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Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees
Open accessAbstract
BACKGROUND: Refugees have been shown to present high prevalence rates of trauma-related mental disorders. Despite their psychological impairment, they are expected to meet high functional requirements in terms of social integration into, and financial independence from, the host society. METHODS: This cross-sectional study examined the relationship of mental health problems, post-migration living difficulties (PMLD), and social integration in a sample of 104 refugees seeking treatment for severe posttraumatic stress and comorbid symptoms in two outpatient clinics in Switzerland. RESULTS: Despite an average time of residence in Switzerland of over 10 years, participants showed poor integration and a high number of PMLD. Integration difficulties were closely associated with psychological symptoms, but not with socio-demographic parameters such as education or visa status. CONCLUSIONS: Psychological impairment in treatment-seeking traumatized refugees is associated with poor integration. To foster social integration, it is crucial to better understand and address the specific needs of this highly vulnerable population.
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“post-migration living difficulties (PMLDs) are also predictive of mental health problems [8–11]”
From A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: A randomized controlled trial (2020) · cites this paper as [10]
In the citing paper
“This scale has previously been used in Arabic-speaking refugees [52].”
From Effectiveness of a brief group behavioral intervention for common mental disorders in Syrian refugees in Jordan: a randomized controlled trial (2022) · cites this paper as [52]
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An Interaction Model of Environmental and Psychological Factors Influencing Refugee Mental Health
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Self-citationJeong, H., Lee, Y. J., Kim, N., Jeon, S., Jun, J. Y., Yoo, S. Y., Lee, S. H., Lee, J., & Kim, S. J. (2021) · Scientific Reports · doi:10.1038/s41598-021-94452-6 · Cited by 24
Trilesnik, B., Altunöz, U., Wesolowski, J., Eckhoff, L., Özkan, İ., Loos, K., Penteker, G., & Graef-Calliess, I. T. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00688 · Cited by 22
“Moreover, it has been shown that the psychiatric impairment goes along with poor integration measures in refugees (35).”
BackgroundAndualem, F., Melkam, M., Takelle, G. M., Nakie, G., Tinsae, T., Fentahun, S., Rtbey, G., Begashaw, T. D., Seid, J., Tegegn, L. F., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1336665 · Cited by 24
Lacour, O., Morina, N., Spaaij, J., Nickerson, A., Schnyder, U., von Känel, R., Bryant, R. A., & Schick, M. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00526 · Cited by 22
“The 17-items Post-Migration Living Difficulties Checklist (47, 48) adapted to the Swiss context (49) was used to assess PMLD.”
BackgroundMethodSelf-citationde Graaff, A. M., Cuijpers, P. J., Acartürk, C., Akhtar, A., Alkneme, M. S., Aoun, M., Awwad, M., Bawaneh, A., Brown, F. L., Bryant, R. A., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058101 · Cited by 24
Self-citationScaling-up problem management plus for refugees in Switzerland - a qualitative study
Spaaij, J., Fuhr, D. C., Akhtar, A., Casanova, L., Klein, T., Schick, M., Weilenmann, S., Roberts, B., & Morina, N. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09491-8 · Cited by 28
“Research has shown that impaired mental health is associated with poor social and economic integration [9, 27, 28].”
BackgroundSelf-citationVaz, E., Lee, K., Moonilal, V., & Pereira, K. (2017) · Habitat International · doi:10.1016/j.habitatint.2017.02.001 · Cited by 21
A network analysis of postmigration living difficulties in refugees and asylum seekers
Wicki, B., Spiller, T. R., Schick, M., Schnyder, U., Bryant, R. A., Nickerson, A., & Morina, N. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1975941 · Cited by 20
“The PMLD scale has consistently been identified as a predictor of mental health among displaced populations (Schick et al., 2016) and”
BackgroundResultInfluentialSelf-citationThe impact of an insecure asylum status on mental health of adult refugees in Germany
Boettcher, V. S., & Neuner, F. (2022) · Clinical Psychology in Europe · doi:10.32872/cpe.6587 · Cited by 18
“However, some studies have provided mixed results (Schick et al., 2016; Winkler, Brandl, Bretz, Heinz, & Schouler-Ocak, 2019).”
