Since 2000, over 600,000 refugees have been settled throughout the U.S., coming from countries as disparate as the former Soviet Union, Somalia, and Vietnam. The often traumatic reasons for leaving the host country as well as the potentially long and hazardous journey and process of resettlement increase the risk for refugees to suffer from a variety of mental health issues. While the screening for and treatment of infectious diseases has been studied and practiced for decades, the identification and treatment of mental health problems has lagged far behind. Complex and varied cultural contexts and languages, scattered refugee populations, and the relative lack of evidence-based interventions have made it difficult to carry out concerted and standardized efforts.
The more common mental health diagnoses associated with refugee populations include post-traumatic stress disorder (PTSD), major depression, generalized anxiety, panic attacks, adjustment disorder, and somatization. The incidence of diagnoses varies with different populations and their experiences. Different studies have shown rates of PTSD and major depression in settled refugees to range from 10-40% and 5-15%, respectively. Children and adolescents often have higher levels with various investigations revealing rates of PTSD from 50-90% and major depression from 6-40%. Risk factors for the development of mental health problems include the number of traumas, delayed asylum application process, detention, and the loss of culture and support systems.
Traditionally the refugee experience is divided into three categories: preflight, flight, and resettlement. The preflight phase may include, for example, physical and emotional trauma to the individual or family, the witnessing of murder, and social upheaval. Adolescents may also have participated in violence, voluntarily or not, as child soldiers or militants. Flight involves an uncertain journey from the host country to the resettlement site and may involve arduous travel, refugee camps, and/or detention centers. Children and adolescents are often separated from their families and at the mercy of others for care and protection. The resettlement process includes challenges such as the loss of culture, community, and language as well as the need to adapt to a new and foreign environment. Children often straddle the old and new cultures as they learn new languages and cultural norms more quickly than their elders. All of these experiences may play a role in the acquisition of, or protection from mental health conditions in each individual within a refugee population.
There are many challenges in the detection and effective treatment of mental health problems in refugees. Often language and cultural barriers and biases, whether of the refugee or the provider, can hinder identification of problems and the development of a therapeutic relationship. Furthermore, there is little evidence for the efficacy of any particular treatment strategy. Much work remains to be done to develop culturally competent means of screening refugees for mental health issues and then implementing evidence-based interventions, both at an individual and community level, for these common and frequently debilitating diagnoses.
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