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Cited by 89Migration, Health and TraumaMigration, Refugees, and IntegrationCOVID-19 and Mental Health

The refugee post-migration stress scale (RPMS) – development and validation among refugees from Syria recently resettled in Sweden

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Malm, Andreas, Tinghög, Petter, Narusyte, Jurgita, Saboonchi, Fredrik·2020·Conflict and Health
DOI 10.1186/s13031-019-0246-5PMC PMC6945710
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Abstract

Abstract Background Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among 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.

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  • Additional post-migration stressors frequently experienced in host countries (e.g., discrimination, poor living conditions, new cultural context, language barriers) are associated with worse mental health among refugees.

    “Additional post-migration stressors frequently experienced in the host countries (e.g., discrimination, poor living conditions, new cultural context, and language barriers) pose further challenges for refugees and are also associated with worse mental health (Tinghög et al., 2017; Malm et al., 2020).”

    From Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature (2023) · cites this paper as Malm et al., 2020

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References 65 · Cited by 89

Research works printed but not linked: 44

  1. [2]Tinghög P Malm A Arwidson C Sigvardsdotter E Lundin A Saboonchi F Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey BMJ Open 2017 7 12 e018899 PMC5778338 29289940
  2. [3]Fazel M Wheeler J Danesh J Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review Lancet (London, England) 2005 365 9467 1309 1314 15823380
  3. [4]Porter M Haslam N Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons - a meta-analysis Jama-J Am Med Assoc 2005 294 5 602 612 16077055
  4. [6]Steel Z Chey T Silove D Marnane C Bryant RA van Ommeren M Association of Torture and Other Potentially Traumatic Events with Mental Health Outcomes among Populations Exposed to mass conflict and displacement a systematic review and meta-analysis Jama-J Am Med Assoc 2009 302 5 537 549 19654388
  5. [8]Chu T Keller AS Rasmussen A Effects of post-migration factors on PTSD outcomes among immigrant survivors of political violence J Immigr Minor Health 2013 15 5 890 897 22976794
  6. [9]Schweitzer RD Brough M Vromans L Asic-Kobe M Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience Aust N Z J Psych 2011 45 4 299 307 21303193
  7. [10]Noh S Beiser M Kaspar V Hou F Rummens J Perceived racial discrimination, depression, and coping: a study of southeast Asian refugees in Canada J Health Soc Behav 1999 40 3 193 207 10513144
  8. [12]Beiser M Hou F Language acquisition, unemployment and depressive disorder among southeast Asian refugees: a 10-year study Soc Sci Med 2001 53 10 1321 1334 11676403
  9. [13]Nickerson A Bryant RA Steel Z Silove D Brooks R The impact of fear for family on mental health in a resettled Iraqi refugee community J Psychiatr Res 2010 44 4 229 235 19875131
  10. [14]Laban CJ Komproe IH Gernaat H de Jong J 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 2008 43 7 507 515 18560785
  11. [15]Tinghög P Al-Saffar S Carstensen J Nordenfelt L The association of immigrant- and non-immigrant-specific factors with mental ill health among immigrants in Sweden Int J Soc Psychiatry 2010 56 1 74 93 19592449
  12. [16]Gorst-Unsworth C Goldenberg E Psychological sequelae of torture and organised violence suffered by refugees from Iraq - trauma-related factors compared with social factors in exile Br J Psychiatry 1998 172 90 94 9534840
  13. [17]Lindencrona F Ekblad S Hauff E Mental health of recently resettled refugees from the Middle East in Sweden: the impact of pre-resettlement trauma, resettlement stress and capacity to handle stress Soc Psychiatry Psychiatr Epidemiol 2008 43 2 121 131 18060523
  14. [18]Carta MG Bernal M Hardoy MC Haro-Abad JM Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1) Clin Pract Epidemiol Menta Health: CP & EMH 2005 1 1 13 PMC1236945 16135246
  15. [19]Schweitzer R Melville F Steel Z Lacherez P Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees Aust N Z J Psych. 2006 40 2 179 187 16476137
  16. [21]Wong S Yoo G Stewart A An empirical evaluation of social support and psychological well-being in older Chinese and Korean immigrants Ethn Health 2007 12 1 43 67 17132584
  17. [22]Silva M Loureiro A Cardoso G Social determinants of mental health: a review of the evidence Eur J Psychiatry 2016 30 4 259 292
  18. [24]Hudson CG Socioeconomic status and mental illness: tests of the social causation and selection hypotheses Am J Orthopsychiatry 2005 75 1 3 18 15709846
  19. [25]Wahlbeck K Cresswell-Smith J Haaramo P Parkkonen J Interventions to mitigate the effects of poverty and inequality on mental health Soc Psychiatry Psychiatr Epidemiol 2017 52 5 505 514 28280872
