In Their Own Words: Mental Health and Quality of Life of West African Refugees in Nigeria

Refugees are exposed to extreme stressors and are therefore at risk of mental health and social problems. Other issues refugees have to cope with include the loss of their country, culture, language, profession, family, friends, and future plans. Much of the studies that have been done on refugee mental health have not attempted to explain what these experiences mean to these individuals. Thus, this study provides explorative data on the mental health and quality of life of West African refugees living in Nigeria in order to understand their views and perspectives. This study carried out in 2010 employed qualitative methods; a total of four focus group discussions (FGDs) were conducted among adult male and female refugees purposively selected at the Oru Refugee Camp, Ogun State, Nigeria. Respondents described quality of life as a major determinant of mental health status. Most of the participants believed that women were more predisposed to mental ill health due to their sensitive emotional make-up. Factors identified by respondents as affecting mental health and quality of life among refugees included poverty, unemployment, physical health, housing and environment, discrimination, stigmatization, and insecurity. Refugees rated their mental health and quality of life as poor due to the aforementioned factors. Recommendations were made to the international community, national and local governments to invest more on education, provision of vocational and entrepreneurial skills as well as adequate housing in order to improve the mental health and quality of life of refugees.     

Health-Related Quality of Life of Asylum Seekers and Refugees in Germany: a Cross-Sectional Study with Data from the German Socio-Economic Panel

The purpose of this study was to estimate the health-related quality of life (HrQoL) of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017. The analysis was based on the 2016 and 2017 refugee samples of the German Socio-Economic Panel (n = 6821). HrQoL was measured using a modified version of the SF-12v2 questionnaire and presented as physical (PCS) and mental (MCS) component summary scores. PCS and MCS scores for the total sample, males and females were calculated by sociodemographic characteristics. Associations between PCS and MCS scores and sociodemographic variables were examined by a linear regression with bootstrapped standard errors. The mean PCS and MCS scores of the sample were 53.4 and 47.9, respectively. Female sex was statistically significantly associated with lower PCS and MCS scores. The SF-12 subscale general health was valued highest with a score of 55.4, whereas the subscale role emotional was valued lowest with a score of 46.9. Employment was statistically significantly associated with higher PCS and MCS scores. Persons from Afghanistan had statistically significantly lower MCS scores than persons from Syria, whereas MCS scores were statistically significantly higher for persons from Eritrea. Physical and mental HrQoL of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017 was higher and lower than the German norm, respectively. Female sex, older age, unemployment and being separated, divorced or widowed were negatively associated with HrQoL. The three largest ethnical groups of asylum seekers and refugees, Syrians, Afghans and Eritreans, differ inherently in their HrQoL.

     

“It's ok if it's hidden”: The discursive construction of everyday racism for refugees and asylum seekers in Wales

Wales has a long history of migration; however, the introduction of dispersed asylum seekers in 2001 has led to Wales becoming a more superdiverse nation. Wales has often been positioned as a more “tolerant nation” than England; however, the increasingly superdiverse nature of Wales in a postdevolution era may now be calling this tolerance thesis into question. Models of refugee and asylum seeker integration suggest that the absence of racism plays a key role in integration. This paper reports the findings of research that centres on refugee and asylum seeker integration in Wales. Nineteen interviews were conducted with refugees and asylum seekers who had been living in Wales for between 1 month and 12 years. Each interview was analysed using a discursive psychology approach. In this paper, I show that the interviewees appeared to negotiate a dilemma when talking about experiencing potentially racist incidents within the interviews, constructing them as trivial so as not to appear critical of the protection they have received in Wales. The findings also highlight the more everyday and banal forms of racism that are regularly experienced by refugees and asylum seekers living in Wales.     

The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers

There is a lack of knowledge about psychosocial resources that may sustain post‐resettlement psychological adjustment among unaccompanied minor asylum‐seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population‐based multi‐ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel.     

