Table_1_Impairments in psychological functioning in refugees and asylum seekers.DOCX

Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version’s total and six subdomains’ scores (‘mobility’, ‘life activities’, ‘cognition’, ‘participation’, ‘self-care’, ‘getting along’) as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in ‘mobility’ and ‘participation’, followed by ‘life activities’ and ‘cognition’. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in ‘participation’, while past events of being close to death were associated with fewer issues with ‘self-care’. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.</p

Trajectories of psychosocial symptoms and wellbeing in asylum seekers and refugees exposed to traumatic events and resettled in Western Europe, Turkey, and Uganda

Background: Longitudinal studies examining mental health trajectories in refugees and asylum seekers are scarce. Objectives: To investigate trajectories of psychological symptoms and wellbeing in refugees and asylum seekers, and identify factors associated with these trajectories. Method: 912 asylum seekers and refugees from the control arm of three trials in Europe (n = 229), Turkey (n = 320), and Uganda (n = 363) were included. We described trajectories of psychological symptoms and wellbeing, and used trauma exposure, age, marital status, education, and individual trial as predictors. Then, we assessed the bidirectional interactions between wellbeing and psychological symptoms, and the effect of each predictor on each outcome controlling for baseline values. Results: Symptom improvement was identified in all trials, and for wellbeing in 64.7% of participants in Europe and Turkey, versus 31.5% in Uganda. In Europe and Turkey domestic violence predicted increased symptoms at post-intervention (ß = 1.36, 95% CI 0.17–2.56), whilst murder of family members at 6-month follow-up (ß = 1.23, 95% CI 0.27–2.19). Lower wellbeing was predicted by murder of family member (ß  = −1.69, 95% CI −3.06 to −0.32), having been kidnapped (ß  = −1.67, 95% CI −3.19 to −0.15), close to death (ß =  −1.38, 95% CI −2.70 to −0.06), and being in the host country ≥2 years (ß =  −1.60, 95% CI −3.05 to −0.14). In Uganda at post-intervention, having been kidnapped predicted increased symptoms (ß = 2.11, 95% CI 0.58–3.65), and lack of shelter (ß  = −2.51, 95% CI −4.44 to −0.58) and domestic violence predicted lower wellbeing (ß  = −1.36, 95% CI −2.67 to −0.05). Conclusion: Many participants adapt to adversity, but contextual factors play a critical role in determining mental health trajectories. Psychological symptoms improved in all participants and the trajectories went in similar directions. For wellbeing, the majority of participants in Western Europe and Turkey improved over time, while this proportion was smaller in Uganda.Asylum seekers and refugees have the capacity to adapt to traumatic events and ongoing adversity, but contextual factors play a critical role in determining mental health trajectories.Future interventions should focus on reinforcing wellbeing and ‘positive’ psychological outcomes, and targeting the social determinants of mental health. Psychological symptoms improved in all participants and the trajectories went in similar directions. For wellbeing, the majority of participants in Western Europe and Turkey improved over time, while this proportion was smaller in Uganda. Asylum seekers and refugees have the capacity to adapt to traumatic events and ongoing adversity, but contextual factors play a critical role in determining mental health trajectories. Future interventions should focus on reinforcing wellbeing and ‘positive’ psychological outcomes, and targeting the social determinants of mental health.</p