Refugee Women's Health: The Effects of Pre-Migration and Post-Migration Stressors

Background & Purpose

As survivors of trauma and displacement, refugees are a vulnerable population at risk of psychological distress and dysfunction. A primary focus in the refugee health literature has been assessing the psychological and health-related consequences of pre-migration war trauma exposure (Neuner & Elbert, 2007). However, a number of studies argue that, beyond the initial years of resettlement, post-migration psychosocial stressors tied to acculturation and discrimination can exert powerful effects on health and well-being (Ellis et al., 2010). The current study aims to test and untangle the relative contribution of pre- and post-migration stressors on the physical and emotional health of Vietnamese and Cambodian refugee women.

Methodology

Data/sample: Data come from the final wave of a 5-year longitudinal study of Vietnamese (n=145) and Cambodian (n=139) refugee women (total n=284). Participants had a mean age of 46 years (SD=7.7) and lived in the U.S. for an average of 17.39 years (SD=5.28). More than half (51.68%) of the women were U.S. citizens; 52.91% were married. Most were employed (67.28%) with others indicating status as homemakers (12.84%), unemployed (3.06%), or disabled (8.26%).

Measures: Physical and emotional health was assessed with three scales of the Medical Outcomes Study Short-Form that reflect general health, physical pain, and emotional well-being (SF-36; Ware, 2000). Exposure to traumatic events was assessed with the Harvard Trauma Questionnaire (HTQ, Mollica et al., 1992). Post-migration stressors included acculturation (Suinn et al., 1992) and everyday discrimination (Williams, et al. 1997). In order to account for the multidimensional nature of acculturation, three subscales reflected orientations toward traditionalism, biculturalism, and assimilation (Tajima & Harachi, 2010).

 

Analysis: Descriptive statistics described all measures. Separate multiple regression analyses by ethnic group examined the associations between war trauma and post-migration stressors on health outcomes; all analyses controlled for age, length of time in the U.S., citizenship status, employment, and marital status.

Results

Among Vietnamese women, acculturation and discrimination were associated with physical and emotional health outcomes. Specifically, higher levels of traditionalism was associated with lowered general health (b=-2.63, SE=.87), increased physical pain (b=3.15, SE=1.44), and diminished psychological well-being (b=-3.41, SE=1.23). Additionally, biculturalism was linked with reduced general health (b=-2.04, SE=.92) while assimilation was associated with enhanced general health (b=4.22, SE=1.54). Furthermore, discrimination was significantly associated with lowered general health (b=-9.19, SE=2.80) and increased physical pain (b=12.39, SE=4.61) and lessened psychological well-being (b=-14.57, SE=3.93).

Among Cambodian women, trauma exposure was associated with physical health while discrimination was associated with emotional well-being. That is, traumatic events degraded general health (b=-5.63, SE=2.51) and physical pain (b=5.19, SE=2.32) while discrimination detracted from psychological well-being (b=-5.92, SE=2.54).

Conclusion & Implications

Overall, the results suggest that acculturation and discrimination detract from self-rated physical and emotional health for Vietnamese refugee women, while trauma and discrimination detract from self-rated physical and emotional health for Cambodian refugee women. The findings underscore the importance of being attune to ethnic and contextual distinctions that prompted refugee migration for understanding the health and well-being of diverse refugee women.