title: Migration experiences, employment status and psychological distress among Somali immigrants: a mixed-method international study.
abstract: BACKGROUND
  The discourse about mental health problems among migrants and refugees tends to focus on adverse pre-migration experiences; there is less investigation of the environmental conditions in which refugee migrants live, and the contrasts between these situations in different countries. This cross-national study of two samples of Somali refugees living in London (UK) and Minneapolis, Minnesota, (USA) helps to fill a gap in the literature, and is unusual in being able to compare information collected in the same way in two cities in different countries.
  
  
  METHODS
  There were two parts to the study, focus groups to gather in-depth qualitative data and a survey of health status and quantifiable demographic and material factors. Three of the focus groups involved nineteen Somali professionals and five groups included twenty-eight lay Somalis who were living in London and Minneapolis. The quantitative survey was done with 189 Somali respondents, also living in London and Minneapolis. We used the MINI International Neuropsychiatric Interview (MINI) to assess ICD-10 and DSM-IV mental disorders.
  
  
  RESULTS
  The overall qualitative and quantitative results suggested that challenges to masculinity, thwarted aspirations, devalued refugee identity, unemployment, legal uncertainties and longer duration of stay in the host country account for poor psychological well-being and psychiatric disorders among this group.
  
  
  CONCLUSIONS
  The use of a mixed-methods approach in this international study was essential since the quantitative and qualitative data provide different layers and depth of meaning and complement each other to provide a fuller picture of complex and multi-faceted life situations of refugees and asylum seekers. The comparison between the UK and US suggests that greater flexibility of access to labour markets for this refugee group might help to promote opportunities for better integration and mental well-being.
authors.affiliation: Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, E1M B6Q, UK. n.warfa@qmul.ac.uk
authors.forename: Nasir
authors.initials: N
authors.lastname: Warfa
authors.forename: Sarah
authors.initials: S
authors.lastname: Curtis
authors.forename: Charles
authors.initials: C
authors.lastname: Watters
authors.forename: Ken
authors.initials: K
authors.lastname: Carswell
authors.forename: David
authors.initials: D
authors.lastname: Ingleby
authors.forename: Kamaldeep
authors.initials: K
authors.lastname: Bhui
mesh_terms: D000328:Adult; D000368:Aged; D004517:Education, Professional; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006304:Health Status; D006801:Humans; D007406:Interview, Psychological; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012998:Somalia / Q000208:ethnology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D014171:Transients and Migrants / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult