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Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK

  • Marija Bogic (a1), Dean Ajdukovic (a2), Stephen Bremner (a3), Tanja Franciskovic (a4), Gian Maria Galeazzi (a5), Abdulah Kucukalic (a6), Dusica Lecic-Tosevski (a7), Nexhmedin Morina (a8), Mihajlo Popovski (a9), Matthias Schützwohl (a10), Duolao Wang (a11) and Stefan Priebe (a1)...

Abstract

Background

Prevalence rates of mental disorders are frequently increased in long-settled war refugees. However, substantial variation in prevalence rates across studies and countries remain unexplained.

Aims

To test whether the same sociodemographic characteristics, war experiences and post-migration stressors are associated with mental disorders in similar refugee groups resettled in different countries.

Method

Mental disorders were assessed in war-affected refugees from the former Yugoslavia in Germany, Italy and the UK. Sociodemographic, war-related and post-migration characteristics were tested for their association with different disorders.

Results

A total of 854 war refugees were assessed (≥255 per country). Prevalence rates of mental disorders varied substantially across countries. A lower level of education, more traumatic experiences during and after the war, more migration-related stress, a temporary residence permit and not feeling accepted were independently associated with higher rates of mood and anxiety disorders. Mood disorders were also associated with older age, female gender and being unemployed, and anxiety disorders with the absence of combat experience. Higher rates of post-traumatic stress disorder (PTSD) were associated with older age, a lower level of education, more traumatic experiences during and after the war, absence of combat experience, more migration-related stress, and a temporary residence permit. Only younger age, male gender and not living with a partner were associated with substance use disorders. The associations did not differ significantly across the countries. War-related factors explained more variance in rates of PTSD, and post-migration factors in the rates of mood, anxiety and substance use disorder.

Conclusions

Sociodemographic characteristics, war experiences and post-migration stressors are independently associated with mental disorders in long-settled war refugees. The risk factors vary for different disorders, but are consistent across host countries for the same disorders.

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Copyright

Corresponding author

Marija Bogic, Academic Unit, Newham Centre for Mental Health, Cherry Tree Way, London E5 8NS, UK. Email: m.bogic@qmul.ac.uk

Footnotes

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This study was funded by a grant from the European Commission (contract number INCO-CT-2004-509175).

Declaration of interest

None.

Footnotes

References

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Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK

  • Marija Bogic (a1), Dean Ajdukovic (a2), Stephen Bremner (a3), Tanja Franciskovic (a4), Gian Maria Galeazzi (a5), Abdulah Kucukalic (a6), Dusica Lecic-Tosevski (a7), Nexhmedin Morina (a8), Mihajlo Popovski (a9), Matthias Schützwohl (a10), Duolao Wang (a11) and Stefan Priebe (a1)...
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eLetters

Refugees and mental illness

Siddharth Sarkar, Senior Resident
04 April 2012

Dear SirWe read with interest the article by Bogic et al 1 which highlights the higher rates of mental disorders in long settled refugees. The authors eloquently discuss the possible causes of differences in rates between thecountries. The findings must be interpreted with some caution. The authorshave documented the different kinds of traumatic war events and migration-related stressors. These show a marked degree of variability across the countries. The authors, for the sake of computational simplicity, have equated the psychological impact and severity of all these stressors; and deal with the 'number of stressors' while determining predictors of mentaldisorders. However, the stressors have qualitative differences and reducing them to additive numbers may mask their importance. Separation from a dear one may cause a different distress as compared to not having asuitable accommodation. Subjective reporting of these items may also be colored by the presence of mental disorder, making causal relationships difficult as noted by authors. Even the actual presence of such post war problems can be circumspect, since the items like 'financial difficulties'can be interpreted differently by different respondents. The statistical analysis, fail to take into account such nuances. Also, the models constructed explain a limited amount of variability, hinting towards heterogeneity of sample, as well as presence of other (potentially many) relevant variables. The logistic regression for presence of any mental disorder would also have been informative. Nonetheless, the authors need to be commended on this painstaking work on differences in mental illnesses in the refugees across countries. More such work on internally and internationally displaced refugees could help formulate constructive policies and better management plans.

References:1. Bogic M, Ajdukovic D, Bremner S, et al. Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. Br J Psychiatry 2012;200:216-23.

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Conflict of interest: None declared

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