Refugee and Forced Displacement Populations

Refugees are those who have fled their country of origin due to well-founded fears of persecution based on race, religion, nationality, political opinion, or a membership in a particular social group ¹.

Whereas refugees request protection while overseas and are given permission to enter the U.S., people seeking asylum seek protection from well-founded fear of persecution while inside the U.S. ¹.

There has been an unprecedented surge in the number of displaced people worldwide, which include refugees, asylum seekers, undocumented immigrants, and unaccompanied minors^{1, 2}.

Around the world, more than 65 million people are currently displaced by war, armed conflict, or persecution. As of early 2018, almost 31 million children worldwide were displaced by violence and conflict ¹.

Significant History—Events which Influenced the Community and Contextualize Assessment and Treatment

Refugees and other conflict-affected persons are reported to have a 15% to 30% prevalence of PTSD and depression, compared with the 3.5% prevalence of PTSD among non-refugee populations ¹.

Research shows that the strongest predictors of poor mental health among this population are exposure to torture and a cumulative number of traumatic events. Factors such as torture, separation from family, stressful asylum processes, isolation, and disadvantage in the host country have been shown to worsen mental health. The post-migration environment can also worsen mental health, including prolonged detention, insecure immigration status, poor access to services, and limitations on work and education ^1,2.

Conflict-affected persons also endure a multitude of emotional distress, including complicated grief, complex trauma, despair, isolation, anger, and lack of trust. Many people are experiencing normal responses to very abnormal experiences ¹.

Studies show that over time, most refugees show modest or no symptoms. A small number of refugees show a pattern of gradual recovery, and a small minority remain chronic ¹.

Psychiatrists may consider evaluating the distinction between situational forms of distress and a diagnosable mental disorder for refugees. This can be done by focusing on a dynamic interplay of exposure to past traumatic experiences, ongoing daily stressors, and the core psychosocial systems in which one is embedded ¹.

Best Practices

Psychiatrists can be of great service to refugees, asylum seekers, and other displaced populations at multidisciplinary levels. These include the following levels:

• Clinical, providing culturally competent mental health care, including conduction of asylum evaluations
• Advocacy, promoting equity of access, sustainability of services for refugees and forcibly displaced people, and
• Community, partnering with interdisciplinary community members such as lawyers, educators, and policy-makers to provide a health care system which can be safe and reliable for refugees and survivors of forced displacement.

References

1. American Psychiatric Association. 2020. Mental Health Facts on Refugees, Asylum-seekers, & Survivors of Forced Displacement (.pdf).
2. American Psychiatric Association. 2019. “Treating Undocumented Immigrants.” Stress & Trauma Toolkit for Treating Historically Marginalized Populations in a Changing Political and Social Environment.