Exploring the relationship between post-migration life difficulties and mental health in asylum seekers and refugees: A Systematic Review

Problem

Research indicates that asylum seekers and refugees suffer from higher rates of mental health difficulties in comparison to the general population of host countries. The available literature provides only partial explanations for this phenomenon, and much of that research utilises quantitative methods of data synthesis. In order to improve our understanding of the psycho-social context that exacerbates mental ill-health in these populations, we are conducting a systematic review and Critical Interpretative Synthesis (CIS). The present systematic review aims to improve our understanding of post-migration life difficulties and their relationship to mental health in asylum seeking and refugee populations.

Approach

MEDLINE, Embase, Web of Science, PsychINFO, SocINDEX were searched using a pre-specified, comprehensive search strategy. The results derived from these searches were imported into DistillerSR (N=9366), and a 4-level screening was performed. All papers at all levels were screened by two independent researchers. Quality appraisal was conducted using COREQ guidelines (N=35). Papers were included if they focussed on (1) asylum seekers/refugees; (2) mental health; (3) reported qualitative data; (4) clearly addressed post-migration issues.

Findings

A total of 35 papers were included and synthesis is on-going. Most studies focus on depression, anxiety and/or PTSD, although only 12 include a clear reference to a diagnosis of at least one common mental health problem. Early findings indicate that the migration journey and experiences of the asylum process and related social issues, such as housing, lack of employment, poor access to healthcare, lack of social connections and family separations contribute to post-migration mental health difficulties. Asylum seekers’ and refugees’ recognition and conceptualisation of mental health and ill-health is often culturally shaped and may, therefore, differ from that of the health care professionals they encounter in high income health care systems. Access to mental health care may be mediated and shaped, amongst other factors, by these discrepancies between asylum seekers’ and refugees’ conceptualisation of mental health, and current service provision, which is rooted in diagnosis and categorisation (e.g. through the use of DSM categories). An additional challenge in the process of this review has been the different terminologies used to describe the migration status of participants in each study (e.g. asylum seekers, refugees, undocumented migrants, economic migrants etc.). We found that terms such as migrant or immigrant are, at times, erroneously used to refer to refugees and/or asylum seekers.

Consequences

The findings from this review can improve our understanding of the saliency of post-migration life difficulties on the mental health of asylum seekers and refugees resettled in high income countries. This has implications for general practitioners and other primary care and community-based mental health professionals, who are often the first point of contact for these patients.