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The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers

  • Disaster Psychiatry: Trauma, PTSD, and Related Disorders (E Foa and A Asnaani, Section Editors)
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Abstract

Refugees demonstrate high rates of post-traumatic stress disorder (PTSD) and other psychological disorders. The recent increase in forcible displacement internationally necessitates the understanding of factors associated with refugee mental health. While pre-migration trauma is recognized as a key predictor of mental health outcomes in refugees and asylum seekers, research has increasingly focused on the psychological effects of post-migration stressors in the settlement environment. This article reviews the research evidence linking post-migration factors and mental health outcomes in refugees and asylum seekers. Findings indicate that socioeconomic, social, and interpersonal factors, as well as factors relating to the asylum process and immigration policy affect the psychological functioning of refugees. Limitations of the existing literature and future directions for research are discussed, along with implications for treatment and policy.

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Correspondence to Angela Nickerson.

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Susan S. Y. Li, Belinda J. Liddell, and Angela Nickerson declare that they have no conflict of interest.

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This article is part of the Topical Collection on Disaster Psychiatry: Trauma, PTSD, and Related Disorders

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Li, S.S.Y., Liddell, B.J. & Nickerson, A. The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers. Curr Psychiatry Rep 18, 82 (2016). https://doi.org/10.1007/s11920-016-0723-0

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