BackgroundChimoriya, R., Mohammad, Y., Thomson, R. J., Webster, C., Dunne, R., Aibangbee, M., Ip, D., & Slewa‐Younan, S. (2023) · International Journal of Mental Health Systems · doi:10.1186/s13033-023-00580-z · Cited by 20
“There is a need for more integrated and culturally informed services for these vulnerable population groups, and it is imperative to develop effective interventions to facilitate optimal adjustment for Arabic-speaking refugees and migrants, particularly those with pre-existing mental health conditions and other relate…”
BackgroundSpaaij, J., de Graaff, A. M., Akhtar, A., Kiselev, N., McDaid, D., Moergeli, H., Pfaltz, M. C., Schick, M., Schnyder, U., Bryant, R. A., et al. (2023) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2023.152421 · Cited by 21
Self-citationAn exploratory study of embitterment in traumatized refugees
Spaaij, J., Schick, M., Bryant, R. A., Schnyder, U., Znoj, H., Nickerson, A., & Morina, N. (2021) · BMC Psychology · doi:10.1186/s40359-021-00599-2 · Cited by 21
Self-citationWilker, S., Catani, C., Wittmann, J., Preuße, M., Schmidt, T. L., May, T., Ertl, V., Doering, B. K., Rosner, R., Zindler, A., et al. (2020) · Trials · doi:10.1186/s13063-020-4127-4 · Cited by 24
Interrupted transit and common mental disorders among migrants in Tijuana, Mexico
Bojórquez, I., Sepúlveda, J., Lee, D., & Strathdee, S. A. (2022) · International Journal of Social Psychiatry · doi:10.1177/00207640221099419 · Cited by 19
“…migrants and the general population, both because of the harsh situations that motivate their journey, and as a result of the various dangers, violence, and discrimination they can encounter while on the move (Heeren et al., 2014; Posselt et al., 2019; Schick et al., 2016; Walther et al., 2020).”
BackgroundFresh eyes on the European refugee crisis
Alisic, E., & Letschert, R. M. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.31847 · Cited by 19
“Our professional community has provided high-quality insights regarding the mental health consequences of war and seeking asylum (see Fazel, Reed, Panter-Brick & Stein, 2012; Hall & Olff, 2016; Porter & Haslam, 2005; Schick et al., 2016).”
BackgroundRose, A., Trounson, J., Skues, J., Daffern, M., Shepherd, S. M., Pfeifer, J. E., & Ogloff, J. R. P. (2019) · Psychiatry Psychology and Law · doi:10.1080/13218719.2019.1642259 · Cited by 19
Rivera, H. H., Lynch, J., Li, J., & Obamehinti, F. (2016) · Canadian Psychology/Psychologie canadienne · doi:10.1037/cap0000076 · Cited by 17
Moderating role of moral injury in the mental health of adolescent refugees
McEwen, C., Alisic, E., & Jobson, L. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23306 · Cited by 16
Kurt, G., Ekhtiari, M., Ventevogel, P., Erşahin, M., İlkkurşun, Z., Akbiyik, N., & Acartürk, C. (2023) · Epidemiology and Psychiatric Sciences · doi:10.1017/s204579602300063x · Cited by 18
“Therefore, mental health problems might hinder refugees’ social and cognitive capacities and skills necessary during the integration process (Nickerson et al. , 2019; Schick et al. , 2016).”
Nafari, J., & Ruebottom, T. (2025) · International Small Business Journal · doi:10.1177/02662426251320321 · Cited by 17
“Stability, predictability and consistent interactions over time can also build trust (Cleveland et al., 2018; Schick et al., 2016).”
InfluentialAkhtar, A., Cuijpers, P. J., Morina, N., Sijbrandij, M., & Bryant, R. A. (2021) · BJPsych Open · doi:10.1192/bjo.2021.1017 · Cited by 19
Self-citationHarris, S., Sandal, G. M., Bye, H. H., Palinkas, L. A., & Binder, P. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.777582 · Cited by 22
“Such stressors can place refugees at considerable risk of developing symptoms of depression, anxiety, post-traumatic stress disorder (PTSD) and related somatic health symptoms (7–12).”
