum seekers are at greater risk of mental illness compared to quota and other refugees. Our findings call for screening for mental illness among newly arrived migrants, especially among those with pending residence permits.

Re-engaging cultural differences: Culture, morality, trauma and the integration of non-Western migrants

We locate our review of recent social scientific literature on non-Western migrants in Western liberal democracies within two opposing master narratives: a subtractive and an additive view of migration. Within this framework, we bring to light the contemporary conceptualizations of non-Western migrants in psychology by focusing on trauma. We then examine the cultural and moral clashes that sometimes arise from trans-global migration and the psychology of integration. We end by highlighting the importance of further research on cultural pluralism and omniculturalism to help foster more peaceful and diverse societies.

The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis

BACKGROUND

Evidence exists reporting a high mental health burden among migrants globally. However, there is no global estimate of mental ill-health among African migrants despite their adverse pre-migration environments. This systematic review and meta-analysis summarise the current scholarship regarding the prevalence of anxiety, depression and Post-traumatic Stress Disorder (PTSD) in the global African migrant population.

METHODS

We searched six databases (Medline (EBSCOHost), PsycINFO (EBSCOHost), Web of Science, PubMed, Scopus and Cumulative Index to Nursing and Allied Health (CINAHL) from 1st January 2000 to 31st August 2021. We screened retrieved articles using strict inclusion and exclusion criteria. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools. Random-effects meta-analyses were employed using DerSimonian and Laird estimator based on inverse variance weights. The I² statistic was used to measure heterogeneity.

RESULTS

Our search retrieved 1091 articles, of which 46 were included representing a total of 28,367 African migrants. The weighted mean age of African migrants was 32.98 years, and nearly half were male (n= 12852, 45.31%). Among the included studies, almost nine out of ten (n=41, 89.1%) were cross-sectional studies. The pooled prevalence of anxiety, depression and PTSD was 34.60%;95%CI (26.30-43.00), 33.20%;95%CI (27.70-38.37) and 37.9%;95%CI (23.5- 52.4) respectively. Significant heterogeneity (I² >98%) existed in the prevalence estimates for anxiety, depression, and PTSD. Sub-group analyses indicate a significantly higher prevalence of anxiety and depression but PTSD for studies conducted in Africa than outside Africa. Similarly, higher prevalence rates for anxiety, depression, and PTSD were seen in studies that used a screening tool than in those that used a diagnostic tool, although a significant difference was observed for depression only.

CONCLUSION

Despite significant heterogeneity among included studies, our systematic review and meta-analysis show a high prevalence of anxiety, depression, and PTSD among African migrants. Our findings underscore the need to develop and implement serious, culturally appropriate mental health interventions that address post-migration stressors that increase their risk of mental ill-health and successful integration into host communities.

Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden

BACKGROUND

Forced migrants fleeing conflict and violence face a high risk of mental health problems due to experiences before displacement, perilous journeys, and conditions in the new host societies. Asylum seekers seem to be in particularly vulnerable situations, indicated by higher prevalence rates of mental health problems compared to resettled refugees. Asylum seekers' mental health is highly influenced by the conditions they face in host countries while awaiting a decision on their case. In Sweden, 40% of asylum seekers reside in state-provided accommodation centers during the asylum process. Collective accommodation centers for asylum seekers have been said to impose restrictive social conditions and to be associated with poorer mental health outcomes than other housing forms (e.g., self-organized housing). However, there seems to be a scarcity of qualitative studies exploring the experiences of asylum seekers in different contexts. The aim of this study was therefore to explore the experiences of asylum seekers and how they manage their mental wellbeing while living at accommodation centers in Sweden.

METHODS

Fourteen semi-structured interviews with asylum seekers were conducted at two accommodation centers in Sweden. Participants were recruited using purposeful sampling and represented a diverse group of asylum seekers regarding age, background, and gender. The data was analyzed using content analysis.

RESULTS

Three overarching categories were identified; 1) Frozen life, 2) Constant worrying and "overthinking", and 3) Distractions and peer support. Participants experienced a state of being that could be characterized as a frozen life, which was associated with intense feelings of psychological distress, mostly described as manifesting itself in consuming patterns of ruminative thoughts, for instance overthinking and constant worrying. However, despite high levels of distress, participants demonstrated agency in managing negative mental health outcomes through self-care practices, peer support, and the development of care practices in caring for others in need.

CONCLUSION

This study offers new insights into the everyday challenges that asylum seekers at accommodation centers face. Furthermore, it offers valuable observations of how asylum seekers at accommodation centers cope through self-care practices, peer support, and care practices in caring for peers in need. In order to enable sustainable and empowering support, mental health and psychosocial support services must identify and address both challenges and strengths, be grounded in the lived reality of asylum seekers, and build on existing resources. Moreover, further policy work needs to be done to enable faster asylum processes.

Conflict driven displacement and child health: Evidence based on mother's nationality from Jordan Population and Family Health Survey

Introduction

Armed conflicts result in greater vulnerability and socioeconomic inequality of populations besides risking their health and well-being. Conflict intensifies the health needs and risks the life and well-being of individuals at large through displacement. Therefore, our study aims to apprise the interventions to which children under-five living in Jordan are especially at risk for acute respiratory infections, diarrhea, and fever in the conflict circumstances.

