PTSD and Quality of Life for Resettling Refugees in Boise: A Random Survey of Households

Background: In partnership with the International Rescue Committee, the Agency for New Americans, and the Idaho Office for Refugees, we conducted a random survey of refugee households who have settled in Boise, Idaho since 2003.  Though research on refugees and recently resettled refugees in the US has demonstrated elevated rates of PTSD and other psychological sequelae, no research to date has examined the prevalence of PTSD symptomology in refugees over time.  Additionally, little is known of how PTSD symptoms in resettling refugee populations relate to their quality of life.  Thus, a random survey of refugee households containing standardized measures of PTSD, quality of life, and demographic characteristics was conducted.

Methods:  From a sample frame of 2948 adult individuals who resettled in Boise, Idaho since 2003 we interviewed 169 randomly selected individuals about their household characteristics, other household members, material well-being, engagement with the community, and attitudes towards various refugee and public services.  Additionally, the selected adult was administered the Harvard Trauma Questionnaire PTSD scale (HTQ) and the Subjective Quality of Life Scale (SQoL); both scales having been utilized in multiple locations internationally with consistently reliable results.  All queries were conducted in the native language of the respondent. 

A series of logistic regression and GLMs were constructed to ascertain the associations between various socio-demographic characteristics with PTSD and quality of life measures.  Using Family Stress Theory, we hypothesized that respondents who have longer tenure and those who’s material and economic well-being were higher would have lower symptomology.  It was also hypothesized that subjective quality of life was inversely associated with PTSD symptomology and positively associated with economic well-being and tenure in the US. 

Results: Findings support our hypothesis that economic well-being is associated with lower PTSD symptomology. Length of stay in the US was not associated with a decrease in symptomology.   Findings also indicated that resettling Iraqis are significantly more likely to be symptomatic for PTSD than all other refugees.  Relative to all other refugees, Iraqis’ HTQ score was associated with a 0.75 standard deviation increase on the HTQ.  Examining the diagnostic threshold of the HTQ, Iraqis were 12 times more likely to be reach this criteria relative to other nationalities.  On the SQoL, longer tenure was associated with improved quality of life while PTSD was associated with a decrease on this scale.  Economic well-being was not associated with improved quality of life.  Age, Females, and Iraqis were also associated with lower scores on this scale.

Implications:  Though quality of life appears to improve the longer a refugee stays in the US, the PTSD symptomology for this at risk group is not associated with length of stay.  Additionally, Iraqis compared to a host of other nationalities, are particularly vulnerable to PTSD symptomology and poorer quality of life.  Examining why symptomology is durable for all refugees should be of concern for those who work with refugees in the US.  Further research with Iraqis is also warranted.