  20. [26]Beckie TM A systematic review of Allostatic load, health, and health disparities Biol Res Nurs 2012 14 4 311 346 23007870
  21. [30]Lundberg J Kristenson M Starrin B Status incongruence revisited: associations with shame and mental wellbeing Sociol Health Illn 2009 31 4 478 493 19144081
  22. [31]Silove D Steel Z McGorry P Mohan P Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants Acta Psychiatr Scand 1998 97 3 175 181 9543304
  23. [33]Lazarus RS. Stress and emotion: a new synthesis. New York: Springer Publishing Company; 2006.
  24. [35]Holm JE, Holroyd KA. The daily hassles scale (revised): does it measure stress or symptoms? Behavioral assessment. 1992;14(3-4):465–482.
  25. [36]Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11(2):213–218. 6059863
  26. [37]Spinelli E The interpreted world: an introduction to phenomenological psychology 2005 London Sage Publications
  27. [38]Aroian KJ Norris AE Tran TV Schappler-Morris N Development and psychometric evaluation of the demands of immigration scale J Nurs Meas 1998 2 175 194 10028782
  28. [39]Muller MJ Zink S Koch E Assessment of perceived stress related to migration and acculturation in patients with psychiatric disorders (MIGSTR10)-development, reliability, and dimensionality of a brief instrument Psychiatry Q 2017 88 3 473 483 27558563
  29. [43]Sigvardsdotter E, Nilsson H, Malm A, Tinghög P, Gottvall M, Vaez M, et al. Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC)—A Brief Checklist for Survey Studies. Int J Enviro Res Public Health. 2017;14(10). PMC5664676 28976937
  30. [44]Collins D Pretesting survey instruments: an overview of cognitive methods Qual Life Res 2003 12 3 229 238 12769135
  31. [45]Drennan J Cognitive interviewing: verbal data in the design and pretesting of questionnaires J Adv Nurs 2003 42 1 57 63 12641812
  32. [47]Lynn RM Determination and quantification of content validity Nurs Res 1986 35 6 382 386 3640358
  33. [48]Polit DF Beck CT Owen SV Is the CVI an acceptable indicator of content validity? Appraisal and recommendations Res Nurs Health. 2007 30 4 459 467 17654487
  34. [50]Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500. 3565621
  35. [52]Brown TA. Confirmatory factor analysis for applied research: Second Edition: Guilford Publications; 2015.
  36. [54]Marsh HW, Morin AJS, Parker PD, Kaur G. Exploratory Structural Equation Modeling: An Integration of the Best Features of Exploratory and Confirmatory Factor Analysis. Annual Review of Clinical Psychology. 10(1):85–110. 24313568
  37. [56]Tarka P An overview of structural equation modeling: its beginnings, historical development, usefulness and controversies the social sciences Qual Quant 2018 52 1 313 354 29416184 PMC5794813
  38. [59]Jennrich RI Bentler PM Exploratory bi-factor analysis Psychometrika. 2011 76 4 537 549 22232562 PMC3253271
  39. [60]Kessler RC McGonagle KA Zhao S Nelson CB Hughes M Eshleman S Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey Arch Gen Psychiatry 1994 51 1 8 19 8279933
  40. [61]Krahn H Derwing T Mulder M Wilkinson L Educated and underemployed: refugee integration into the Canadian labour market Journal of International Migration and Integration / Revue de l'integration et de la migration internationale 2000 1 1 59 84
  41. [62]Kim I Beyond trauma: post-resettlement factors and mental health outcomes among Latino and Asian refugees in the United States J Immigr Minor Health 2016 18 4 740 748 26169507
  42. [63]Blair RG Risk factors associated with PTSD and major depression among Cambodian refugees in Utah Health & Social Work 2000 25 1 23 30 10689600
  43. [64]Edelen M Reeve O Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement Quality of Life Research 2007 16 Supplement 1 5 18 17375372
  44. [65]Tavakol M Dennick R Making sense of Cronbach's alpha Int J Med Educ 2011 2 53 55 28029643 PMC4205511

Authors
Malm, A., Tinghög, P., Narusyte, J., & Saboonchi, F.
Affiliations
  • Röda Korsets Högskola (SE)
  • Karolinska Institutet (SE)
Corresponding author
Malm, Andreas
ORCID
Venue
Conflict and Health
Publisher
Springer Science and Business Media LLC
Published
2020-01-06
Volume
14
Issue
1
Pages
2-2
ISSN
1752-1505 (ISSN-L)
DOI
10.1186/s13031-019-0246-5
PMC
PMC6945710
OpenAlex
W3000380537
Cited by
89
References
65
Citations by year
2026: 8 · 2025: 18 · 2024: 10 · 2023: 9 · 2022: 29 · 2021: 12 · 2020: 3
FWCI
5.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Conflict and Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Forskningsrådet om Hälsa, Arbetsliv och Välfärd (2016-07194)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Social Sciences › Sociology and Political Science › Migration, Refugees, and Integration
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
post-migration stressors, refugees, Syrian refugees, refugee resettlement, mental health, scale development, psychometric validation, perceived discrimination, social strain, financial stress, post-traumatic stress disorder, anxiety, depression, psychological well-being, Sweden

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