Materials and methods

Secondary data analysis is used in the present study. We used a weighted sample of around 9650 children from Jordan Population and Family Health Survey (JPFHS), 2017–18. Bivariate analysis including prevalence rates were used to examine the distribution of socio-demographic characteristics of children. The study has also used multinomial logistic regression model, in order to evaluate the variations in the probability of nationality of under-five children living in Jordan.

Results

“Syrian nationalist” children have a higher relative risk of ARI (RRR = 1.19, [1.08, 1.32]), and “Other-nationalist” children have two times greater risk of ARI compared to “Jordanian children.” The relative risk of diarrhea is lower among “Syrian nationalist” and “Other-nationalist” children compared to “Jordanian children.” Children belong “Other-nationalist” are found to be less relative risk of fever (RRR = 0.9, [0.80, 1.01]) than “Jordanian children.”

Conclusions

Our study concludes that conflict-driven displacement has an immediate effect on child health through access, availability, and affordability of health care services, resulting in more significant health care risks. However, sufficient investment is required to address such adversities that affect the health care system due to uneven demand as experienced by the Jordanian health care system. Thus, collaborative efforts through global partners can play a significant role in the countries facing the challenges of managing these health care emergencies.

An Evaluation of Suicide Prevention Education for People Working With Refugees and Asylum Seekers

Abstract.Background: There are concerning rates of suicidality among asylum seekers and refugees in Australia, and tailored suicide prevention initiatives are needed. Aims: We aimed to evaluate the impact of a tailored suicide prevention education program for people working with asylum seekers and refugees. Method: Attendees of the education program completed self-report questionnaires at pretraining, posttraining, and 4–6 months follow-up. Results: Over 400 workers, volunteers, and students across Australia took part in the education program. A series of linear mixed-effects models revealed significant improvements in outcome measures from pretraining (n = 247) to posttraining (n = 231). Improvements were maintained at follow-up (n = 75). Limitations: Limitations of this research were the lack of a control group and a low follow-up response rate. Conclusion: Findings suggest that a 2 days tailored suicide prevention education program contributes to significant improvements in workers’ attitudes toward suicide prevention, and their confidence and competence in assessing and responding to suicidal distress.

A Systematic Review of Factors Affecting Mental Health and Well-Being of Asylum Seekers and Refugees in Germany

Background: Since the onset of the 2015 European refugee crisis, ~4. 46 million people have sought asylum in the European Union, with Germany logging the largest share of all asylum applications. In addition to the severe adversities before and during flight, the process of settling into a new environment involves stressors that affect psychological well-being and mental health. The aim of this systematic review was to examine contextual factors during post-migration that influence the mental health and well-being of asylum seekers and refugees (ASRs) in Germany. Methods: Following PRISMA guidelines, a systematic review was conducted across multiple databases for English and German studies published between 2015 and 2020 with index keywords. Results: From a total of 303 articles, 156 duplicates were removed and, after title review, another 87 were excluded for not meeting the inclusion criteria. After assessing the abstracts of the remaining 60 articles, 39 were excluded. Full texts of 21 articles were assessed for eligibility and after excluding 8 articles, 13 articles were included in the review. The results demonstrate high rates of psychological distress among ASRs in Germany and the significant influence of contextual factors on their mental health and psychological well-being. The risk factors for poor mental health include an uncertain asylum status, living in shared asylum accommodations, separation from the nuclear family, lack of German language skills, integration issues and discrimination, while employment is a protective factor. Conclusion: Asylum seekers and refugees have high prevalence rates of psychological distress directly influenced by contextual factors in Germany. Based on these findings, policy makers are strongly recommended to apply preventive strategies to reduce mental health problems of ASRs in Germany.

An Interaction Model of Environmental and Psychological Factors Influencing Refugee Mental Health

In this paper, we draw on empirical research and theoretical models of refugee and posttrauma mental health to propose the "Psychological Interaction with Environment (PIE) Matrix Model" of refugee mental health. This model focuses on the mental health of adult refugees and proposes that psychological factors and the external environment interact to influence mental health outcomes and functioning for individuals with refugee backgrounds. Environmental factors include adversity faced before, during, and after the migration journey, including adversity faced in a resettlement or postdisplacement environment. Psychological factors refer to psychological (i.e., cognitive and emotional) mechanisms that individuals may use to cope with adversity. We posit that individuals from refugee backgrounds are likely to show individual differences in psychological processes that may protect against or underpin the development and maintenance of psychopathology following exposure to trauma and displacement. The PIE Matrix Model proposes a framework to guide intervention by identifying key pathways by which psychological and environmental factors impact one another. We suggest that psychological interventions can be targeted according to the kind and level of support different individuals may require, based on individualized and context-driven assessments of the interaction between environmental and psychological factors at any given point in time. This model draws on existing models of refugee adaptation and highlights the need for longitudinal and experimental research to explain the interaction between these factors and their causal impact on refugee mental health.