Healthy Migrants in an Unhealthy City? The Effects of Time on the Health of Migrants Living in Deprived Areas of Glasgow

This paper examines the healthy immigrant effect in Glasgow, a post-industrial city where the migrant population has more than doubled in the last decade. Using data from a community survey in 15 communities across the city, the paper compares four health outcomes for the following three groups: British-born, social and economic migrants and asylum seekers and refugees. Migrants were found to be healthier than the indigenous population on all four measures, particularly in the case of adult households in both migrant groups and for older asylum seeker and refugee households. Health declines for social and economic migrants with time spent in the UK, but there is no clear pattern for asylum seekers and refugees. Health declined for refugees according to time spent awaiting a decision, whilst their health improved after a leave-to-remain decision. Indigenous and social and economic migrant health declines with time spent living in a deprived area; this was true for three health indicators for the former and two indicators for the latter. Asylum seekers and refugees who had lived in a deprived area for more than a year had slightly better self-rated health and well-being than recent arrivals. The study’s findings highlight the role of destination city and neighbourhood in the health immigrant effect, raise concerns about the restrictions placed upon asylum seekers and the uncertainty afforded to refugees and suggest that spatial concentration may have advantages for asylum seekers and refugees.     

Self-harming behaviours of asylum seekers and refugees in Europe: A systematic review

The increasing number of asylum seekers and refugees in Europe calls for even more professionals to take care of refugees' mental health. Although different studies claim that migration could be a potential risk factor for self-harming behaviours, an in-depth exploration of the presence and characteristics of self-harm in the context of asylum is needed. In accordance with PRISMA guidelines, a systematic review was conducted across the databases Scopus, PubMed, Web of Knowledge and PsycArticles, regarding the main features of self-harming behaviour among refugees in Europe. Twelve articles and 3 main trajectories were identified: (1) A context at-risk: self-harm and detention centres; (2) A target at-risk: self-harm and unaccompanied minors; (3) A comparison between the mental health of asylum seekers and natives. Research on this topic in Europe is still underdeveloped and disorganised. Studies have mainly carried out wider quantitative investigations on mental health, usually overlapping self-harm with suicide. Detention centres emerged as the most widely investigated context and the one with the highest risk for self-harming behaviours. Instead, unaccompanied minors emerged as a particularly vulnerable category. Research in this field should be improved, combining quantitative and qualitative methods for a deeper understanding of the meanings of self-harm across cultures.     

Psychological Distress in Refugee Children: A Systematic Review

Nearly one-quarter of the refugees worldwide are children. There have been numerous studies reporting their levels of psychological distress. The aim of this paper is to review systematically and synthesize the epidemiological research concerning the mental health of refugee children residing in Western countries. A Cochrane Collaboration style review was conducted searching nine major databases, bibliographies, and grey literature from 2003 to 2008. Included studies had to meet the reporting standards of STROBE and investigate mental health in non-clinical samples of asylum seeking and refugee children residing in OECD countries. A total of twenty-two studies were identified of 4,807 retrieved citations, covering 3,003 children from over 40 countries. Studies varied in definition and measurement of problems, which included levels of post-traumatic stress disorder from 19 to 54%, depression from 3 to 30%, and varying degrees of emotional and behavioral problems. Significant factors influencing levels of distress appear to include demographic variables, cumulative traumatic pre-migration experiences, and post-migration stressors. Importantly, the research base demands greater contextual and methodological refining such that future research would have greater generalizability and clinical implications.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

Practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugee clients

The present study is the first study undertaken in Australia that seeks to explore practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugees. We used thematic analysis to analyse extracts of interviews that were conducted with nine professionals who worked therapeutically with asylum seekers and refugees and had experience of participating in individual and peer supervision. The findings of the study suggest that supervision encouraged practitioners to develop multicultural awareness and explore therapeutic ways of working that are compatible with their clients’ frame. In addition, supervision provided the context in which practitioners explored the impact of the asylum legislative framework on their clinical work and reflected upon their feelings of powerlessness and political impotence. Implications for practice that derive from supervisory needs of practitioners who work with asylum seekers and refugees are explored.     

