Trajectories of psychosocial symptoms and wellbeing in asylum seekers and refugees exposed to traumatic events and resettled in Western Europe, Turkey, and Uganda

Marianna Purgato; Federico Tedeschi; Giulia Turrini; Ceren Acartürk; Minna Anttila; Jura Augustinavicious; Josef Baumgartner; Richard Bryant; Rachel Churchill; Zeynep Ilkkursun; Eirini Karyotaki; Thomas Klein; Markus Koesters; Tella Lantta; Marx R Leku; Michela Nosè; Giovanni Ostuzzi; Mariana Popa; Eleonora Prina; Marit Sijbrandij; Ersin Uygun; Maritta Välimäki; Lauren Walker; Johannes Wancata; Ross G White; Pim Cuijpers; Wietse Tol; Corrado Barbui

doi:10.1080/20008066.2022.2128270

Trajectories of psychosocial symptoms and wellbeing in asylum seekers and refugees exposed to traumatic events and resettled in Western Europe, Turkey, and Uganda

Eur J Psychotraumatol. 2022 Oct 7;13(2):2128270. doi: 10.1080/20008066.2022.2128270. eCollection 2022.

Authors

Marianna Purgato^{1

2}, Federico Tedeschi¹, Giulia Turrini^{1

2}, Ceren Acartürk³, Minna Anttila⁴, Jura Augustinavicious⁵, Josef Baumgartner⁶, Richard Bryant⁷, Rachel Churchill⁸, Zeynep Ilkkursun³, Eirini Karyotaki⁹, Thomas Klein¹⁰, Markus Koesters¹⁰, Tella Lantta⁴, Marx R Leku¹¹, Michela Nosè^{1

2}, Giovanni Ostuzzi^{1

2}, Mariana Popa¹², Eleonora Prina¹, Marit Sijbrandij⁹, Ersin Uygun¹³, Maritta Välimäki^{4

14}, Lauren Walker¹⁵, Johannes Wancata⁶, Ross G White¹⁶, Pim Cuijpers⁹, Wietse Tol¹⁷, Corrado Barbui^{1

2}

Affiliations

¹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.
² Cochrane Global Mental Health, University of Verona, Verona, Italy.
³ Department of Psychology, Koc University, Istanbul, Turkey.
⁴ Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland.
⁵ School of Population and Global Health, McGill University, Montréal, Canada.
⁶ Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
⁷ School of Psychology, University of New South Wales, Sydney, Australia.
⁸ Centre for Reviews and Dissemination, University of York, York, UK.
⁹ Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁰ Department of Psychiatry II, Ulm University, Günzburg, Germany.
¹¹ Health Right International, Kampala, Uganda.
¹² Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
¹³ Trauma and Disaster, Mental Health, Bilgi University, Istanbul, Turkey.
¹⁴ Central South University, Changsha, People's Republic of China.
¹⁵ Department of Health Sciences, University of York, York, UK.
¹⁶ School of Psychology, Queen's University Belfast, Belfast, Northern Ireland.
¹⁷ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Abstract
in English, Spanish, Chinese

Background: Longitudinal studies examining mental health trajectories in refugees and asylum seekers are scarce. Objectives: To investigate trajectories of psychological symptoms and wellbeing in refugees and asylum seekers, and identify factors associated with these trajectories. Method: 912 asylum seekers and refugees from the control arm of three trials in Europe (n = 229), Turkey (n = 320), and Uganda (n = 363) were included. We described trajectories of psychological symptoms and wellbeing, and used trauma exposure, age, marital status, education, and individual trial as predictors. Then, we assessed the bidirectional interactions between wellbeing and psychological symptoms, and the effect of each predictor on each outcome controlling for baseline values. Results: Symptom improvement was identified in all trials, and for wellbeing in 64.7% of participants in Europe and Turkey, versus 31.5% in Uganda. In Europe and Turkey domestic violence predicted increased symptoms at post-intervention (ß = 1.36, 95% CI 0.17-2.56), whilst murder of family members at 6-month follow-up (ß = 1.23, 95% CI 0.27-2.19). Lower wellbeing was predicted by murder of family member (ß = -1.69, 95% CI -3.06 to -0.32), having been kidnapped (ß = -1.67, 95% CI -3.19 to -0.15), close to death (ß = -1.38, 95% CI -2.70 to -0.06), and being in the host country ≥2 years (ß = -1.60, 95% CI -3.05 to -0.14). In Uganda at post-intervention, having been kidnapped predicted increased symptoms (ß = 2.11, 95% CI 0.58-3.65), and lack of shelter (ß = -2.51, 95% CI -4.44 to -0.58) and domestic violence predicted lower wellbeing (ß = -1.36, 95% CI -2.67 to -0.05). Conclusion: Many participants adapt to adversity, but contextual factors play a critical role in determining mental health trajectories.

