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Long-term mental health of war-refugees: a systematic literature review.

Bogic M, Njoku A, Priebe S - BMC Int Health Hum Rights (2015)

Bottom Line: Studies of higher methodological quality generally reported lower prevalence rates.Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression.This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.

View Article: PubMed Central - PubMed

Affiliation: Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, E13 8SP, London, UK. m.bogic@qmul.ac.uk.

ABSTRACT

Background: There are several million war-refugees worldwide, majority of whom stay in the recipient countries for years. However, little is known about their long-term mental health. This review aimed to assess prevalence of mental disorders and to identify their correlates among long-settled war-refugees.

Methods: We conducted a systematic review of studies that assessed current prevalence and/or factors associated with depression and anxiety disorders in adult war-refugees 5 years or longer after displacement. We searched Medline, Embase, CINAHL, PsycINFO, and PILOTS from their inception to October 2014, searched reference lists, and contacted experts. Because of a high heterogeneity between studies, overall estimates of mental disorders were not discussed. Instead, prevalence rates were reviewed narratively and possible sources of heterogeneity between studies were investigated both by subgroup analysis and narratively. A descriptive analysis examined pre-migration and post-migration factors associated with mental disorders in this population.

Results: The review identified 29 studies on long-term mental health with a total of 16,010 war-affected refugees. There was significant between-study heterogeneity in prevalence rates of depression (range 2.3-80%), PTSD (4.4-86%), and unspecified anxiety disorder (20.3-88%), although prevalence estimates were typically in the range of 20% and above. Both clinical and methodological factors contributed substantially to the observed heterogeneity. Studies of higher methodological quality generally reported lower prevalence rates. Prevalence rates were also related to both which country the refugees came from and in which country they resettled. Refugees from former Yugoslavia and Cambodia tended to report the highest rates of mental disorders, as well as refugees residing in the USA. Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression.

Conclusions: There is a need for more methodologically consistent and rigorous research on the mental health of long-settled war refugees. Existing evidence suggests that mental disorders tend to be highly prevalent in war refugees many years after resettlement. This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.

No MeSH data available.


Related in: MedlinePlus

Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method
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Fig3: Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method

Mentions: Heterogeneity between studies remained high (I2 > 90 %) after stratifying for clinical and methodological characteristics of the studies. The subgroup analysis indicated that heterogeneity was partly explained by displacement duration (p = 0.017), host region (p = 0.004) and the language of the interviewer (p = 0.035). Reported rates of depression also showed gradual decline with increasing time since resettlement in a study country, although the difference was only approaching statistical significance (p = 0.073). Similarly, there were differences, although only approaching statistical significance, between studies with small and large sample sizes (p = 0.092). Prevalence rates of depression stratified by clinical and methodological characteristics are displayed with forest plots in Figs. 3–5.Fig. 3


Long-term mental health of war-refugees: a systematic literature review.

Bogic M, Njoku A, Priebe S - BMC Int Health Hum Rights (2015)

Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4624599&req=5

Fig3: Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method
Mentions: Heterogeneity between studies remained high (I2 > 90 %) after stratifying for clinical and methodological characteristics of the studies. The subgroup analysis indicated that heterogeneity was partly explained by displacement duration (p = 0.017), host region (p = 0.004) and the language of the interviewer (p = 0.035). Reported rates of depression also showed gradual decline with increasing time since resettlement in a study country, although the difference was only approaching statistical significance (p = 0.073). Similarly, there were differences, although only approaching statistical significance, between studies with small and large sample sizes (p = 0.092). Prevalence rates of depression stratified by clinical and methodological characteristics are displayed with forest plots in Figs. 3–5.Fig. 3

Bottom Line: Studies of higher methodological quality generally reported lower prevalence rates.Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression.This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.

View Article: PubMed Central - PubMed

Affiliation: Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, E13 8SP, London, UK. m.bogic@qmul.ac.uk.

ABSTRACT

Background: There are several million war-refugees worldwide, majority of whom stay in the recipient countries for years. However, little is known about their long-term mental health. This review aimed to assess prevalence of mental disorders and to identify their correlates among long-settled war-refugees.

Methods: We conducted a systematic review of studies that assessed current prevalence and/or factors associated with depression and anxiety disorders in adult war-refugees 5 years or longer after displacement. We searched Medline, Embase, CINAHL, PsycINFO, and PILOTS from their inception to October 2014, searched reference lists, and contacted experts. Because of a high heterogeneity between studies, overall estimates of mental disorders were not discussed. Instead, prevalence rates were reviewed narratively and possible sources of heterogeneity between studies were investigated both by subgroup analysis and narratively. A descriptive analysis examined pre-migration and post-migration factors associated with mental disorders in this population.

Results: The review identified 29 studies on long-term mental health with a total of 16,010 war-affected refugees. There was significant between-study heterogeneity in prevalence rates of depression (range 2.3-80%), PTSD (4.4-86%), and unspecified anxiety disorder (20.3-88%), although prevalence estimates were typically in the range of 20% and above. Both clinical and methodological factors contributed substantially to the observed heterogeneity. Studies of higher methodological quality generally reported lower prevalence rates. Prevalence rates were also related to both which country the refugees came from and in which country they resettled. Refugees from former Yugoslavia and Cambodia tended to report the highest rates of mental disorders, as well as refugees residing in the USA. Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression.

Conclusions: There is a need for more methodologically consistent and rigorous research on the mental health of long-settled war refugees. Existing evidence suggests that mental disorders tend to be highly prevalent in war refugees many years after resettlement. This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.

No MeSH data available.


Related in: MedlinePlus