Assessing Psychosocial Vulnerability in Asylum-seeking and Refugee Populations

Abstract

Background
Asylum seekers and refugees are two of the most vulnerable populations worldwide. Studies frequently report of the increased prevalence of mental health disorders among these groups. The literature indicates that Post-traumatic Stress Disorder, Complex Post-traumatic Stress Disorder, Depression, and Anxiety are among the most pervasive disorders. While it is known that psychological morbidity is a salient outcome of forced migration, less is written about the social/environmental factors that affect these outcomes.
Objective
The aim of this thesis was to explore how traumatic exposure in combination with social stressors, specifically those in the host environment, affects mental health outcomes in asylum-seeking and refugee populations in Europe. To this end, this study investigated the relationship between psychosocial vulnerability, traumatic exposure, and mental health outcomes.
Methods:
This study involved a review of the relevant literature and a practical research component, involving the Care Centre for Survivors of Torture in the Republic of Ireland, Spirasi. Using 133 client case files, this study incorporated a quantitative analysis, involving Latent Class Analysis and Multinomial Logistic Regression techniques. Based on the literature, it was predicted that there would be 15 significant variables that, as a whole, would explain psychosocial vulnerability for asylum seekers and refugees in Europe. The study was completed over a 36-month period, from March 2017 to February 2020.
The practical component of the study was completed in conjunction with the care centre for survivors of torture in the Republic of Ireland, Spirasi (Spiritan Asylum Services Initiative). Spirasi offers rehabilitation, psychosocial and educational services to asylum seekers, refugees, and other disadvantaged migrant groups in the Republic of Ireland. The majority of clients with whom Spirasi works have been exposed to multiple traumatic experiences, largely assaultive and interpersonal, including torture under governmental and civilian duress. Service users present to Spirasi with varied psychological, somatic, and social difficulties owing to their experiences preceding, during, and after migration. The sample used in this study was randomly selected from years 2014 through 2017.
This study used quantitative methodologies to analyse data extracted from n=133 service user files. It was hypothesised that 3 latent classes of polyvictimised asylum seekers and refugees could be identified from the dataset and that (1) demographic variables (age, gender, number of children home/Republic of Ireland, and marital status) would be significant predictors of trauma class membership; (2) the level of common mental health disorders (anxiety, depression, and somatisation) would vary across the classes, with the highest levels being associated with the classes representing high levels of trauma exposure; (3) the level of trauma related health disorders (PTSD and DSO) would vary across the classes, with the highest levels being associated with the classes representing high levels of trauma exposure.
Results:
A systematic review of the literature on post-migration factors and mental health outcomes in asylum-seeking and refugee populations in Europe found that, contrary to common hypothesis, residency status was not independently associated with mental health. Instead, residency was found to be a marker for other explanatory variables. The descriptive data was largely in line with previous research findings, in terms of continents of origin. Both African and Asian nations are shown to be the most frequently cited countries of exile.
Only 8.4% (n=11) of participants reached the threshold for probable diagnosis of PTSD. 75.6% (n=101) met scores for probable diagnosis of anxiety. The threshold for probable diagnosis of depression was reached by 73.7% (n=98) of participants. Overall, a large proportion of participants (n=66, 83.5%) did not meet the requirements for diagnosis with PTSD, C-PTSD, depression, or anxiety. Somatisation was increasingly related to PTSD as opposed to other forms of mental ill-health among asylum seekers and refugees. Three classes of polyvictimised individuals were identified. The largest proportion of participants (n= 53, 39.9%,) was found in the ‘high risk’ category.
Having a history of suicidality or self-harm and depression was found to be a statistically significant predictor of a ‘medium’ need. A history of suicidality or self-harm, depression, and current suicidal ideation increased one’s likelihood of being in the ‘high’ need category. Both PTSD and C-PTSD were not found to be significant predictors of any of the need categories.

Date of Award	May 2020
Original language	English
Sponsors	EU Framework Programme Horizon 2020
Supervisor	Mark Shevlin (Supervisor) & Jamie Murphy (Supervisor)