The Mutually Constitutive Relationship between Place and Identity: The Role of Place‐Identity in Discourse on Asylum Seekers and Refugees

Recent discursive research has shown that constructions of place may function to regulate social relations and reinforce particular notions of belonging. However, extant discursive research on place‐identity has so far neglected the mutually constitutive relationships between constructions of place and identity in legitimising people's presence. To address this gap, this study, undertaken in Scotland, applies the notion of place‐identity to the discursive analysis of interviews with asylum seekers and refugees, people who work in organisations that support asylum seekers and refugees and locals who live in areas where asylum seekers and refugees tend to be housed. The analysis suggests that constructions of asylum seekers’ and refugees’ countries of origin as dangerous, and the host society as relatively problem‐free, function to constitute their identities as legitimate and to justify their presence in the host society. Moreover, constructions of place may work to portray refugees and asylum seekers as benefiting the local community and as belonging more than certain other locals. In contrast, constructing the host society as ‘full’ functions to oppose their presence through portraying them as not being able to belong. This demonstrates the mutually constitutive roles of place and identity in legitimising or resisting people's movement and belonging. Copyright © 2013 John Wiley & Sons, Ltd.     

Job insecurity and the benefits of work

The presented study combines conservation of resource theory with latent deprivation theory to explain the negative relationship between job insecurity and mental health. Specifically, we propose that people who face the threat of job insecure would perceive worse access to the benefits of work, which would explain the negative effect of job insecurity on mental health. In a two-wave study, employees rated their perceived job insecurity, their access to the benefits of work, and their mental health. Cross-sectional multiple mediation analysis at Time 1 (n = 295) and Time 2 (n = 236) showed that the negative relationship between job insecurity and mental health was partly due to a perceived lack of the benefits of work. Longitudinal results (n = 173) revealed that job insecurity was related to a decrease in financial benefits, which in turn predicted mental health. However, this effect was only visible if it was not controlled for prior levels of the benefits of work. The results are discussed with regards to conservation of resource theory and latent deprivation theory and the potential of this framework for explaining negative mental health effects of job insecurity.     

Psychopathologie und Aufenthaltsstatus

This study compared the mental health status of various groups of people living in Switzerland. A total of 65 asylum seekers, 34 refugees, 21 illegal migrants, 26 migrant laborers and 56 Swiss citizens were assessed for psychopathological symptoms of posttraumatic stress, anxiety and depression. Specifically, it was tested if the residence permit status was associated with psychopathology if potentially confounding factors, such as social desirability, trauma history and integration were statistically controlled. The results showed that the majority of the asylum seekers, refugees and illegal migrants included in the study suffered from substantial psychopathological symptoms. An association between residence permit status and psychopathology was found even after controlling for other influencing factors. The results imply that not only trauma experiences lead to psychopathology in specific population groups with a migration background but also factors related to an insecure residence permit can contribute to psychopathological symptoms.     

Organising Somalian,Congolese and Rwandan Migrants in a Time of Xenophobia in South Africa: Empirical and Methodological Reflections

Xenophobic practices pervade civil society and the state in South Africa. But its victims are not passive. Academic scholarship has not sufficiently recognised the multiple roles of refugees and asylum seekers migrant organisations in a context where refugees are required to “self-settle”. The dominant methodological focus of existing research has been on the migrant as the individual. This paper’s main research objectives are to question this focus and examine evidence of the collective responses to struggles faced by foreign African migrants and refugee groups in Cape Town. Eleven refugee and asylum seeker associations formed by Somalians, Congolese and Rwandan asylum seekers and refugees were investigated, based on extensive interviews with 11 leaders of refugee organisations. These organisations not only strongly defend migrant interests but also project a long-term view of integration into South African society. In addition, the paper concludes by arguing for a shift in the focus of research in order to show that migrant organisations are crucial in an individual’s collective security concerns, in advocacy with government institutions and in initiatives to build relationships with South Africans.     

Les nouveaux «Gastarbeiter»? Les réfugiés sur le marché du travail suisse

With about 28,000 asylum requests a year since 1990, Switzerland is one of the western countries with the highest inflow of refugees. The aim of this article is to answer two questions: What is the role of refugees in the Swiss economy? and what are the factors influencing their incorporation into the labour market? The research is based on the multivariate analysis of an individual database of 110,000 asylum seekers and refugees, in-depth interviews and 174 questionnaires to refugees and employers.     

Preparing Counselors to Work with Refugees: Integration of Experiential Activities

The number of globally displaced refugees has increased by record-high numbers. Refugees are forced out of their home countries and many are resettled in the United States. As the number of refugees entering the US continues to increase, there is a need to ensure that mental health counselors understand the unique needs of this population and provide culturally appropriate counseling services. The aim of this article is to present experiential activities that counselor educators can use in counselor preparation programs to better prepare counselors-in-training to work with refugees.     

