Beyond Trauma: Post-Resettlement Factors and Mental Health Outcomes Among Latino and Asian Refugees in the United States

Background: War-related traumatic experiences receive major attention when addressing refugees’ mental health issues. In long-term refugee resettlement, however, a growing body of literature points to resettlement contextual factors as playing equally important roles in contributing to the mental health outcomes of resettled refugees. So far, there is limited empirical evidence to support this claim for resettled refugees in the United States. Thus, we used the social determinants of mental health (SDMH) framework to examine structural and sociocultural dimensions of the post-resettlement environment as critical factors in shaping long-term mental health outcomes among refugee populations in the United States. This study examined two research questions: (a) What structural, material, and psychosocial factors are associated with mental health outcomes among Latino and Asian refugees in the United States? and (b) Compared with other factors, how much impact do traumas (both pre- and post-resettlement) have on their overall mental health outcomes?

Methods: We conducted a secondary data analysis using a subsample of refugees (N=656) in the 2002-2003 National Latino and Asian American Study (NLAAS). The NLAAS is a nationally representative survey that targeted non-institutionalized Latino and Asian adults 18 years or older. Three mental health outcome measures (self-reported mental health (SRMH), mood and anxiety disorders) based on the World Mental Health Composite International Diagnostic Interview were examined for this study. Linear and logistic regressions examined structural factors (racial background, discrimination, neighborhood environment), material factors (poverty status, employment status, insurance status), and psychosocial factors (pre-/post-resettlement traumas, length of U.S. residence, and English language proficiency (ELP)). The analyses controlled for four sociodemographic characteristics (sex, age, education, and reporting bias).

Results: Compared with Latino refugees, being an Asian refugee was significantly associated with lower SRMH scores (b=-0.44, SE=0.13), but had significantly lower odds (OR=0.35, CI=0.13-0.93) of being diagnosed with anxiety disorders. Everyday discrimination was significantly associated with higher odds (OR=2.59, CI=1.52-4.42) of being diagnosed with anxiety disorders. Neighborhood environment was significantly associated (b=0.22, SE=0.12) with SRMH scores. Compared with employed refugees, refugees who were not in the labor force had significantly higher odds (OR=6.48, CI=2.05-20.49) of being diagnosed with mood disorders measured in the survey. Compared with uninsured refugees, refugees with private insurance reported significantly better SRMH (b=0.33, SE=0.14). Post-migration traumas were significantly associated (b=-0.09, SE=0.04) with SRMH and with higher odds (OR=1.43, CI=1.06-1.95) of having mood disorders. Pre-resettlement traumas were not significantly associated with any mental health outcomes. English language proficiency was associated with significantly higher odds (OR=0.21, CI=0.07-0.66) of having mood disorders.

Implications: The results of this study suggest that pre-resettlement traumas experienced by Asian and Latino refugees may not always be the most robust indicator of their mental health outcomes. Sociocultural factors based on resettlement context significantly contribute to mental health outcomes for refugees, independent of pre-resettlement traumas. Therefore, future studies and intervention programs addressing the mental health issues of refugees must pay closer attention to structural and sociocultural factors after their resettlement.