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.     

“Sad day for the UK”: The linking of debates about settling refugee children in the UK with Brexit on an anti-immigrant news website

This article uniquely demonstrates how UK debates about supporting child refugees during the “refugee crisis” came to be used as support for leaving the European Union (EU). The research question “how did users of a news website respond to a report about the UK government's decision to allow child refugees into the UK?” is addressed with a rigorous discursive analysis of an internet discussion forum on the anti-immigrant website MailOnline consisting of 2,014 unique posts, with a reach of 30 million viewers. Analysis demonstrated that (1) child refugees were presented as adults, (2) allowing in refugees was presented as a “burden” on taxpayers, (3) the decision was presented as opposed to the public's will, and (4) this was used as a warrant for leaving the EU. The significant implication of this analysis is that political attempts at associating the refugee crisis with the EU may have been successful in this context.     

Personal Contact with Refugees is Key to Welcoming Them: An Analysis of Politicians' and Citizens' Attitudes Towards Refugee Integration

Politicians are influential both in directing policies about refugees and in framing public discourse about them. However, unlike other host country residents, politicians' attitudes towards refugees and integration are remarkably understudied. We therefore examine similarities and differences between politicians' attitudes towards refugee integration and those held by citizens. Based on the stereotype content model, we expect that political ideology informs stereotypes about refugees, which subsequently shape attitudes towards refugee integration. Based on the Contact Hypothesis, we further argue that personal contact with refugees reduces negative stereotypes about them—in particular for those endorsing a right-wing ideology. We draw on data collected via two surveys with 905 politicians and 8013 citizens in the Netherlands to show that (1) unlike those with a left-wing orientation, residents (i.e., both politicians and citizens) with a right-wing orientation hold more negative stereotypes about refugees, which in turn relate to more negative attitudes towards refugee integration; (2) personal contact with refugees is associated with less negative stereotypes among residents; and (3) politicians, compared to citizens, report less negative stereotypes and more positive attitudes towards refugee integration. The practical implication of fostering residents' contact with refugees as well as the implications for future research are discussed.     

Social representations of refugees: Place of origin as a delineating resource

This study investigated social understandings of refugees from Africa in a regional town in NSW, Australia. Drawing from Social Representations Theory (Moscovici, 1984 ), the study investigated whether place of origin (Africa) mediated understandings held about refugees. Two studies were conducted. In the first study, a between‐subjects manipulation using word association tasks revealed that the super‐ordinate term Refugees, and Refugees from Africa shared a common core of elements (poor, war). Although sharing a core, these representations were differentiated by peripheral elements which concurred with social understanding of Africa (e.g. disease), and media portrayal of refugees/asylum seekers (e.g. boat). The salience of these meanings in the community was further explored using a self‐report questionnaire. Results suggested that place of origin, manifested as peripheral representational elements, may play an important role in differentiating, orientating and linking specific refugee groups to particular socio‐political contexts. Further, we contend that place of origin may be understood as a discursive resource, deployed for rhetorical ends. Copyright © 2009 John Wiley & Sons, Ltd.     

From empathy to action: Can enhancing host‐society children's empathy promote positive attitudes and prosocial behaviour toward refugees?

Over half of refugees are school‐aged children. In host communities, children's attitudes and behaviours are important for the integration of refugee children. This study examines the empathy–attitudes–action model in middle childhood (N = 94, 8 to 11 years old). In both the experimental and control conditions, children were introduced to a (fictional) refugee and told that he or she would be moving to their school. The experimental condition also listened to a storybook about the child's refugee experience. Empathy, outgroup attitudes, and prosocial behaviour toward the incoming child, and refugees as a group, were measured. Although mediation was not supported, the storybook condition reported more empathy and helping intentions, and attitudes predicted helping intentions but not giving to refugees. Results highlight how host‐society children can welcome refugees.     

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.     

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.     

(THE IMAGE OF) GOD IN ALL OF US

This essay compares Sikh and Christian thought about and practices of hospitality in light of the global refugee crisis. It aims to show how both practices of hospitality, and religious ethical thought about hospitality, can be enhanced by dialogue between traditions. The refugee crisis arises out of a global failure of hospitality, and the type of hospitality refugees most fundamentally need is that which confers membership in a political community. Comparing Christian and Sikh ethics of hospitality provides guidance toward building rooted religious communities that welcome outsiders, including by incorporating them into political communities. In particular, Christians who hold social power and privilege can better fulfill ethical mandates of hospitality by looking to the example of Sikhs and other marginalized groups. Sikhs have often built communities through acts of hospitality and welcomed outsiders without fear, even in contexts where their own belonging is questioned and their own security is under threat.     

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.     

