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Cited by 1,166Migration, Health and TraumaMental Health Treatment and AccessPosttraumatic Stress Disorder Research

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Long-term mental health of war-refugees: a systematic literature review

Open access
Bogic, Marija, Njoku, Anthony, Priebe, Stefan·2015·BMC International Health and Human Rights
DOI 10.1186/s12914-015-0064-9PMC PMC4624599
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Abstract

BACKGROUND: There are several million war-refugees worldwide, majority of whom stay in the recipient countries for years. However, little is known about their long-term mental health. This review aimed to assess prevalence of mental disorders and to identify their correlates among long-settled war-refugees. METHODS: We conducted a systematic review of studies that assessed current prevalence and/or factors associated with depression and anxiety disorders in adult war-refugees 5 years or longer after displacement. We searched Medline, Embase, CINAHL, PsycINFO, and PILOTS from their inception to October 2014, searched reference lists, and contacted experts. Because of a high heterogeneity between studies, overall estimates of mental disorders were not discussed. Instead, prevalence rates were reviewed narratively and possible sources of heterogeneity between studies were investigated both by subgroup analysis and narratively. A descriptive analysis examined pre-migration and post-migration factors associated with mental disorders in this population. RESULTS: The review identified 29 studies on long-term mental health with a total of 16,010 war-affected refugees. There was significant between-study heterogeneity in prevalence rates of depression (range 2.3-80%), PTSD (4.4-86%), and unspecified anxiety disorder (20.3-88%), although prevalence estimates were typically in the range of 20% and above. Both clinical and methodological factors contributed substantially to the observed heterogeneity. Studies of higher methodological quality generally reported lower prevalence rates. Prevalence rates were also related to both which country the refugees came from and in which country they resettled. Refugees from former Yugoslavia and Cambodia tended to report the highest rates of mental disorders, as well as refugees residing in the USA. Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression. CONCLUSIONS: There is a need for more methodologically consistent and rigorous research on the mental health of long-settled war refugees. Existing evidence suggests that mental disorders tend to be highly prevalent in war refugees many years after resettlement. This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.

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Crossref · 10.1186/s12914-015-0064-9

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Fig. 1 Flowchart of study selection
Fig. 1 Flowchart of study selectionCC BY · PubMed Central
Fig. 2 Forest plot of prevalence rates (%, with 95 % CI) of depression in long-settled war refugees in individual studies. For each study, only the name of the first author is shown
Fig. 2 Forest plot of prevalence rates (%, with 95 % CI) of depression in long-settled war refugees in individual studies. For each study, only the name of the first author is shownCC BY · PubMed Central
Fig. 3 Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method
Fig. 3 Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic methodCC BY · PubMed Central
Fig. 4 Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study and refugee characteristics: interview language, publication decade, origin regiona, and gender. a ‘Europe’ includes former Yugoslavia. ‘Middle East & Africa’ includes Liberia, Somalia, and Sudan. ‘Southeast Asia’ includes Cambodia, Laos, and Vietnam. ‘Other’ includes Guatemala and mixed country of origin samples
Fig. 4 Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study and refugee characteristics: interview language, publication decade, origin regiona, and gender. a ‘Europe’ includes former Yugoslavia. ‘Middle East & Africa’ includes Liberia, Somalia, and Sudan. ‘Southeast Asia’ includes Cambodia, Laos, and Vietnam. ‘Other’ includes Guatemala and mixed country of origin samplesCC BY · PubMed Central
Fig. 5 Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by refugee characteristics: host regiona, displacement and resettlement duration. a‘Europe’ includes France, Germany, Italy, Netherlands, and United Kingdom. ‘Other Western’ includes Canada and Australia. ‘Other’ includes refugee camps in Mexico and on Thailand-Cambodia border
Fig. 5 Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by refugee characteristics: host regiona, displacement and resettlement duration. a‘Europe’ includes France, Germany, Italy, Netherlands, and United Kingdom. ‘Other Western’ includes Canada and Australia. ‘Other’ includes refugee camps in Mexico and on Thailand-Cambodia borderCC BY · PubMed Central
Fig. 6 Forest plot of prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees in individual studies
Fig. 6 Forest plot of prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees in individual studiesCC BY · PubMed Central
Fig. 7 Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling method, and interview language
Fig. 7 Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling method, and interview languageCC BY · PubMed Central
Fig. 8 Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by study and refugee characteristics: publication decade, origin regiona and gender. a ‘Southeast Asia’ includes Cambodia, Laos, Sri Lanka, and Vietnam. ‘Middle East & Africa’ includes Afghanistan, Iran, Somalia, and Sudan. ‘Other’ includes Guatemala, Bosnia, and mixed country of origin samples
Fig. 8 Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by study and refugee characteristics: publication decade, origin regiona and gender. a ‘Southeast Asia’ includes Cambodia, Laos, Sri Lanka, and Vietnam. ‘Middle East & Africa’ includes Afghanistan, Iran, Somalia, and Sudan. ‘Other’ includes Guatemala, Bosnia, and mixed country of origin samplesCC BY · PubMed Central
Fig. 9 Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by refugee characteristics: host regiona, displacement and resettlement duration. a ‘Europe’ includes France, The Netherlands, and United Kingdom. ‘Other’ includes Mexico
Fig. 9 Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by refugee characteristics: host regiona, displacement and resettlement duration. a ‘Europe’ includes France, The Netherlands, and United Kingdom. ‘Other’ includes MexicoCC BY · PubMed Central
Fig. 10 Forest plot of prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees in individual studies. For each study, only the name of the first author is shown
Fig. 10 Forest plot of prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees in individual studies. For each study, only the name of the first author is shownCC BY · PubMed Central
Fig. 11 Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method
Fig. 11 Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic methodCC BY · PubMed Central
Fig. 12 Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by study and refugee characteristics: interview language, publication decade, region of origin, and gender. a ‘Europe’ includes former Yugoslavia. ‘Middle East & Africa’ includes Afghanistan, Ethiopia, Iran, Rwanda, and Somalia. ‘Southeast Asia’ includes Cambodia, Indonesia, Laos, Sri Lanka, and Vietnam. ‘Other’ includes Guatemala and mixed country of origin samples
Fig. 12 Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by study and refugee characteristics: interview language, publication decade, region of origin, and gender. a ‘Europe’ includes former Yugoslavia. ‘Middle East & Africa’ includes Afghanistan, Ethiopia, Iran, Rwanda, and Somalia. ‘Southeast Asia’ includes Cambodia, Indonesia, Laos, Sri Lanka, and Vietnam. ‘Other’ includes Guatemala and mixed country of origin samplesCC BY · PubMed Central
Fig. 13 Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by refugee characteristics: host region, displacement and resettlement duration,. a ‘Europe’ includes Germany, The Netherlands, Norway, and United Kingdom. ‘Other Western’ includes Australia and Canada. ‘Other’ includes refugee camps in Mexico, Uganda and on Thailand-Cambodia border
Fig. 13 Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by refugee characteristics: host region, displacement and resettlement duration,. a ‘Europe’ includes Germany, The Netherlands, Norway, and United Kingdom. ‘Other Western’ includes Australia and Canada. ‘Other’ includes refugee camps in Mexico, Uganda and on Thailand-Cambodia borderCC BY · PubMed Central

