title: Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees.
abstract: BACKGROUND
  Refugees have been shown to present high prevalence rates of trauma-related mental disorders. Despite their psychological impairment, they are expected to meet high functional requirements in terms of social integration into, and financial independence from, the host society.
  
  
  METHODS
  This cross-sectional study examined the relationship of mental health problems, post-migration living difficulties (PMLD), and social integration in a sample of 104 refugees seeking treatment for severe posttraumatic stress and comorbid symptoms in two outpatient clinics in Switzerland.
  
  
  RESULTS
  Despite an average time of residence in Switzerland of over 10 years, participants showed poor integration and a high number of PMLD. Integration difficulties were closely associated with psychological symptoms, but not with socio-demographic parameters such as education or visa status.
  
  
  CONCLUSIONS
  Psychological impairment in treatment-seeking traumatized refugees is associated with poor integration. To foster social integration, it is crucial to better understand and address the specific needs of this highly vulnerable population.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland.|Faculty of Medicine, University of Zurich, Zurich, Switzerland; matthis.schick@usz.ch.
authors.forename: Matthis
authors.initials: M
authors.lastname: Schick
authors.affiliation: Faculty of Medicine, University of Zurich, Zurich, Switzerland.|Outpatient Clinic for Victims of Torture and War, Swiss Red Cross, Bern, Switzerland.
authors.forename: Andre
authors.initials: A
authors.lastname: Zumwald
authors.affiliation: Department of Psychology, University of Bern, Bern, Switzerland.
authors.forename: Bina
authors.initials: B
authors.lastname: Knöpfli
authors.affiliation: School of Psychology, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Nickerson
authors.affiliation: School of Psychology, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland.|Faculty of Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schnyder
authors.affiliation: Psychiatric Services Thurgau, Münsterlingen, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Müller
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland.|Faculty of Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Naser
authors.initials: N
authors.lastname: Morina
keywords: Integration; PTSD; mental health; migration; post-migration living difficulties; posttraumatic stress; refugees