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Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey
The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.ORCID iD: 0000-0001-6138-6427
The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet / The Swedish Red Cross Treatment Center for Persons Affected by War and Torture.ORCID iD: 0000-0002-9836-5336
The Swedish Red Cross University College, Department of Health Sciences.
The Swedish Red Cross University College, Department of Health Sciences.ORCID iD: 0000-0003-0970-0436
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2017 (English)In: BMJ Open, 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.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017. Vol. 7, no 12, article id e018899
Keywords [en]
Mental Health, Post-migration Stress, Refugees, Resettlement, Syria, Trauma
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:rkh:diva-2518DOI: 10.1136/bmjopen-2017-018899PubMedID: 29289940OAI: oai:DiVA.org:rkh-2518DiVA, id: diva2:1170640
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194Swedish Red CrossAvailable from: 2018-01-04 Created: 2018-01-04 Last updated: 2023-08-28Bibliographically approved
In thesis
1. Post-migration stress and mental health among refugees: a population-based survey among refugees from Syria recently resettled in Sweden
Open this publication in new window or tab >>Post-migration stress and mental health among refugees: a population-based survey among refugees from Syria recently resettled in Sweden
2021 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Refugees are exposed to several risk factors for mental ill health before, during, and after the migration. While the impact of traumatic experiences on the mental health of refugees is well-known, the effect of adverse experiences and circumstances in the post-migration context have been less investigated, although a shift has been seen in recent years.

The overall aim of this thesis was to increase the knowledge on post-migration stress and its associations with mental ill health among refugees. The thesis is based around a crosssectional and population-based survey among refugees from Syria who were granted permanent residence permit in Sweden between 2011-2013.

The objective of Study I was to estimate the prevalence of mental ill health and its associations to potential traumas and post-migration stress among refugees from Syria recently resettled in Sweden. A postal questionnaire was sent to a random sample of 4 000 individuals aged 18-64 years drawn from a sample frame containing all eligible participants. Access to registered-based information enabled the construction of non-response weights. Weighted analyses were conducted to calculate prevalence rates and associations, and associations were investigated through a series of logistic regression analyses. Results indicate that prevalence rates for anxiety, depression, PTSD, and low SWB are highly elevated among refugees from Syria with a majority meeting criteria for at least one of the included measures of mental ill health. Furthermore, experiences of potentially traumatic events (PTEs) before and during the migration as well as experiences of post-migration stress were common. Most types of PTEs and post-migration stress were associated with increased risk for mental ill health.

The objective of Study II was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), an instrument for assessing refugee-related post-migration stress. The development was conducted in two phases. In the first phase, a preliminary instrument was developed based on a theoretical model of post-migration stress, covering seven hypothesized domains: 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 second phase, the factorial structure of the instrument was investigated in the context of the survey described in Study I, using Confirmatory and Exploratory Factor Analyses. The analyses resulted in a 7-factor model of post-migration stress that showed excellent fit to data. The final version of the RPMS contains 21 items for assessing refugeerelated post-migration stress across seven domains.

Experiences of post-migration stress are common among refugees from Syria recently resettled in Sweden, and as the results in this thesis show, post-migration stress is associated with increased risk for mental ill health. In order to facilitate recovery from traumatic experiences, measures should be taken on a societal level to mitigate the adverse effects of post-migration stress among refugees.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2021. p. 61
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-4065 (URN)978-91-8016-243-2 (ISBN)
Presentation
2021-06-21, Emmy Rappe (T1), Red Cross University College / via Zoom, Hälsovägen 1, Huddinge, 09:00 (English)
Supervisors
Available from: 2021-06-15 Created: 2021-06-15 Last updated: 2021-06-15Bibliographically approved

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Tinghög, PetterMalm, AndreasArwidson, CharlottaSigvardsdotter, ErikaSaboonchi, Fredrik

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