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Show all 111 references

Research works printed but not linked: 5

  1. UNHCR. 2014 Global Trends: World at War. Geneva: United Nations High Commissioner for Refugees; 2015.
  2. Bowling A. Research Methods in Health: Investigating health and health services. Philadelphia: Open University Press; 2002.
  3. Buseh AG, McElmurry BJ, Fox PG. Acculturative stress and depressed mood among Liberian men residing in a large U.S. Midwestern city. Int J Psychiatr Nurs Res. 2000;6:695–713.
  4. Department of Economic and Social Affairs (DESA). World Economic and Social Survey 2004: International Migration. New York: United Nations; 2004.
  5. Kühne P, Rüßler H. Die Lebensverhältnisse der Flüchtlinge in Deutschland [The living conditions of refugees in Germany]. Campus-Verlag: Frankfurt; 2000.

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Metadata

Authors
Bogic, M., Njoku, A., & Priebe, S.
Affiliations
  • Horizon Health Network (CA)
  • Queen Mary University of London (GB)
ORCID
Venue
BMC International Health and Human Rights
Publisher
Springer Science and Business Media LLC
Published
2015-10-28
Volume
15
Issue
1
Pages
29-29
ISSN
1472-698X (ISSN-L)
DOI
10.1186/s12914-015-0064-9
PMC
PMC4624599
OpenAlex
W1948339546
Cited by
1,166
References
111
Citations by year
2026: 84 · 2025: 158 · 2024: 133 · 2023: 145 · 2022: 159 · 2021: 105 · 2020: 163 · 2019: 88 · 2018: 70 · 2017: 44 · 2016: 14
FWCI
6.12
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC International Health and Human Rights (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
Funders
Queen Mary University of London
Topics
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
war refugees, long-term mental health, depression, anxiety disorders, post-traumatic stress disorder, prevalence of mental disorders, pre-migration trauma, post-migration stressors, socioeconomic status, resettlement, Cambodian refugees
MeSH terms
War Exposure, Armed Conflicts, Adult, Anxiety Disorders, Depression, Humans, Mental Health, Refugees, Risk Factors, Social Class, Stress, Psychological, Time Factors, Internationality

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