RPMS: Validating Post-Migration Stress in Resettled Syrian Refugees

Results

Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.

In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.

Conclusions

The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.

With an unprecedented 70.8 million forcibly displaced people worldwide, the global crisis for those who are forced to leave their homes as a result of conflict and persecution shows no signs of abating. Of the displaced, nearly 25.9 million have crossed a border into another country, hence making them refugees according to international law, while another 3.5 million are asylum seekers [1]. Refugees typically have experiences of war, persecution and loss, with potentially traumatic events occurring both in the country of origin and during migration [2]. While living conditions for those refugees who end up in neighboring countries are often harsh, resettling in a socially and culturally unfamiliar country far from home may pose significant challenges of other kinds, laying additional burden on individuals who are already exposed to numerous risk factors. Elevated prevalence rates for mental ill health in refugee groups compared to the general population have been shown in several studies [3, 4]. Although reported rates vary substantially between different studies and population, it remains clear that refugees are at risk for developing long-lasting psychological disorders, such as post-traumatic stress disorder (PTSD), anxiety and depression [5, 6].

Historically, the primary focus in research has been on pre-migratory and trauma-related risk factors and their impact on refugees’ mental health, but recent years has seen a shift of focus towards the health implications of the living conditions that refugees face after resettlement in the host country (for a comprehensive review, see Li et al. [7]). In the same vein, post-resettlement factors have even been suggested to be of potentially greater importance than pre-migratory conditions for refugees’ mental health [4, 8, 9]. However, despite the increased attention given to the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress and a validated measure for assessing post-migration stress among refugees are still lacking.

Several different types of resettlement experiences have been shown to be associated with mental ill health among refugees and migrants. These experiences include perceived discrimination [10, 11], low host-country language skills [12], being separated from family [9, 13], uncertainty relating to asylum application [8, 14], financial difficulties and unemployment [12, 15], lack of private accommodation [4], social isolation [16], loss of status [17, 18], poor social support [14, 19], and conflicts between spouses or parents and children [20, 21].

In general, there is ample evidence that socioeconomic adversities and disadvantaged living conditions are linked to mental ill health [22, 23]. The account of poor socioeconomic living conditions as causal agents inserting significant impact on mental ill health has been outlined as the social causation hypothesis [24]. This causal link may be viewed as asserting an indirect impact, e.g., through the poverty-based lack of access to healthcare services [25]. Another plausible pathway is through the impact mediated by psychosocial stress generated by the poor socioeconomic conditions [26, 27]. The psychosocial stress pathway has specifically been used to explain ethnicity-based health disparities [28]. By incorporating facets such as perceived racism [29] and social status incongruency [30], the psychosocial stress pathway appears to be applicable to post-resettlement living conditions of refugees.