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Malm, A., Tinghög, P., Narusyte, J. & Saboonchi, F. (2020). The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden. Conflict and Health, 14, Article ID 2.
Open this publication in new window or tab >>The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden
2020 (English)In: Conflict and Health, ISSN 1752-1505, E-ISSN 1752-1505, Vol. 14, article id 2Article in journal (Refereed) Published
Abstract [en]

Background: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees.

Results: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.

Conclusions: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Assessment, Confirmatory factor analysis, Construct validity, Exploratory factor analysis, Mental health, Post-migration stress, Refugee, Scale development, Syria
National Category
Psychiatry
Identifiers
urn:nbn:se:rkh:diva-3130 (URN)10.1186/s13031-019-0246-5 (DOI)31921332 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016–07194
Available from: 2020-01-24 Created: 2020-01-24 Last updated: 2020-01-24Bibliographically approved
Nilsson, H., Saboonchi, F., Gustavsson, C., Malm, A. & Gottvall, M. (2019). Trauma-afflicted refugees' experiences of participating in physical activity and exercise treatment: a qualitative study based on focus group discussions. European Journal of Psychotraumatology, 10(1), Article ID 1699327.
Open this publication in new window or tab >>Trauma-afflicted refugees' experiences of participating in physical activity and exercise treatment: a qualitative study based on focus group discussions
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2019 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 10, no 1, article id 1699327Article in journal (Refereed) Published
Abstract [en]

Background: Refugees with prolonged and repeated experiences of trauma, often in combination with post-migration living difficulties, are subjected to severe levels of stress and stress-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever. However, the effect of PA and exercise has received scarce attention in the context of PTSD, and particularly in the field of refugees' health.

Objective: The objective of this study was to explore the experience of participation in PA and exercise as part of the treatment for trauma-afflicted refugees.

Method: An explorative qualitative research design was used. Six focus group discussions were conducted with 33 female and male participants that had experience of group-based PA and exercise treatment. The gathered data was analysed by qualitative content analysis.

Results: The analysis resulted in one over-arching theme reflecting the participants overall experience of PA and exercise as a process of building resilience. Participants experienced improvements in both physical and mental health domains. Increased self-awareness and self-confidence were seen as additional important benefits, and the interruption of daily stressors provided a sense of relief and recovery. The treatment group settings were experienced as becoming a vehicle for overcoming social fear and isolation, which also carried an empowering and strength-building impact over to participants' family life and social relationships. Treatment characteristics were experienced as highly supportive and often referred to as the basis of other positive experiences and perceived health benefits.

Conclusions: The result of this study outlines a detailed account of trauma-afflicted refugees' experiences and preferences of PA and exercise-based treatment from a broad range of perspectives. These findings provide a starting point for future research in this field and indicate a particular need for both research and intervention development to include the real-life impact of participating in such treatments.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
PTSD, Physical activity, exercise, group-based treatment, mental health, physiotherapy, post-migration stress, post-traumatic stress disorder, refugee, trauma
National Category
Psychiatry
Identifiers
urn:nbn:se:rkh:diva-3121 (URN)10.1080/20008198.2019.1699327 (DOI)31853335 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00426
Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2020-01-29Bibliographically approved
Sigvardsdotter, E., Nilsson, H., Malm, A., Tinghög, P., Gottvall, M., Vaez, M. & Saboonchi, F. (2017). Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC)-A Brief Checklist for Survey Studies. International Journal of Environmental Research and Public Health, 14(10), Article ID 1175.
Open this publication in new window or tab >>Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC)-A Brief Checklist for Survey Studies
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2017 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 10, article id 1175Article in journal (Refereed) Published
Abstract [en]

A high proportion of refugees have been subjected to potentially traumatic experiences (PTEs), including torture. PTEs, and torture in particular, are powerful predictors of mental ill health. This paper reports the development and preliminary validation of a brief refugee trauma checklist applicable for survey studies.

