title: The Psychological Consequences of Pre-Emigration Trauma and Post-Migration Stress in Refugees and Immigrants from Africa.
abstract: Over 50 million people have been displaced, some as a result of conflict, which exposure can lead to psychiatric sequelae. The aims of this study were to provide estimates of pre-emigration trauma, post-migration stress, and psychological sequelae of immigrants and refugees from predominantly Sub-Saharan Africa who immigrated to Sweden. We also examined the predictors of the psychiatric sequelae as well as acculturation within the host country. A total of 420 refugees and immigrants were enrolled using stratified quota sampling. A battery of questionnaires including the Harvard Trauma Questionnaire, Post-Migration Living Difficulties Scale, the Cultural Lifestyle Questionnaire; and the Hopkins Checklist were administered. Descriptive statistics, Chi square analyses, Pearson correlations, analysis of variance, and logistic and linear regression were performed to test the aims of the study. Eighty-nine percent of participants reported at least one traumatic experience prior to emigration. Forty-seven percent of refugees reported clinically significant PTSD and 20 % reported clinically significant depressive symptoms. Males reported a significantly greater number of traumatic events [F(1, 198) = 14.5, p < 0.001] and post-migration stress than females [F(1, 414) = 5.3, p = 0.02], particularly on the financial, discrimination, and healthcare subscales. Females reported a higher prevalence of depressive symptoms when compared to males [F(1, 419) = 3.9, p = 0.05]. Those with a shorter duration in Sweden reported higher rates of PTSD [F(63, 419) = 1.7, p < 0.001]. The greater number of traumatic events was found to be significantly associated with the severity of PTSD symptoms [F(34, 419) = 9.6, p < 0.001]. Using regression analysis, 82 and 83 % of the variances associated with anxiety and depression, respectively, was explained by gender, education, religion, PTSD and post-migration stress. Sixty-nine percent of the variance associated with PTSD included education, number of traumatic events, depressive symptoms and post-migration stress. Forty-seven percent of the variance for acculturation was accounted for by a model that included age, education, duration in Sweden, anxiety, depression, and post-migration stress. These predictors were also significant for employment status with the exception of depressive symptoms. Multidimensional interventions that provide treatments to improve psychiatric symptoms in combination with advocacy and support to reduce stress (e.g., financial, access to health care) are recommended. The focus of the intervention may also be modified based on the gender of the participants.
authors: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. steeljl@upmc.edu.
authors: Jennifer L
authors: JL
authors: Steel
authors: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
authors: Andrea C
authors: AC
authors: Dunlavy
authors: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
authors: Collette E
authors: CE
authors: Harding
authors: Department of Neuroscience Karolinska Institute, Karolinska Institutet, 171 77, Stockholm, Sweden.
authors: Töres
authors: T
authors: Theorell
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000523:psychology*; D004641:Emigration and Immigration; D004651:Employment / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000208:ethnology*; D008875:Middle Aged; D000067073:Psychological Trauma / Q000208:ethnology; D063505:Racism / Q000208:ethnology; D012036:Refugees / Q000523:psychology*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology; D040921:Stress Disorders, Traumatic / Q000208:ethnology*; D013315:Stress, Psychological / Q000208:ethnology*; D013548:Sweden / Q000453:epidemiology; D000069756:Undocumented Immigrants / Q000523:psychology; D014857:Warfare; D055815:Young Adult
keywords: Acculturation; Depression; PTSD; Post-migration stress; Refugees; Trauma