One in four older refugees are in psychological distress -- even decades after resettlement

November 19, 2020

A new study of Canadians aged 45-85, released this week in the International Journal of Social Psychiatry, found that 24% of refugees were in psychological distress compared to 13% of non-refugee immigrants and those born in Canada.

"Refugees are very vulnerable to negative mental health in later life. The average time these refugees had lived in Canada was more than 4 decades, yet one in four were still in substantial psychological distress," says the study's first author Hongmei Tong, Assistant Professor of Social Work at MacEwan University in Edmonton.

"Since refugees had twice the prevalence of distress compared to other immigrants, we hypothesize that pre-migration traumas, rather than the post-migration challenges of resettlement, are probably driving the high levels of psychological distress" says Tong.

The researchers found that individuals without social support were twice as likely to experience psychological distress compared to those with at least some social support. In addition, more than one-quarter of the refugees in the study did not have someone they could regularly confide in, nor someone they could turn to for advice in a crisis. Almost one in five refugees had no one who regularly showed them love or attention. Immigrants who were not refugees and those born in Canada were much less likely to lack these key aspects of social support.

"We believe this extreme lack of social support may be a contributing factor to refugees' increased vulnerability to distress," says senior author, Esme Fuller-Thomson, director of the Institute for Life Course & Aging and professor at the University of Toronto's Factor-Inwentash Faculty of Social Work (FIFSW). "These findings underline the importance of finding effective interventions to help refugees integrate into their community and develop supportive relationships."

Consistent with earlier studies, older Canadian adults in this study who were less educated, poor, experiencing chronic pain and those with more co-morbid health conditions had a higher prevalence of psychological distress.

"Mental health professionals must be careful not to neglect physical health concerns such as chronic health conditions and chronic pain." says co-author Yu Lung, a doctoral candidate at the University of Toronto's FIFSW.

The study also found that in the general population women and visible minority members are at a higher risk of psychological distress than men and whites.

"Programs to address mental health concerns should target the groups in these higher risk categories," says co-author Karen Kobayashi, a professor in the Department of Sociology and a research fellow at the Institute on Aging & Lifelong Health at the University of Victoria.

The study's findings have important policy implications.

"With such a high prevalence of distress among older refugees, there is a need to screen for depression and to provide trauma informed mental health interventions for those who are struggling," says co-author Karen Davison, Health Science Faculty and Nutrition Informatics Research Program Director at Kwantlen Polytechnic University in Surrey, B.C.

This study was published online, ahead of print, in the International Journal of Social Psychiatry this month. It uses data from the Canadian Longitudinal Study on Aging and includes information on 244 refugees, 4,765 non-refugee immigrants and 23,149 respondents born in Canada.
Media Contact:

Professor Hongmei Tong


Professor Esme Fuller-Thomson
416 209-3231


Tong H, Lung Y, Lin S, Kobayashi, K, Davison, KM, Agbeyaka, S & Fuller-Thomson, E, (2020). Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging. International Journal of Social Psychiatry. (Published online ahead of print)

A copy of the paper is available to credentialed journalists upon request.

University of Toronto

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