Refugees living with high levels of PTSD and depression

A comprehensive study of mental health of refugees both in Australia and internationally has found almost one third experience posttraumatic stress disorder (PTSD) and depression – which is almost eight times that in the general population for PTSD and almost three times the prevalence of depression in the general population.

Importantly the study found that the prevalence of PTSD and depression persists for years post-displacement, highlighting the need for long term mental health support for refugee communities.

The Monash University led study, in conjunction with leading refugee psychiatrist from Oxford University, Associate Professor Mina Fazel, conducted a review of 26 studies and trials across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406) – was published in the prestigious journal, PLOS Medicine.

The lead authors were Dr Melanie Gibson-Helm and PhD student Rebecca Blackmore, from the Monash Centre for Health Research and Implementation within the School of Public Health and Preventive Medicine. Together with their team, they found that refugees have high and persistent rates of PTSD and depression, “highlighting the need for ongoing, long-term mental health care beyond the initial period of resettlement because the PTSD and depression appears to persist for many years after displacement”.

According to Dr Gibson-Helm, the changing nature of forced displacement and record numbers of refugees and asylum seekers, even before the COVID-19 pandemic, raises the importance of having adequate mental health data relating to refugees. “Accurate prevalence information is a powerful tool for advocacy and can also assist host countries and humanitarian agencies to strengthen health services and provide the essential components of timely diagnosis and treatment for mental illnesses,” which is in line with the priorities and objectives of the World Health Organization (WHO) Draft Global Action Plan ‘Promoting the health of refugees and migrants’ (2019–2023), she said.

Such figures would assist in planning and provision of long term mental health plans for refugees, “which has long-term benefits for the social and economic capital of that country, which will likely impact not only the displaced generation but the second generation as well,” the paper argues.

Interestingly the study found that the prevalence of anxiety disorders (11%) and psychosis (1.5%) in refugees and asylum seekers appears to be less than the lifetime prevalence in general population samples, however there were few studies looking at these conditions.

Populations from Africa reported the highest prevalence of PTSD. This result likely reflects how countries within Africa are consistently ranked at the highest levels of the Political Terror Scale from Amnesty International and the US State Department which measures the levels of extensive human rights violations and violence within nations.

The study also found that refugee populations from Europe, which mostly consisted of individuals from the former Yugoslavia, had the highest prevalence of depression, and the Middle East refugee populations had the highest prevalence of anxiety.

The persistence of PTSD and depression many years post displacement, according to the authors, suggests “ongoing suffering from mental illnesses in the postmigration environment. This environment can include complexities of social and cultural isolation, reconfigured family relationships, difficulties adjusting to life in a foreign country, and often limited opportunities to contribute economically and socially to their new communities.”

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