Antecedentes: Estudios longitudinales que examinan las trayectorias de la salud mental en los refugiados y solicitantes de asilo son escasos.Objetivos: Investigar las trayectorias de los síntomas psicológicos y el bienestar en refugiados y solicitantes de asilo, e identificar factores asociados a estas trayectorias.Métodos: Se incluyeron 912 solicitantes de asilos y refugiados del brazo control de tres ensayos clínicos en Europa (n = 229), Turquía (n = 320) y Uganda (n = 363). Describimos las trayectorias psicológicas de los síntomas y el bienestar, y utilizamos la exposición traumática, la edad, el estado marital, la educación y el juicio individual como predictores. Después, evaluamos las interacciones bidireccionales entre el bienestar y los síntomas psicológicos, y el efecto de cada uno de los predictores en cada resultado controlando por los valores iniciales.Resultados: Se identificó una mejoría en los síntomas en todos los ensayos, y del bienestar en el 64.7% de los participantes en Europa y Turquía, versus el 31.5% en Uganda. En Europa y en Turquía, la violencia doméstica predijo el incremento de síntomas de después de la intervención (ß = 1.36, 95% CI 0.17 a 2.56), mientras que el homicidio de algún miembro familiar a los 6 meses de seguimiento (ß = 1.23, 95% CI 0.27 a 2.19). Un menor bienestar fue predicho por el homicidio de algún miembro de la familia (ß = −1.69, 95% CI −3.06 a −0.32), haber sido secuestrado (ß = −1.67, 95% CI −3.19 a −0.15), haber estado próximo a la muerte (ß = −1.38, 95% CI −2.70 a −0.06), y estar en el país de acogida ≥2 años (ß = −1.60, 95% CI −3.05 a −0.14). En Uganda, después de la intervención, haber sido secuestrado predijo un aumento de los síntomas (ß =2.11, 95% CI 0.58 a 3.65), y la falta de refugio (ß = −2.51, 95% CI −4.44 a −0.58) y la violencia doméstica predijo un menor bienestar (ß = −1.36, 95% CI −2.67 a −0.05).Conclusión: Muchos participantes se adaptan a la adversidad, pero los factores contextuales juegan un papel crítico en determinar las trayectorias de la salud mental.

背景：研究难民和寻求庇护者心理健康轨迹的纵向研究很少。目的：考查难民和寻求庇护者心理症状和幸福感的轨迹，并确定这些轨迹的相关因素。方法：包括来自欧洲（n = 229）、土耳其（n = 320）和乌干达（n = 363）三个试验控制组的 912 名寻求庇护者和难民。我们描述了心理症状和幸福感的轨迹，并使用创伤暴露、年龄、婚姻状况、教育和个人试验作为预测因素。然后，我们评估了幸福感和心理症状之间的双向交互作用，以及每个预测变量对控制基线值后每个结果的影响。结果：在所有试验中都发现症状有所改善，欧洲和土耳其有 64.7% 参与者的健康状况得到改善，而乌干达有 31.5%。在欧洲和土耳其，家庭暴力预测干预后症状会增加（ß = 1.36，95% CI 0.17 至 2.56），和在 6 个月的随访中家庭成员被谋杀（ß = 1.23，95% CI 0.27 至 2.19）。家庭成员被谋杀 (ß = −1.69, 95% CI −3.06 to −0.32)、被绑架 (ß = −1.67, 95% CI −3.19 to −0.15)、濒临死亡 (ß = −1.38，95% CI −2.70 到 –0.06），和在东道国 ≥2 年（ß = −1.60，95% CI −3.05 到 −0.14）预测了更低的幸福感。乌干达组干预后，被绑架预测了更高的症状（ß = 2.11，95% CI 0.58 至 3.65），缺乏庇护所（ß = −2.51，95% CI −4.44 至 −0.58）和家庭暴力预测了更低的幸福感（ß = −1.36, 95% CI −2.67 至 −0.05）。结论：许多参与者适应逆境，但背景因素在确定心理健康轨迹方面起着关键作用.

Keywords: Individual participant data analysis; asylum seekers; psychological symptoms; refugees; wellbeing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Europe / epidemiology
Humans
Refugees* / psychology
Stress Disorders, Post-Traumatic* / diagnosis
Turkey
Uganda / epidemiology

Grants and funding

This work was funded by the European Commission (grant agreement No. 779255; ‘RE-DEFINE: Refugee Emergency: DEFining and Implementing Novel Evidence-based psychosocial interventions').

Abstract in English, Spanish, Chinese

Publication types

MeSH terms

Grants and funding

Abstract
in English, Spanish, Chinese