Mental Health Inequalities During COVID-19 Outbreak: The Role of Financial Insecurity and Attentional Control

The COVID-19 pandemic and subsequent lockdowns negatively impacted the mental health of populations. This impact is not equally distributed and increases existing mental health inequalities. Indeed, government restrictions and the economic consequences of the pandemic affect more the less educated and less wealthy people. However, psychological processes implicated in this increase of mental health inequalities during the COVID-19 pandemic remain unexplored. The present study (N=591) tested the role of financial insecurity and attentional control in the relation between socioeconomic status and mental health, along with the influence of trait anxiety. Based on Structural Equation Modelling, findings showed a mediation effect of financial insecurity, but not of attentional control, in the relationship between socioeconomic status and mental health. In addition, exploratory analyses suggested that financial insecurity also mediated the effect of attentional control on mental health. Results of the present research point at the importance of understanding psychological processes implicated in the effect of economic crises on mental health inequalities.     

The impact of post-migration stressors on refugees’ emotional distress and health: A longitudinal analysis

Refugees often experience poor physical and mental health outcomes following resettlement. These outcomes have been linked to the conditions that are experienced by refugees in the post-migration context, but little is known about the mechanisms by which these conditions influence health. We therefore conducted secondary analyses of the Survey of New Refugees, a large longitudinal study commissioned by the UK Home Office with data collected at four time points spanning 21 months. Refugees’ experience of emotional distress such as feeling stressed, worried, and depressed fully mediated the relationship between post-migration stressors and longitudinal general health. There was no evidence that perceived social support influenced this relationship. These findings suggest that emotional distress contributes to poor health outcomes among refugees and thus that interventions might target emotional distress.     

Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.     

‘I Feel Like a Beggar’: Asylum Seekers Living in the Australian Community Without the Right to Work

While numbers of asylum seekers received by Australia are small compared to global figures, a range of deterrence measures have been implemented in response to increasing numbers arriving by boat in recent years. One of the more recent measures was denying asylum seekers who arrived by boat after 13 August 2012 the right to work upon their release from immigration detention into the community. There are around 26,000 asylum seekers who have been subject to this policy with most still waiting for their initial interview for refugee status and none have had their refugee claims resolved. This paper examines the findings of a study that explored the implications of this policy for asylum seekers. It draws on 29 semi-structured interviews with asylum seekers and highlights the distress and fear that many are enduring, caused by the denial of the right to work and ongoing uncertainty about their refugee claims. The study’s findings provide support for the conclusions of earlier research that highlight the importance of the right to work and securing employment for the mental health of asylum seekers, as well as studies that found there were negative mental health consequences of forcing asylum seekers to live for long periods with uncertainty around their protection claims.     

Our Relations to Refugees: Between Compassion and Dehumanization*

After the so-called refugee crisis of 2015–2016 European reactions to foreigners had come to the fore and we are seeing xenophobic political and populist movements become increasingly mainstream. The massive rejection of refugees/asylum seekers taking place has made their conditions before, during and after flight, increasingly difficult and dangerous. This paper relates current xenophobia to historical attitudinal trends in Europe regarding Islam, and claims that a much more basic conflict is at work: the one between anti-modernism/traditionalism and modernism/globalization. Narratives on refugees often relate them to both the foreign (Islam) and to “trauma”. In an environment of insecurity and collective anxiety, refugees may represent something alien and frightening but also fascinating. I will argue that current concepts and theories about “trauma” or “the person with trauma” are insufficient to understand the complexity of the refugee predicament. Due to individual and collective countertransference reactions, the word “trauma” tends to lose its theoretical anchoring and becomes an object of projection for un-nameable anxieties. This disturbs relations to refugees at both societal and clinical levels and lays the groundwork for the poor conditions that they are currently experiencing. Historically, attitudes towards refugees fall somewhere along a continuum between compassion and rejection/dehumanization. At the moment, they seem much closer to the latter. I would argue that today’s xenophobia and/or xeno-racism reflect the fact that, both for individuals and for society, refugees have come to represent the Freudian Uncanny/das Unheimliche.