BackgroundInfluentialVersey, H. S., Murad, S., McPhee, I., & Schwarz, W. (2022) · Journal of International Migration and Integration / Revue de l integration et de la migration internationale · doi:10.1007/s12134-021-00908-z · Cited by 15
Hamrah, M. S., Hoang, H., Mond, J., Pahlavanzadeh, B., Charkazi, A., & Auckland, S. (2020) · Early Intervention in Psychiatry · doi:10.1111/eip.12957 · Cited by 15
“The PMLD scale has been widely used in studies of mental health problems among refugee populations (Nickerson, Steel, Bryant, Brooks, & Silove, 2011; Schick et al., 2016) and has good psychometric properties including good internal consistency in a recent study of Afghan refugees resettled in…”
MethodMoral injury related to immigration detention on Nauru: a qualitative study
Passardi, S., Hocking, D. C., Morina, N., Sundram, S., & Alisic, E. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2029042 · Cited by 14
Self-citationMelese, M., Simegn, W., Esubalew, D., Limenh, L. W., Ayenew, W. A., Chanie, G. S., Seid, A. M., Beyna, A. T., Mitku, M. L., Mengesha, A. K., et al. (2024) · BMC Psychology · doi:10.1186/s40359-024-01554-7 · Cited by 18
Neural correlates of emotional reactivity and regulation in traumatized North Korean refugees
Lee, K. H., Lee, H. Y., Park, I., Lee, Y. J., Kim, N., Jeon, S., Kim, S., Jeon, J. E., & Kim, S. J. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01579-1 · Cited by 15
Struggle to Settle down! Examining the Voices of Migrants and Refugees on Twitter Platform
Khatua, A., & Nejdl, W. (2021) · ACM Conference on Computer Supported Cooperative Work (CSCW) · doi:10.1145/3462204.3481773 · Cited by 16
“[32] argues that exposure to traumatic experiences leads to substantial psychological impairment, and this study has also observed a strong correlation between the lack of social integration and mental health problem.”
BackgroundRizkalla, N., Alsamman, S., Bakr, O., Masud, H. R., Sbini, S., & Segal, S. P. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2400833 · Cited by 12
“The social and economic implications are detrimental, as survivors often struggle with employment, and they face social isolation (Schick et al., 2016; Wang et al., 2012).”
BackgroundLeo, A. D., Cotrufo, P., & Gozzoli, C. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01296-3 · Cited by 12
“[12] highlighted that during this vulnerable time, ASs must also contend with their personal histories, uncertain residence status, isolation from family and social ties, integration into a new society and language barriers.”
BackgroundSalinas, M. G., & Salinas, J. L. (2021) · Health Equity · doi:10.1089/heq.2020.0116 · Cited by 12
Opaas, M., & Hartmann, E. (2021) · PubMed Central · doi:10.1097/nmd.0000000000001396 · Cited by 3
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Theisen-Womersley, G. (2021) · Springer eBooks · doi:10.1007/978-3-030-67712-1_2 · Cited by 19
Potter, F., Zehb, M., Dohrmann, K., Müller-Bamouh, V., Rockstroh, B. S., & Crombach, A. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05004-3 · Cited by 11
“Their integration into their host nation society remains a challenge not only for Germany, but for many countries [3, 4].”
Background
Metadata
- Authors
- Schick, M., Zumwald, A., Knöpfli, B., Nickerson, A., Bryant, R. A., Schnyder, U., Müller, J., & Morina, N.
- Affiliations
- University of Zurich (CH)
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- University of Bern (CH)
- UNSW Sydney (AU)
- Kantonsspital Münsterlingen (CH)
- Corresponding author
- Schick, Matthis
- Venue
- European Journal of Psychotraumatology
- Publisher
- Informa UK Limited
- Published
- 2016-02-12
- Volume
- 7
- Issue
- 1
- Pages
- 28057-28057
- ISSN
- 2000-8066 (ISSN-L)
- PMC
- PMC4756625
- OpenAlex
- W2262007362
- Cited by
- 233
- References
- 61
- Citations by year
- 2026: 18 · 2025: 34 · 2024: 23 · 2023: 23 · 2022: 24 · 2021: 36 · 2020: 33 · 2019: 11 · 2018: 15 · 2017: 7 · 2016: 7
- FWCI
- 17.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Psychotraumatology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Figshare (cc-by)
- Funders
- Parrotia-Stiftung
- National Health and Medical Research Council
- National Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Sociology and Political Science › Migration, Refugees, and Integration
- Social Sciences › Sociology and Political Science › Migration and Exile Studies
- Keywords
- refugees, social integration, psychological impairment, post-migration living difficulties, post-traumatic stress disorder, comorbid symptoms, host society integration, mental health
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