From Victims of Internal Conflicts to Resettlement: Addressing Mental Health Needs of Refugees

Purpose: Untreated mental health conditions among refugees resulting from a period of prolonged war and atrocities have a deleterious impact (Onyut et al., 2009). Compared to the general population, refugees are tenfold more likely to suffer from PTSD and depression (Fazel, Wheeler & Danesh, 2005) and are extremely susceptible to psychiatric morbidity and trauma. Little is known about the efficacy of various mental health interventions for refugees. This study compared three mental health interventions:  community-based group support, office-based counseling, and home-based counseling to determine effects on PTSD symptoms, anxiety, depression and social support.

Methods: Participants were a community sample of refugees from 5 countries (Burundi, Burma, Congo, Rwanda, and Bhutan) resettled in an urban North Texas city (n=116). Recruitment was at the refugees’ apartment complexes during weekly meetings. All participants completed consent and survey measures including the Patient Health Questionnaire: Somatic, Anxiety, and Depressive Symptoms Scale (PHQ-SADS), the Post-Traumatic Stress Disorder Checklist-Civilian (PCL-C), and the Medical Outcomes Study-Social Support Survey (MOS-SSS). Pre- and post- intervention assessments were conducted between 2012 and 2013. A final sample of 81 participants who completed all project survey measurements was used for this analysis. Participants were randomly assigned to three different intervention settings, each lasting 8 weeks:  1) a community-based group support; 2) office-based clinical counseling; and 3) home-based clinical counseling.

SPSS version 21 was used to compare mean differences of the three groups using paired t-tests.

 

Results: Participants in home based counseling group (16.61%) and community-based group support (14.9%) reported significantly higher levels of social support than those in office-based counseling (8.1%). Significant differences in social support were noted for community-based group support (t=-3.59, p<.001) and the home-based counseling group (t=-3.45, p<.01). Similarly, participants in community-based group support and home-based counseling experienced a significant reduction in post-traumatic stress symptoms (35.17% and 34.39%, respectively). Participants in office-based counseling and home-based counseling noticed larger decreases in anxiety (55.11% and 50.63%) as well as in somatization (40.8% and 51.50%) respectively, than participants in community-based group support. Overall, participants in home-based counseling reported significantly higher levels of improvement in their mental health outcomes than community-based group support and office-based group support at the conclusion of the intervention.

Conclusion and Implications: Our study suggests that western-style therapy of office-based settings may not be the best setting for non-western populations with a history of mental health issues. The study thus quantifies that utilizing cultural community leaders, and the provision of home-based counseling from a trained therapist could effectively contribute to the reduction in depression, anxiety, somatization and post-traumatic stress symptoms for refugees compared to the traditional office-based counseling conducted by trained therapists.

 

References

Fazel, M., Wheeler, J., Danesh, J. (2005). Prevalence of serious mental disorder in 7,000    refugees resettled in Western countries: A systematic review. Lancet, 365(9467), 1309-14

Onyut, L. P., Neuner, F., Ertl, V., Schauer, E., Odenwald, M., & Elbert, T. (2009). Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement - an epidemiological study. Conflict & Health, 31(16). doi:10.1186/1752-1505-3-6