Editorial: Refugee Mental Health

Screening Tools for Mental Disorders Among Female Refugees: a Systematic Review

Female refugees are particularly vulnerable to mental disorders but assessment may be complex and challenging. Various screening tools have been developed for this population, but little is known about their usefulness. The main aim is to examine the literature on the effectiveness of screening tools for mental health problems among female refugees. Systematic review of PubMed, PsycINFO and Embase to locate all published work. Comprehensive search terms were used and inclusion and exclusion criteria were formulated. The initial search yielded 877 articles, of which 757 were removed after titles and abstracts were reviewed. Then, 121 full-text versions of articles were examined and 96 excluded according to the criteria. A total of 25 articles were included in this systematic review in accordance with the PRIMSA guidelines. Twenty screening tools were evaluated. There is a lack of tools used to screen refugee women, and in particular those in emergency settings. Cultural factors may not be accounted for in the development of screening instruments. Further research in this field can help inform public health policies to address social, educational and occupational inclusion for refugee women in different contexts.

Mental Health and Integration: A Qualitative Study on the Struggles of Recently Arrived Refugees in Germany

Introduction: Forcibly displaced people are at particular risk of mental health problems and also face specific integration challenges upon resettlement. Existing literature suggests that there may be a bidirectional relationship between mental health and integration. The present study seeks to understand the relationship between integration processes and mental health problems or significant negative emotional experiences among adult refugees in Germany. Method: Applying a qualitative approach, we conducted 54 semi-structured interviews with refugees and asylum seekers who arrived in Germany between 2013 and 2018 currently residing in Berlin, Leipzig, or the Duisburg area in North Rhine-Westphalia. Data was collected between December 2018 and September 2019. We analyzed transcripts inductively using thematic analysis. Results: Five themes covering the various links between integration and mental health problems or significant negative emotional experiences were identified. First, we found that the mental health consequences of past adverse experiences, as well as ongoing worries about those left behind in the homeland, can seriously impede refugees' ability to pursue activities key to integration. Second, the process of applying for and securing asylum can result in uncertainty and fear, which, in turn, burden the individual and may impact motivation for integration. Third, many of our participants described mental health ramifications related to feeling stuck and thwarted in the pursuit of building a life, especially in securing employment. Fourth, some participants described feeling so overwhelmed by fundamental tasks throughout the integration process, namely, language learning and bureaucratic processes, that these take a psychological toll. Fifth, we identified several forms of social disconnection between refugees and members of the host community due to xenophobia, social and cultural differences, physical and emotional isolation in refugee camps, as well as with co-nationals and fellow refugees. Negative emotions, mistrust, and socio-cultural differences that emerge throughout the integration processes seem to erode social cohesion among refugee communities, potentially further threatening mental health. Conclusion: Mental health problems and integration processes appear to be closely related across different areas of integration. Innovative solutions to challenges identified by members of the refugee community in Germany stand to benefit mental health and integration outcomes simultaneously.

Displacement as trauma and trauma as displacement in the experience of refugees

This paper investigates the relations between displacement, home, trauma and the self in the experience of refugees, which has become an issue of unexpected and far-reaching proportions in recent times. It questions to what extent and under what conditions displacement in the world may be traumatic and how trauma may be considered the effect of an inner displacement. Refugees' lives are marked by forced migration that is related to a certain suffering due to the changes in their family, relational, social and cultural lives. The paper explores the extent to which these changes can represent a break so significant as to be traumatic. It outlines the way in which traumatic experiences can produce an inner displacement and reorganization of one's mental life that leads to a focus on traumatic complexes. Under the most severe traumatic conditions, this can be understood as a displacement of the central axis of Self, in which the ego complex yields its position to other complexes, with a deep change in the organization and functioning of self. The experience of refugees highlights the way in which we live in a matrix of conscious and unconscious links between inner and outer worlds that need deeper and simultaneous consideration to understand their implications and mutual resonances for the psyche. Clinical cases of refugees will illustrate some aspects of these interconnections.