Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Determinants of resource needs and utilization among refugees over time



This study examined refugees’ resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories.


Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms.


Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview.


Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

This is a preview of subscription content, log in to check access.


  1. 1.

    Martin DC (2011) Refugees and asylees: 2010. https://www.dhs.gov/xlibrary/assets/statistics/publications/ois_rfa_fr_2010.pdf

  2. 2.

    Wood R (2010) The political terror scale (PTS): a re-introduction and a comparison to the CIRI. Hum Rights Q 32(2):367–400

  3. 3.

    Yako RM, Biswas B (2014) “We came to this country for the future of our children. We have no future”: acculturative stress among Iraqi refugees in the United States. Int J Intercult Relat 38:133–141

  4. 4.

    Laban CJ, Gernaat HBPE, Komproe IH, De Jong JTVM (2007) Prevalence and predictors of health service use among Iraqi asylum seekers in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 42(10):837–844

  5. 5.

    Nielsen SS, Jensen NK, Kreiner S, Norredam M, Krasnik A (2015) Utilisation of psychiatrists and psychologists in private practice among non-Western labor immigrants, immigrants from refugee-generating countries and ethnic Danes: the role of mental health status. Soc Psychiatry Psychiatr Epidemiol 50:67–76

  6. 6.

    Taylor EM, Yanni EA, Pezzi C, Guterbock M, Rothney E, Harton E, Montour J, Elias C, Burke H (2014) Physical and mental health status of Iraqi refugees resettled into the United States. J Immigr Minor Health 16(6):1130–1137

  7. 7.

    Choi S, Davis C, Cummings S, Van Regenmorter C, Barnett M (2015) Understanding service needs and utilization among older Kurdish refugees and immigrants in the USA. Int Soc Work 58(1):63–74

  8. 8.

    Morris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC (2009) Healthcare barriers of refugees post-resettlement. J Community Health 34(6):529–538

  9. 9.

    Laban CJ, Komproe IH, Gernaat H, de Jong J (2008) The impact of a long asylum procedure on quality of life, disability and physical health in Iraqi asylum seekers in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 43(7):507–515

  10. 10.

    Ackerman L (1997) Health problems of refugees. J Am Board Fam Pract 10(5):337–348

  11. 11.

    Walker PF, Jaranson J (1999) Refugee and immigrant health care. Med Clin North Am 83(4):1103–1120

  12. 12.

    Porter M, Haslam N (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA 294(5):602–612

  13. 13.

    Maximova K, Krahn H (2010) Health status of refugees settled in Alberta: changes since arrival. Can J Public Health 101(4):322–326

  14. 14.

    Shoeb M, Weinstein H, Mollica R (2007) The Harvard Trauma Questionnaire: adapting a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Iraqi refugees. Int J Soc Psychiatr 53(5):447–463

  15. 15.

    Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA (1996) Psychometric properties of the PTSD checklist (PCL). Behav Res Ther 34(8):669–673

  16. 16.

    Ruggiero KJ, Del Ben K, Scotti JR, Rabalais AE (2003) Psychometric properties of the PTSD Checklist-Civilian Version. J Trauma Stress 16(5):495–502

  17. 17.

    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiat Scand 67(6):361–370

  18. 18.

    Cochran WG (1950) The comparison of percentages in matched samples. Biometrika 37(3/4):256–266

  19. 19.

    Office of Refugee Resettlement (2015) Health insurance. http://www.acf.hhs.gov/programs/orr/health

  20. 20.

    Nickerson A, Bryant RA, Schnyder U, Schick M, Mueller J, Morina N (2015) Emotion dysregulation mediates the relationship between trauma exposure, post-migration living difficulties and psychological outcomes in traumatized refugees. J Affect Disord 173:185–192

  21. 21.

    Alhasnawi S, Sadik S, Rasheed M et al (2009) The prevalence and correlates of DSM-IV disorders in the Iraq Mental Health Survey (IMHS). World Psychiatry 8(2):97–109

  22. 22.

    Lofvander M, Rosenblad A, Wilkund T, Bennstrom H, Leppert J (2014) A case-control study of self-reported health, quality-of-life and general functioning among recent immigrants and age- and sex-matched Swedish-born controls. Scand J Public Health 42(8):734–742

  23. 23.

    Slewa-Younan S, Guajardo MGU, Heriseanu A, Hasan T (2014) A systematic review of post-traumatic stress disorder amongst Iraqi refugees located in Western Countries. J Immigr Minor Health 17(4):1231–1239

  24. 24.

    Elsouhag D, Arnetz BB, Jamil H, Lumley MA, Broadbridge CL, Arnetz J (2014) Factors associated with healthcare utilization among Arab Immigrants and Iraqi Refugees. J Immigr Minor Health 17(5):1305–1312

  25. 25.

    Ciftci A, Jones N, Corrigan PW (2013) Mental health stigma in the Muslim community. J Muslim Ment Health 7(1):17–32

  26. 26.

    Kulwicki AD (2002) The practice of honor crimes: a glimpse of domestic violence in the Arab world. Issues Ment Health Nurs 23(1):77–87

  27. 27.

    Barkho E, Fakhouri M, Arnetz JE (2011) Intimate partner violence among Iraqi immigrant women in metro Detroit: a pilot study. J Immigr Minor Health 13(4):725–731

  28. 28.

    Erickson CD, Al-Timmi NR (2001) Providing mental health services to Arab Americans: recommendations and considerations. Cult Divers Ethn Minor Psychol 7(4):308–327

  29. 29.

    Youssef J, Deane FP (2006) Factors influencing mental-health help-seeking in Arabic-speaking communities in Sydney, Australia. Ment Health Relig Cult 9(1):43–66

  30. 30.

    Jenkins CN, Stephen TL, McPhee SJ, Stewart S, Ha NT (1996) Health care access and preventive care among Vietnamese immigrants: do traditional beliefs and practices pose barriers? Soc Sci Med 43(7):1049–1056

  31. 31.

    Sujoldzic A, Peternel L, Kulenovic T, Terzic R (2006) Social determinants of health—a comparative study of Bosnian adolescents in different cultural contexts. Coll Anthropol 30(4):703–711

  32. 32.

    Tinghog P, Hemmingsson T, Lundberg I (2007) To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors? Soc Psychiatry Psychiatr Epidemiol 42(12):990–996

Download references


This research was supported by a grant from the National Institute of Mental Health (NIMH, award number R01MH085793) and National Institute of Environmental Health Sciences (P30ES020957). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH, nor NIEHS. The authors wish to thank Yousif Talia, M.D., Evone Barkho, M.D., MPH, and Monty Fakhouri, M.S., for their work in collecting data and Mrs. Raja Yaldo for her help with data entry. Sincere thanks to Lutheran Social Services of Michigan, The Kurdish Human Rights Watch, and the Catholic Services of Macomb County for their assistance in participant recruitment. The authors also extend their gratitude to the refugees who participated in this study. Bengt Arnetz, Judith Arnetz, and Hikmet Jamil completed this work at Wayne State University, Detroit, Michigan, but have since moved to Michigan State University, East Lansing & Grand Rapids, Michigan.

Author information

Correspondence to A. Michelle Wright.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wright, A.M., Aldhalimi, A., Lumley, M.A. et al. Determinants of resource needs and utilization among refugees over time. Soc Psychiatry Psychiatr Epidemiol 51, 539–549 (2016). https://doi.org/10.1007/s00127-015-1121-3

Download citation


  • Refugees
  • Resource need
  • Resource utilization
  • PTSD
  • Depression