Refugee health compromised by stress

October 30, 2000

The stress of adjusting to a foreign country plays an under-recognized role in the health complaints of refugees, according to the results of a study of refugees in the Netherlands.

"We need to pay attention not only to health complaints and to past violent experiences but also the psychological factors that influence health status in responding to the needs of refugees," said one of the authors Loes H.M. van Willigen.

Van Willigen, formerly of the Pharint Foundation in Amsterdam, and colleagues undertook two studies of refugees from Latin America and the Middle East, who reported high rates of physical illness, as well as psychological complaints such as anxiety, depression, sleep disturbances, and irritability.

Almost all of the 480 study participants in the first study and 156 study participants in the second study had experienced some form of violence in their home country. Most also had friends or family members who were victims of violence.

Many study participants suffered physical torture, such as beating and kicking, and psychological torture, such as being forced to witness torture. In the second study, which had the highest imprisonment rates, 86 percent of the men and 77 percent of the women had been imprisoned.

The more violent events refugees experienced, the more health complaints they had, with the study participants who had been tortured experiencing the most health complaints. However, this finding was only part of the picture; the psychological health of the refugees was also influenced by their current worries about matters such as housing and financial problems.

In addition, when van Willigen and colleagues asked study participants themselves to name causes of their health complaints, "worries about family left behind," "worries about the future," and "developments in country of origin," were listed with comparable frequency to "torture," and "persecution events."

"So although violent events in the past accounted for a large number of the attributed causes of health complaints, current migration-related stress or ongoing sociopsychological strain was clearly also important," said van Willigen.

The study results are published in the October issue of the Journal of Traumatic Stress.

Only 6 percent of the refugee study participants were categorized as suffering from post-traumatic stress disorder (PTSD), which the researchers found surprising given the amount of violence the refugees experienced. Cultural misunderstandings between refugees and Dutch physicians who examined them, and delayed PTSD onset, were among the suggested causes for this low rate.

"A medical diagnosis does not describe the ongoing postmigration stress of refugees sufficiently," said van Willigen. "Attention to refugees' migration-related stressors is probably essential for understanding the real meaning of their suffering."

Dr. van Willigen is presently working as a refugee health care consultant in Amsterdam.
The Journal of Traumatic Stress is the peer-reviewed journal of the International Society of Traumatic Stress Studies. For information about the journal, contact Dean Kilpatrick, PhD, (843) 792-2945. Posted by the Center for the Advancement of Health For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, For information about the Center, call Petrina Chong, 202-387-2829.

Center for Advancing Health

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