METHODS: A pool of 232 items was generated based on pre-existing instruments. Conceptualization, item selection and item refinement was conducted based on existing literature and in collaboration with experts. Ten cognitive interviews using a Think Aloud Protocol (TAP) were performed in a clinical setting, and field testing of the proposed checklist was performed in a total sample of n = 137 asylum seekers from Syria.

RESULTS: The proposed refugee trauma history checklist (RTHC) consists of 2 × 8 items, concerning PTEs that occurred before and during the respondents' flight, respectively. Results show low item non-response and adequate psychometric properties Conclusion: RTHC is a usable tool for providing self-report data on refugee trauma history surveys of community samples. The core set of included events can be augmented and slight modifications can be applied to RTHC for use also in other refugee populations and settings.

Keywords
population study, refugees, self-report instrument, trauma, trauma checklist
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2450 (URN)10.3390/ijerph14101175 (DOI)28976937 (PubMedID)
Funder
Swedish Red CrossForte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194
Available from: 2017-10-05 Created: 2017-10-05 Last updated: 2020-01-29Bibliographically approved
Tinghög, P., Malm, A., Arwidson, C., Sigvardsdotter, E., Lundin, A. & Saboonchi, F. (2017). Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey. BMJ Open, 7(12), Article ID e018899.
Open this publication in new window or tab >>Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e018899Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To estimate the prevalence of and associations between anxiety, depression, post-traumatic stress disorder (PTSD), low subjective well-being (SWB), potential traumas and postmigration stress among refugees from Syria resettled in Sweden.

DESIGN: A cross-sectional and population-based questionnaire study based on a known and complete sample frame. The survey included multiple measures of mental ill health and factors of particular relevance for refugees. Weighted analyses were conducted to calculate representative prevalence rates and associations. Associations were investigated through a series of logistic regression analyses. All analyses were supplemented with robust 95% CIs.

SETTING: Sweden.

PARTICIPANTS: A random sample of 1215 individuals (response rate 30.4%) from Syria aged 18-64 years that were granted residency in Sweden on grounds of asylum between 2011 and 2013.

MAIN OUTCOME MEASURES: Anxiety, depression, PTSD and low SWB were assessed through Hopkins Symptom Checklist, Harvard Trauma Questionnaire and WHO-5 Well-being Index, using established cut-offs.

RESULTS: A majority of the participants met the criteria for at least one of the studied types of mental ill health, and the comorbidity was high. Depression was the most the common type with 40.2% (95% CI 36.9% to 43.3%), followed by low SWB with 37.7% (95% CI 34.8% to 40.1%), anxiety with 31.8% (95% CI 29.2% to 34.7%) and PTSD with 29.9% (95% CI 27.2% to 32.6%). Refugee-related potentially traumatic events (PTEs) experienced before or during migration was common as was substantial levels of postmigration stress. Most types of refugee-related PTEs, especially being exposed to interpersonal violence, and postmigration stress were associated with increased risks for anxiety, depression, low SWB and PTSD.

CONCLUSIONS: Mental ill health, in terms of anxiety, depression, low SWB and PTSD, are highly elevated and comorbid among refugees from Syria. Increased attention from multiple societal sectors to adequately support Syrian refugees' mental health needs, promoting recovery and reducing postmigration stress are needed.

Keywords
Mental Health, Post-migration Stress, Refugees, Resettlement, Syria, Trauma
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2518 (URN)10.1136/bmjopen-2017-018899 (DOI)29289940 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194Swedish Red Cross
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-08-30Bibliographically approved
Tinghög, P., Arwidson, C., Sigvardsdotter, E., Malm, A. & Saboonchi, F. (2016). Nyanlända och asylsökande i Sverige: En studie av psykisk ohälsa, trauma och levnadsvillkor. Huddinge: Röda Korsets Högskola
Open this publication in new window or tab >>Nyanlända och asylsökande i Sverige: En studie av psykisk ohälsa, trauma och levnadsvillkor
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2016 (Swedish)Report (Other academic)
Abstract [sv]