Promoting Hmong Refugees’ Well-Being Through Mutual Learning: Valuing Knowledge, Culture, and Experience

Refugees who resettle in a new country face numerous struggles, including overcoming past traumas and coping with post-migration stressors, such as lack of meaningful social roles, poverty, discrimination, lack of environmental mastery, and social isolation. Thus, in addition to needing to learn concrete language skills and gain access to resources and employment, it is important for refugees to become a part of settings where their experiences, knowledge, and identity are valued and validated. The Refugee Well-Being Project (RWBP) was developed to promote the well-being of Hmong refugees by creating settings for mutual learning to occur between Hmong adults and undergraduate students. The RWBP had two major components: (1) Learning Circles, which involved cultural exchange and one-on-one learning opportunities, and (2) an advocacy component, which involved undergraduates advocating for and transferring advocacy skills to Hmong families to increase their access to resources in their communities. The project was evaluated using a mixed quantitative and qualitative approach. This article discusses data from qualitative interviews with participants, during which the importance of reciprocal helping relationships and mutual learning emerged as significant themes.     

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.     

Counselling asylum seekers and refugees: a study of Kurds in early and later stages of exile

This study explores the experience of asylum seekers and refugees in early and later phases of exile. Twenty-five Kurds (mainly asylum seekers) were interviewed in Greece in early phases of exile and twenty Kurds (mainly refugees) in later phases of exile in the UK. Refugee camps in Greece and community centres in London were the main locations for these interviews. Representatives from eight support organizations were also interviewed in each country. The multidimensional aspects of being a refugee are discussed, including models of formulating the experience, PTSD and the cross-cultural context. Key findings of the study include the desperate need among the asylum seekers and refugees, in the early phases, to have the story of their traumatic journey to Greece witnessed and validated by an outsider; the differing experiences of men and women; a change in identity over time; and considerable fear, which was evident in early and later phases. Moreover, all the support organizations expressed pronounced frustration but responded to it in different ways. Those organizations with supervision and support groups in place demonstrated more insight into their interactions with asylum seekers and refugees. Counselling approaches are evaluated with reference to the asylum seekers' and refugees' needs, and the desirability of adequate support for those with a counselling role is highlighted.     

Letting Diasporic Voices Be Heard

More than 68.5 million people were forced to move from their countries, according to the UN Refugee Agency, UNHCR, in 2018. Forced displacements are caused by poverty, war, and lack of safety. Since 2015, Europe has been experiencing a so‐called refugee crisis that calls European values and policies into question. Beyond data, there are the experiences of those who are on the move. The number of people arriving on the continent has made integration a decisive topic. This research aims to discover the portrayal of refugees and migrants in media. This goal includes the challenge of making European media evaluate their work to improve the treatment given to complex subjects such as migration. This article is the result of research derived from the project Refugees Reporting in 2017, coordinated by the Europe Region of the World Association for Christian Communistories ancation and the Churches' Commission for Migrants in Europe.     

Managing Identity in the Face of Resettlement

Refugees who are resettled in third countries may be at greater risk of experiencing identity problems, such as identity distress, crisis, and its resolution, than are their nonrefugee, nonimmigrant peers. A multidimensional approach was employed to explore the identity (re)formation and resolution of 50 Karen refugees who were resettled in London, Ontario, Canada. Problematic identity processes in social, personal, and ego domains of identity were examined. Fifty nonrefugee Canadians served as comparisons. The findings revealed that the resettlement process impaired the sense of temporal sameness and continuity, promoted confusion and crisis in identity, prolonged identity resolution, and stimulated distress concerning social and personal identity issues (work, career, values, group loyalties) for the refugees who participated in this study.     

The housing situation of refugees in Montréal three years after arrival: The case of asylum seekers who obtained permanent residence

This article presents the results of a secondary analysis of the housing-related variables contained in a survey of the settlement experiences of some 400 regularized refugee claimants living in Greater Montréal. It examines housing as a vector of settlement and integration, as well as the related neighbourhood context. The data indicate that the refugees are relatively well housed in terms of dwelling quality, but spend inordinately high percentages of their income on rent, essentially because of their low incomes. More optimistically, the refugees have access to social support from within their ethnolinguistic group, and in their neighbourhoods they are not isolated from the majority cultural groups of Québec society.     

Le logement des réfugiés à Montréal trois ans après leur arrivée: le cas des demandeurs d'asile ayant obtenu la résidence permanente

This article presents the results of a secondary analysis of the housing-related variables contained in a survey of the settlement experiences, of some 400 regularized refugee claimants living in Greater Montréal. It examines housing as a vector of settlement and integration, as well as the related neighbourhood context. The data indicate that the refugees are relatively well housed in terms of dwelling quality, but spend inordinately high percentages of their income on rent, essentially because of their low incomes. More optimistically, the refugees have access to social support from within their ethnolinguistic group, and in their neighbourhoods they are not isolated from the majority cultural groups of Québec society.     

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.     

Preaching and political debate on refugees

The article investigates how preaching relates to political debate on refugees through a study of sermons in Church of Norway in 2015/2016. The sermons are analysed in the context of the “refugee crisis” as it was mediated by national media and treated in public debate. The debate revolved around refugee politics, but included an exchange over the church’s role in the debate. The article investigates sermons as contributions to political debate on refugees and as negotiating the church’s role in political debate. A distinct finding is that most sermons collapse the historical distance to the biblical texts and employ them directly as instructions for moral and political action. The article identifies three homiletic strategies connected with three different ways of relating to public debate: A sentimental, a moralistic, and a heroic style of preaching.