Människor som flyr från krig och konflikt har ofta varit med om omskakande händelser som kan leda till långvariga problem och ohälsa. Det finns lite kunskap om hur sådana erfarenheter påverkar en människa. För att öka kunskapen genomfördes under perioden maj 2015 till oktober 2016, en forskningsstudie vid Röda Korsets Högskola. Studien hade som syfte att uppskatta förekomsten av psykisk ohälsa bland nyanlända från Syrien och asylsökande från Eritrea, Syrien och Somalia samt att kartlägga förekomsten av erfarenheter av traumatiska händelser, post-migratorisk stress och svagt socialt stöd.

Data har samlats in via två enkäter samt register i två kompletterande studiepopulationer. Den första studiepopulationen bestod av 1215 nyanlända från Syrien med permanent uppehållstillstånd som blivit kommunmottagna mellan åren 2011 och 2013. Den andra studiepopulationen bestod av 173 asylsökande från Syrien, Eritrea och Somalia som bodde på ett asylboende i västra Sverige.

Resultaten från studien visar bland annat att den psykiska ohälsan i Sverige 2016 är mycket utbredd bland nyanlända från Syrien och bland asylsökande från Eritrea, Somalia och Syrien. Bland nyanlända från Syrien har var tredje en högst påtaglig depressions- eller ångestproblematik, detta samtidigt som 30 % uppger symtom som stämmer överens med posttraumatiskt stressyndrom (PTSD). Studien indikerar dessutom att psykisk ohälsa i form av depression, ångest, PTSD och lågt välbefinnande är betydligt vanligare bland asylsökande än bland nyanlända, särskilt bland asylsökande från Eritrea och Somalia.

Place, publisher, year, edition, pages
Huddinge: Röda Korsets Högskola, 2016. p. 82
Series
Röda Korsets Högskolas rapportsserie ; 2016:1
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2324 (URN)978-91-983684-0-6 (ISBN)
Projects
Psykisk ohälsa bland flyktingar
Funder
Swedish Red Cross
Available from: 2016-12-28 Created: 2016-12-28 Last updated: 2017-10-30Bibliographically approved
Sigvardsdotter, E., Malm, A., Tinghög, P., Vaez, M. & Saboonchi, F. (2016). Refugee trauma measurement: a review of existing checklists. Public Health Reviews, 37, Article ID 10.
Open this publication in new window or tab >>Refugee trauma measurement: a review of existing checklists
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2016 (English)In: Public Health Reviews, ISSN 0301-0422, E-ISSN 2107-6952, Vol. 37, article id 10Article, review/survey (Refereed) Published
Abstract [en]

Studies have shown that a high proportion of refugees have been subjected to potentially traumatic experiences (PTEs). PTEs, including torture, are powerful predictors of mental ill health. This paper reports a review of refugee trauma history self-report measures used in population studies.

Methods

A review of existing instruments and checklists, up to September 2015, was performed.

Results

The types of measures for refugee trauma history vary from semi-structured interviews and medical records to extensive multi-item trauma-checklists. The Harvard Trauma Questionnaire (HTQ) was the most commonly used instrument for measuring trauma history among refugee populations. Few checklists included PTEs during the flight.

Conclusion

Trauma history checklists are often used as a tool to control for background variables when studying refugees’ mental health and have mostly been developed in clinical or semi-clinical settings. There is a need for acceptable, reliable and valid brief checklists for measuring trauma in refugees, for the purpose of performing larger scale population studies.

Keywords
Refugee trauma, Review, Trauma checklist, Review of trauma instruments
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2292 (URN)10.1186/s40985-016-0024-5 (DOI)
Funder
Swedish Red Cross
Available from: 2016-10-14 Created: 2016-10-14 Last updated: 2017-11-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9836-5336

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